Colorectal cancer detection in an asymptomatic population: fecal immunochemical test for hemoglobin vs. fecal M2-type pyruvate kinase

Introduction

Screening programs for colorectal cancer (CRC) are mainly based on a first-line fecal immunochemical test for hemoglobin (FIT). Fecal M2-type pyruvate kinase (M2-PK) has been evaluated in clinical settings showing promising results for early CRC detection. However, the impact of fecal M2-PK assessment on the performance of first-round CRC screening programs is not known. We investigated whether fecal M2-PK alone or in combination with FIT may improve CRC screening efficacy in the general population.

Materials and methods

A total of 1027 asymptomatic subjects (median age 66 [59-74] years; females 504 [49.1%]), identified through the general practitioners’ rosters, were invited for the collection of 2 fecal samples for FIT and M2-PK evaluation. Participants with at least positive one fecal test were referred for colonoscopy. Quality indicators for screening performance were calculated and analyzed using Fisher’s exact test.

Results

Overall, 572 subjects underwent both FIT and M2-PK assessment (participation rate 55.7%): 93 participants showed positive results for at least one test (positivity rate 16.3%). Only 10 patients were positive for both tests. Attendance rate to colonoscopy was 86.0% and a total of 65 adenomas and 7 cancers were detected. Combined use of FIT and fecal M2-PK permitted the identification of 18 more neoplasm (25%) without improving colonoscopy workload, as deduced by the comparable number needed to scope (P = 0.402).

Conclusion

The addition of M2-PK testing to FIT offers the potential to detect additional neoplasms that either do not bleed or only bleed intermittently without reducing participation rate and without increasing endoscopy workload.Key words: biomarker, colorectal cancer, occult blood, M2-type pyruvate kinase, screening     

Concurrent and longitudinal predictors of calculation skills in preschoolers

Early calculation abilities in preschoolers are predictive of mathematics achievement in subsequent grades (e.g., Jordan et al. 2009). Two studies were conducted to evaluate concurrent and longitudinal predictors of early calculation skills. In the first study, 102 preschoolers (57.8 % female; mean age?=?60.57?±?8.66 months) were given vocabulary, language comprehension, and verbal working memory tasks and a test battery that evaluated components of early number competence (quantity comparison, counting, number line, size seriation, semantic knowledge of digits, visual-spatial memory). The children were also asked to complete early calculation tasks, including addition and subtraction calculations. The results of this task constituted the dependent variable. The results showed that vocabulary, size seriation, and visual-spatial memory were significant concurrent predictors of early calculation competence. In the second study, 43 children completed the early number competence battery at time 1 (53.5 % female; mean age?=?59.30?±?3.46 months) and the linguistic and early calculation tasks at time 2, about 10 months later (mean age?=?69.43?±?3.31 months). The analysis of the longitudinal predictors of early calculation showed significant effects for counting and size seriation. The implications for preschool assessment and intervention are discussed.     

Spectroscopic methods for the analysis of celadonite and glauconite in Roman green wall paintings

One set of samples from wall paintings of the X^th Regio of Italy containing green colours was analysed exploiting different spectroscopic techniques, aiming to identify the pigments used. The possibility to distinguish between glauconite and celadonite, the most common green pigments used in such paintings, was of particular interest. Samples of celadonite from Monte Baldo and glauconite from Belgium were considered as standard materials for comparison. The results obtained using FTIR, EDS, AAS, Colorimetry, Raman and EPR spectroscopies were compared for the identification of the green pigments.     

Accidental digitoxin intoxication: an interplay between laboratory and clinical medicine

Introduction:

Two Italian adults arrived at the Emergency Department referring diarrhea, nausea and vomiting for 4 days; weakness, fatigue and visual hallucinations were also complained of. Patients reported the ingestion of some leaves of a plant, which they supposed to be “donkey ears”, a week before. Physical examination showed hypotension and bradycardia and ECG examination disclosed sinus rhythm and repolarization abnormalities (scooping of the ST-T complex) in both patients and a 2:1 AV block in the man.

Materials and methods:

Digoxin concentration was evaluated twice for each patient (at the admission and after 4 hours) by the automated immunoassay system ADVIA Centaur^®. Digitoxin concentration was evaluated by liquid chromatography-mass spectrometry (LC-MS/MS).

Results:

Despite clinical picture was suggestive of digitalis intoxication, digoxin levels were undetectable. Due to the more severe clinical picture, the male patient was treated with anti-digoxin antibodies (Digifab^®) achieving a good clinical improvement and remission of the AV block within two hours. Initial diagnosis was confirmed by LC-MS/MS showing high digitoxin concentrations, but digoxin was undetectable. Patients remained stable and 48 hours later were discharged from the hospital.

Conclusion:

Whereas digoxin determination frequently relies on monoclonal antibodies which do not cross-react to digitoxin, polyclonal antibodies constituting Digifab^® recognize a large spectrum of cardiac glycosides, including digitoxin. This report emphasizes the primary role of the clinical approach to patients in the emergency setting and how an active communication and a continuous sharing of professional experiences between Laboratory and Clinicians ensure an early and correct diagnosis.     

A behavioural dynamic model of the relative age effect

Abstract

The relationship between date of birth and success in a variety of sports, including hockey, is well established. This phenomenon is known as the relative age effect (RAE). We model the RAE in Canadian youth hockey as a positive feedback loop where an initial age advantage is reinforced through additional training and playing opportunities based on perceived skill superiority. The same causal mechanism leads to a higher quit rate for relatively younger players. Our model effectively replicates the birth month distribution of Canadian National Hockey League players (R² = 86.79%) when driven by Canadian birth distributions. We use this model to evaluate three policies that aim to lessen the RAE. All of the policies reduce the RAE with a significant delay. The most effective policy is a combination of providing additional support to age disadvantaged children and rotating the cut-off date for youth leagues between January 1st and July 1st annually. In equilibrium, this approach leads to a 96% reduction in the RAE compared to the base case.     

Teachers’, school staff’s and parents’ efficacy beliefs as determinants of attitudes toward school

Self- and collective efficacy beliefs were examined as correlates of attitudes toward school of teachers, school staff, and parents. 726 teachers, 387 staff members, and 1994 parents from 18 junior high schools in Milan and Rome, Italy, were administered questionnaires assessing self-efficacy beliefs, perceptions about colleagues’ bahavior, collective efficacy beliefs, affective commitment and job satisfaction of teachers and school staff and parents satisfaction with school. Path analyses corroborated a conceptual model in which self- and collective efficacy beliefs represent, respectively, the distal and proximal determinants of affective commitment and job satisfaction for teachers and staff and of satisfaction with school for parents. Perceptions that teachers, staff and parents hold about the behavior of their colleagues largely mediated the links between self- and collective efficacy beliefs. collective efficacy beliefs, in turn, largely mediated the influence that self-efficacy beliefs and perceptions of school constituencies’ behaviors exert on attitudes toward school of teachers, staff and parents.     

Departmental organization,legitimacy, and faculty militancy: Structural sources of pro union sentiment in a public university

This paper examines the influence of departmental organization on faculty sentiments for social change via unionization. Two structural sources (inequalities of resources between departments; goal-rewarded discontinuities within departments) and one individual source (discontent with departmental governance) of attitudinal militancy are specified in path models and empirically examined using a sample of 338 faculty in 38 departments in a large, public university. Results lend limited support for inequalities of resources between departments as a source of militancy. Departmental discontinuities have important effects on the legitimacy of rewards, but only a weak indirect effect on militancy. Governance discontent has a strong impact on the legitimacy of rewards and an interesting indirect effect on militancy.     

Repeated sprint ability in young basketball players: one vs. two changes of direction (Part 2)

The aim of this study was to compare the training effects based on repeated sprint ability (RSA) (with one change of direction) with an intensive repeated sprint ability (IRSA) (with two changes of direction) on jump performance and aerobic fitness. Eighteen male basketball players were assigned to repeated sprint ability and intensive repeated sprint ability training groups (RSAG and IRSAG). RSA, IRSA, squat jump (SJ), countermovement jump (CMJ) and Yo-Yo intermittent recovery level 1 test were assessed before and after four training weeks. The RSA and IRSA trainings consisted of three sets of six sprints (first two weeks) and eight sprints (second two weeks) with 4-min sets recovery and 20-s of sprints recovery. Four weeks of training led to an overall improvement in most of the measures of RSA, but little evidence of any differences between the two training modes. Jump performance was enhanced: CMJ of 7.5% (P < 0.0001) and 3.1% (P = 0.016) in IRSAG and RSAG respectively. While SJ improved of 5.3% (P = 0.003) for IRSAG and 3.4% (P = 0.095) for RSAG. Conversely the Yo-Yo distance increased 21% (P = 0.301) and 34% (P = 0.017) in IRSAG and RSAG respectively. Therefore, short-term repeated sprint training with one/two changes of direction promotes improvements in both RSA and IRSA respectively but the better increase on jump performance shown a few changes on sprint and endurance performances.     

Contamination of lithium heparin blood by K2-ethylenediaminetetraacetic acid (EDTA): an experimental evaluation

Introduction:

The contamination of serum or lithium heparin blood with ethylenediaminetetraacetic acid (EDTA) salts may affect accuracy of some critical analytes and jeopardize patient safety. The aim of this study was to evaluate the effect of lithium heparin sample contamination with different amounts of K₂EDTA.

Materials and methods:

Fifteen volunteers were enrolled among the laboratory staff. Two lithium heparin tubes and one K₂EDTA tube were collected from each subject. The lithium-heparin tubes of each subject were pooled and divided in 5 aliquots. The whole blood of K₂EDTA tube was then added in scalar amount to autologous heparinised aliquots, to obtained different degrees of K₂EDTA blood volume contamination (0%; 5%; 13%; 29%; 43%). The following clinical chemistry parameters were then measured in centrifuged aliquots: alanine aminotranspherase (ALT), bilirubin (total), calcium, chloride, creatinine, iron, lactate dehydrogenase (LD), lipase, magnesium, phosphate, potassium, sodium.

Results:

A significant variation starting from 5% K₂EDTA contamination was observed for calcium, chloride, iron, LD, magnesium (all decreased) and potassium (increased). The variation of phosphate and sodium (both increased) was significant after 13% and 29% K₂EDTA contamination, respectively. The values of ALT, bilirubin, creatinine and lipase remained unchanged up to 43% K₂EDTA contamination. When variations were compared with desirable quality specifications, the bias was significant for calcium, chloride, LD, magnesium and potassium (from 5% K₂EDTA contamination), sodium, phosphate and iron (from 29% K₂EDTA contamination).

Conclusions:

The concentration of calcium, magnesium, potassium, chloride and LD appears to be dramatically biased by even modest K₂EDTA contamination (i.e., 5%). The values of iron, phosphate, and sodium are still reliable up to 29% K₂EDTA contamination, whereas ALT, bilirubin, creatinine and lipase appear overall less vulnerable towards K₂EDTA contamination.