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Biomedical subjects

T Groth

Publications and source records attributed to T Groth.

At least 127 records · Page 7Linked to original sources

Purine metabolism of human erythrocytes during storage and physiological conditions.

Some results from storage experiments at +4 degrees C with adenine and purine nucleosides (cf. [1]) are compared with incubation experiments at 37 degrees C with guanosine at pH 7.0 and 7.4 and three different levels of inorganic phosphate (iP). At the lower pH and 20 mmol . l-1 iP the synthesis of GTP was extremely rapid; the intracellular concentration reached 0.5 mmol . l-1 within 25 min constituting 1/3 of the purine nucleoside triphosphate pool. Replacement of ATP by an ATP-GTP mixture has metabolic effects on several enzymic steps, e.g., phosphofructose kinase and phosphoglycerate kinase explaining the reported beneficial effect on human erythrocytes during preservation. In order to explore the role of erythrocytes in the physiological transport of purines and purine nucleosides in vitro experiments were designed in which the substances were continuously added to the appropriate concentrations by means of a dialysis tubing. Prior to incubation the erythrocytes were stored with NaF in order to reduce the total adenylate concentration. The rate of synthesis of adenylates was about 0.05 mmol . h-1 (calculated per litre of erythrocytes) both when adenosine and adenine were supplied as source for the adenine moiety of the adenylates. Analyses of purines, nucleosides, glucose, lactate and iP in the efferent dialysis solution and the extra- and intracellular volumes reveal the metabolic processes in the erythrocytes if the transport across the dialysis tubing is accounted for. The low capacity of the erythrocyte adenylate synthesis indicates that only a minor part of the adenine compounds physiologically exported by the liver could be delivered as intraerythrocytic adenylates.

Adenine↗

Turnover in humans of beta 2-microglobulin: the constant chain of HLA-antigens.

The turnover of beta 2-microglobulin, the common subunit of the HLA antigens, has been examined in normal subjects and in some patients with kidney disorders, multiple myeloma and rheumatoid arthritis. All patients displayed elevated serum levels of beta 2-microglobulin. The plasma disappearance curve of 125I-beta 2-microglobulin demonstrated that the protein has a rapid turnover (t 1/2 = 2.1 h; range 1.1-2.8 h) in normal persons and in patients with a normal glomerular filtration rate. In patients with kidney disorders the impaired renal filtration prolonged the turnover time and led to elevated serum levels of beta 2-microglobulin. Simultaneous measurements of 125I-beta 2-microglobulin in serum and urine allowed estimations of the beta 2-microglobulin net reabsorption in the renal tubuli. Two patients with renal disease reabsorbed 84% and 89%, respectively, of the beta 2-microglobulin filtered in the glomeruli. In normal persons the net reabsorption is close to 100%. In patients with normal kidney function increased serum levels of beta 2-microglobulin seem to be due to an increased synthetic rate of the protein as the elimination rate is normal. HLA antigen heavy chains in serum are present in smaller amounts than beta 2-microglobulin. The present data, therefore, suggest an imbalanced synthesis of the two chains.

Adult↗

Plasma concentration and renal excretion of adenine and 2,8-dihydroxyadenine after administration of adenine in man.

A new method of high performance liquid chromatography (HPLC) which makes it possible to analyse 2,8-dihydroxyadenine (DOA) in plasma in concentrations exceeding 0.25 mumol/l is described. The method was used to study the renal elimination of DOA. For comparison, the renal handling of adenine was also investigated. The results from an analysis of the experimental data support the assumption that more than one concentration-dependent mechanism exists in the renal tubuli for each of the two purines, adenine and DOA. In general the clearance values are higher for DOA than for adenine and indicate net secretion for both substances.

Adenine↗

Methods and approaches to determine "optimal" quality for clinical chemical data.

Although clinical reasoning and decision-making may be very complex, there are methods to perform both piecemeal and more complete optimizations with regard to the use of clinical chemical data and for assessing quality specification. Some methods and approaches are described and illustrated with examples: (i) rules for propagation of errors in simple algebraic/statistical transformations; (ii) systems and sensitivity analysis using biochemical/pathophysiological simulation models; (iii) systems and sensitivity analysis of simulated clinical classification and decision processes. It is concluded that the possible gain of useful information by improving analytical and pre-analytical quality should be related to the often more important aspects of test selection test and test combination, period and frequency of observation, and the use of correct conceptual models for transformation of data.

Chemistry Techniques, Analytical↗

Pancreatic iso-amylase in serum as a diagnostic test in different clinical situations. A simulation study.

The potential use of a pancreatic iso-amylase test has been studied by computer simulation. This simulation was performed to assess the quality requirements on the test in different clinical situations. It was shown that, in most situations studied, an optimal discriminating level and an optimal analytical quality (imprecision and bias) could be established. In one situation studied in more detail, it was found that the influence of pre-analytical variation, duplicate determinations, reclassification of borderline cases and size of reference sample groups were of minor importance. The weighting ratio of false negatives: false positives was found to be critical for the results. It is concluded that a simulation study of this type can be recommended prior to entering the phases of analytical refinement and clinical testing on patients.

Adult↗

Influence of analytical quality on the diagnostic power of a single S-CK B test in patients with suspected acute myocardial infarction.

We have compared tow theoretical methods for assessing the effects of changing analytical quality of a clinical chemical test. The test considered was S-creatine kinase B subunit activity, used as the only diagnostic criterion for acute myocardial infarction. The two methods applied were based on (i) graphical analysis, and (ii) computer simulation. The results comprise the effects of changing analytical imprecision and bias on the weighted sum of misclassified cases on basis of the test results. The two methods yield comparable results at high analytical imprecision, but due to differences in assumptions about the error distribution of test results the difference increases with increased analytical imprecision. The graphical analysis is easily performed but is restricted in possible applications. The computer simulation is not a generally available methodology, but allows for mixing of different types of statistical distributions, which is not the case in conventional variance analysis.

Chemistry Techniques, Analytical↗

Diagnosis, size estimation and prediction of acute myocardial infarction from S-myoglobin observations. A system analysis to assess the influence of various sources of variability.

Three different ways of using S-myoglobin observations for early diagnosis of acute myocardial infarction have been investigated by computer simulation techniques, viz. classification based on (i) single determination in relation to a decision limit, (ii) the peak serum concentration value, (iii) estimated or predicted value of infarct size from serial serum concentration determinations. The results of the in numero experiments indicate that it is possible to define optimal conditions with regard to time, period and frequency of observation, as well as to assess requirements on pre-analytical/analytical variation. The optimal time for a single observation should be about 10-12 h after onset of symptoms. The influence of pre-analytical/analytical variation is not very critical in this connection and the quality requirements are achievable in the clinical chemical laboratory today (total CV about 0.10). The peak serum value has good diagnostic power, but does not provide a good index of infarct size, no matter how good the analytical quality may be. It should be possible to predict infarct size from early serial S-myoglobin observations. A coefficient of pre-analytical/analytical variation below 0.05 is then required in addition to frequent blood specimen collection from admission up to peak time of the serum concentration curve.

Humans↗

Equivalence of quantitative models for tumour response to ionizing radiation in treatment field optimisation procedures.

Three cell kinetic models of tumour response to ionising radiation were compared with regard to their prediction of variation in curability when the dose to the tumour varied between 54 and 66 Gy given in 30 fractions. It was found that a simple model emulated the results of the more complex ones when the parameters of the simple model were properly adjusted. A comparison of the simple model and the CRE formula gave a similar result.

Cell Survival↗

Influence of a between-run component of variation, choice of control limits, and shape of error distribution on the performance characteristics of rules for internal quality control.

A computer-stimulation study has been performed to determine how the performance characteristics of quality-control rules are affected by the presence of a between-run component of variation, the choice of control limits (calculated from within-run vs. total standard deviations), and the shape of the error distribution. When a between-run standard deviation (Sb) exists and control limits are calculated from the total standard deviation (St, which includes Sb as well as the within-run standard deviation, Sw), there is generally a loss in ability to detect analytical disturbances or errors. With control limits calculated from Sw, there is generally an increase in the level of false rejections. The presence of non-gaussian error distribution appears to have considerably less effect. It can be recommended that random error be controlled by use of a chi-square or range-control rule, with control limits calculated from Sw. Optimal control of systematic errors is difficult when Sb exists. An effort should be made to reduce Sb, and this will lead to increased ability to detect analytical errors. When Sb is tolerated or accepted as part of the baseline state of operation for the analytical method, then further increases in the number of control observations will be necessary to achieve a given probability for error detection.

Chemistry, Clinical↗

Power functions for statistical control rules.

We have studied power functions for several control rules by use of a computer simulation program. These power functions show the relationship between the probability for rejection and the size of the analytical errors that are to be detected. They allow some assessment of the quality available from present statistical control systems and provide some guidance in the selection of control rules and numbers of control observations when new control systems are designed.

Chemistry, Clinical↗

The usefulness of 125I-sodium lothalamate as a GFR-indicator in single intravenous injection tests.

Clearance of sodium iothalamate was estimated from plasma elimination curves obtained from 90 patients having varying renal function, after a single intravenous injection of 125I-sodium iothalamate. The usefulness of sodium iothalamate as a GFR-indicator with this technique was tested by a strict statistical comparison with conventional inulin clearance as a reference. The regression line, covering the clearance range 2-163 ml min-1, Clinulin = 1.08.Clsodiumiothalamate-3.7, (n = 84, r = 0.85, SEE = 2.3 ml.min-1) was not significantly different from the identity line, which means (i) that extrarenal elimination could not be detected, and (ii) that I125-sodium iothalamate should be regarded as a useful glomerular marker for single intravenous injection studies. An open two-compartment model of mamillary type was found to give an adequate representation of the plasma disappearance curve. The results are not critically dependent on the choice of approximating function. The method by Sapirstein et al., the method by Nosslin and a power-law method were used for comparison and were found to give the same results. However, the present type of curve fitting analyses requires frequent blood sampling or external counting over a long period in order to give reliable estimates of GFR. This circumstance makes these methods less attractive for clinical use.

Adult↗

The molecular function of hemoglobin as reflected in ligand binding data: analysis of data on erythrocytes.

Hemoglobin oxygen binding data on erythrocytes at diffrent pH, PCO2 and bisphosphoglycerate concentrations have been analyzed in terms of an extended version of the Herzfeld-Stanley model of 1972. The binding of oxygen to subunits when the tetramer is in the quaternary oxy conformation was found to be insensitive to moderate changes in pH and pCO2 (0.71 +/- 0.05 mm Hg-1). Utilizing this circumstance it has been possible to obtain, for the first time, unique estimates of energy parameters related to hemoglobin cooperativity and effector action. At 37 degrees C, pH 7.2 and pCO2 22 mm Hg the following parameter values were obtained: The allosteric constant: (1.5 + 0.4)-10(4); the oxygen binding constant of the deoxy state: (5.4 +/- 0.3).10(-3) mm Hg-1; the 2,3-bisphosphoglycerate binding constants: (3.3 +/- 1.3).10(3)1. mol-1(deoxy), (1.3 +/- 0.5).10(2)1. mol-1 (oxy). Quarternary transition most likely takes place after binding of the second O2 molecule. Following the concepts of Perutz the results suggest that (1) protons and carbon dioxide act as constraint effectors and/or as quaternary effectors; (2) the difference in total conformational energy between the two quaternary ligand-free states is almost exclusively confined to molecular constraints and very little to the difference in quaternary conformational energy. The consistency of the results indicate that the model may be regarded as a useful tool for the description of the functional interrelations in the hemoglobin oxygenation process as reflected in oxygen binding data.

Binding Sites↗

A simple method for the estimation of glomerular filtration rate.

A simple method is presented for indirect estimation of the glomerular filtration rate from two venous blood samples, drawn after a single injection of a small dose of [125I]sodium iothalamate (10 muCi). The method does not require exact dosage, as the first sample, taken a few minutes (t = 5 min) after injection, is used to normalize the value of the second sample, which should be taken in between 2-4 h after injection. The glomerular filtration rate, as measured by standard inulin clearance, may then be predicted from the logarithm of the normalized value and linear regression formulas with a standard error of estimate of the order 1-2 ml/min/1.73 m2. The slope-intercept method for direct estimation of glomerular filtration rate is also evaluated and found to significantly underestimate standard inulin clearance. The normalized 'single-point' method is concluded to be superior to the slope-intercept method and more sophisticated methods using curve fitting technique, with regard to predictive force and clinical applicability.

Adult↗

Performance characteristics of rules for internal quality control: probabilities for false rejection and error detection.

When assessing the performance of an internal quality control system, it is useful to determine the probability for false rejections (pfr) and the probability for error detection (ped). These performance characteristics are estimated here by use of a computer stimulation procedure. The control rules studied include those commonly employed with Shewhart-type control charts, a cumulative sum rule, and rules applicable when a series of control measurements are treated as a single control observation. The error situations studied include an increase in random error, a systematic shift, a systematic drift, and mixtures of these. The probability for error detection is very dependent on the number of control observations and the choice of control rules. No one rule is best for detecting all errors, thus combinations of rules are desirable. Some appropriate combinations are suggested and their performance characteristics are presented.

Chemistry, Clinical↗

Combined Shewhart-cusum control chart for improved quality control in clinical chemistry.

We describe the adaptation of the decision limit cumulative sum method (cusum) to internal quality control in clinical chemistry. With the decision limit method, the cusum is interpreted against a numerical limit, rather than by use of a V-mask. The method can be readily implemented in computerized quality-control systems or manually on controls charts. We emphasize the manual application here and demonstrate how the technique can be implemented on existing Shewhart or Levey-Jennings control charts. This permits both cusum and Shewhart control rules to be used simultaneously on a single control chart and also minimizes the data calculations necessary for the cusum method. Computer simulation studies are used to determine the performance characteristics of several different cusum rules, alone and in combination with a Shewhart rule. These studies indicate that improvements in existing quality-control systems should be possible by addition of this simple cusum method and by use of a combined Shewhart-cusum control chart. This should be particularly advantageous when introducing the cusum method in laboratories with manual quality-control systems.

Chemistry, Clinical↗