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In situ polymerase chain reaction: general methodology and recent advances.

In situ PCR is a new molecular technique, that combines the extreme sensitivity of PCR with the cellular localization provided by in situ hybridization (ISH), through the amplification of specific gene sequences within intact cells or tissue sections and increasing copy numbers to levels detectable by ISH or immunohistochemistry. In addition to the detection of viral DNA (CMV, HBV, HIV), we have used this technique for the study of DNA rearrangements, chromosomal translocations (t14;18) and viral RNA (HCV) in cells in suspension, cytocentrifuge preparations or archival tissue sections. We compared different approaches to in situ amplification of target sequences and visualization of PCR products by either subsequent ISH (indirect in situ PCR) or by direct detection of labeled nucleotides, which have been incorporated during PCR (direct in situ PCR). Our results indicate, that in situ PCR includes a number of different techniques, which are not equally applicable to all types of samples. In situ PCR appears to be most effective for the detection of DNA in single cell preparations with controlled fixation and pretreatment, although the quantification of results remains problematic. Artifacts caused by diffusion and extracellular generation of PCR products are a significant problem potentially leading to false positive results. In situ PCR works less efficiently in archival tissue sections due to poor quality of nucleic acids and retention of PCR products. Direct in situ PCR yields less specific results than indirect in situ PCR and requires additional controls such as omission of primers in the reaction mixture to detect artifacts.(ABSTRACT TRUNCATED AT 250 WORDS)

Artifacts↗

Sensitivity and specificity of CT in the diagnosis of inflammatory abdominal aortic aneurysms.

PURPOSE: The purpose of this study is to assess the diagnostic ability (sensitivity and specificity) of CT in the diagnosis of inflammatory abdominal aortic aneurysm (IAAA) and to quantitatively evaluate its features. METHOD: A retrospective survey of 355 consecutive patients with abdominal aortic aneurysm and iliac artery aneurysm who underwent CT examination and surgical repair yielded 18 patients with operatively confirmed IAAA. The sensitivity, specificity, and diagnostic accuracy of CT were evaluated in this review. Eighteen IAAAs were then analyzed in terms of distribution and degree of perianeurysmal fibrosis as well as time-dependent change of CT values of the aneurysmal wall on contrast-enhanced CT. Complications related to IAAA were also determined. RESULTS: Fifteen of the 18 cases of IAAA could be easily diagnosed on CT prior to surgical repair. Three false-negative and one false-positive case were found. This gives a sensitivity rate of 83.3% for this imaging technique, with specificity and accuracy rates of 99.7 and 93.7%, respectively. Thickening of the aortic wall was noticed mostly in the anterolateral wall of the aneurysm as compared with the posterior wall. The thickness of the perianeurysmal fibrosis correlated neither with the size of aneurysm nor with the inflammatory reaction such as erythrocyte sedimentation rate, C-reactive protein level, and white blood cell count. CT indicated the complications in 7 of 18 patients with IAAA. These included hydronephrosis, aortoenteric fistula, and infected iliac aneurysm. CONCLUSION: CT scan with contrast enhancement was a highly reliable imaging modality for the diagnosis of IAAA.

Aortic Aneurysm, Abdominal↗

Capture and RT-PCR of hepatitis C virus RNA with safety primers.

The principle and practice of the polymerase chain reaction (PCR) has had a major impact on medical research. This is a powerful method but it does have its limitations, especially for clinical diagnostic work. We describe some improvements of hepatitis C virus (HCV) amplification such as simplification of specimen preparation, elimination of false negative reactions influenced by point mutations, and fluorimetric detection. The aim of the method is to make the procedure as easy and as inexpensive as possible for routine laboratories and for blood screening. After rapid chemical denaturation of the clinical specimen with guanidine thiocyanate and simultaneous hybridization of biotinylated primers to template HCV RNA, the product was fixed to streptavidin-coated magnetic beads and potential inhibitors were removed in easy washing steps. To eliminate the influence of point mutations within the primer binding sites, primer sets with different lengths at their 3'-end were developed for capture, reverse transcription, and amplification of genomic fragments by PCR. Positive results were identified by fluorescence staining. The low cost of the method allows the quantitation of templates by testing of dilution series as is common in microbiological laboratories.

DNA Primers↗

Open, closed and intradermal testing in nickel allergy.

Open, closed and intradermal testing with NiCl2 was performed in 15 subjects with patch-test-proven allergy to 5% NiSO4 in pet. Intradermal testing proved to be a reliable method in confirming nickel sensitivity within 24 h. Open testing with non-toxic concentrations of NiCl2 in alcohol resulted in 73% and 93% positive reactions at 24 h and 48 h readings, respectively. This test method can be used as a reliable screening method in nickel allergy. Open testing often resulted in positive reactions within a few hours. This makes it possible to investigate pathogenetic events of acquired allergic contact dermatitis at a much earlier stage than with the usual 48-h occlusion. 24-h occlusion with Finn Chambers is not sufficient if one is to avoid false negative reactions in nickel allergy. Occlusion with Finn Chambers seems to delay the reaction.

Adolescent↗

Evaluation of the Minitek system for identification of Enterobacteriaceae.

Clinical isolates (869) and stock cultures (35) of Enterobacteriaceae were tested in parallel with the Minitek and conventional systems. The Minitek correctly identified 822 of 904 cultures. When a deoxyribonuclease plate was inoculated along with the Minitek, it was possible to speciate Enterobacteriaceae within 24 h. False-positive hydrogen sulfide reactions were the major fault with this system. Reactions were clear-cut and easy for technologists to read.

Bacteriological Techniques↗

[Causes of error in the study of fibrinogen clumping and the diagnosis of Staphylococcus aureus: Micrococci and Acinetobacter].

Rapid presumptive identification of S. aureus, particularly on the agar slant of biphasic blood culture bottles can be performed by modified slide clumping factor tests. We compared two commercial reagents (Staphyslide and Staphaurex) using strains of "Gram-positive cocci arranged in clusters" (S. aureus, S. epidermidis, Micrococcus) or diplococci-like organisms such as Acinetobacter. Micrococcus and Acinetobacter can be responsible for false-positive reactions with sensitized or not sensitized particles. Control reactions with not sensitized particles or autoagglutination tests in water rather than saline must be performed.

Acinetobacter↗

Evaluation of a Digene-recommended algorithm for human papillomavirus low-positive results present in a "retest zone".

The Digene Hybrid Capture 2 (hc2) high-risk human papillomavirus (HPV) DNA test (Digene, Gaithersburg, MD) is widely used for triage of women with atypical squamous cells of undetermined significance. Results in a "retest zone" (weakly positive tests) are repeated up to 2 times according to the Digene-recommended algorithm. We studied 56 cervical samples in the retest zone. Specimens were tested by a multiplex polymerase chain reaction (PCR)-based genotyping assay, and relevant cytopathologic results were reviewed. Digene results were compared with a reference standard that combined PCR genotyping and cytopathology results. The first repeated Digene assay yielded a sensitivity of 85.2% and a specificity of 62.1% with false-positive and false-negative rates of 40.0% and 15.4%, respectively. The 22 negative samples underwent a second retest and 18 (82%) were negative by the reference standard. The combined first and second retest sensitivity, specificity, and predictive values remained unchanged from the first retest alone. Repeating specimens in the retest zone is necessary, but a second retest does not offer advantages over the first retest.

Algorithms↗

The occurrence of HIV antibodies in drug addicts autopsied at the University Institute of Forensic Medicine in Copenhagen in 1987.

In 1987 a total of 89 intravenous drug addicts were admitted to medico-legal autopsy at the University Institute of Forensic Medicine in Copenhagen. Totally 10 cases were reactive by the Elisa test and five of these, or 7% of the total material tested, could be confirmed by the immuno-blotting test. The other five cases must be considered as false positive, possibly due to antibodies against cellular antigens. Among the five real positive cases, four were known before-hand while in one case the HIV-positivity was not known. These findings - together with the possibility of false negative reactions - especially regarding persons with acute HIV-infection, requires special precautionary measures when autopsies of drug addicts are performed.

Adult↗

Microbial receptor assay for rapid detection and identification of seven families of antimicrobial drugs in milk: collaborative study.

A microbial competitive receptor assay for detecting residues of antibiotic families in milk was studied collaboratively by 13 laboratories. The drugs and levels (ppb) tested in this study include penicillin G, 4.8; cephapirin, 5.0; cloxacillin, 100; tetracycline, 2000; chlortetracycline, 2000; oxytetracycline, 2000; erythromycin, 200; lincomycin, 400; clindamycin, 400; sulfamethazine, 75; sulfamethoxazole, 50; sulfisoxazole, 50; streptomycin, 1000; novobiocin, 50; and chloramphenicol, 800. In this method, microbial cells added to a milk sample provide specific binding sites for which 14C or 3H labeled drug competes with drug residues in the sample. The 14C or 3H binding to the specific binding sites is measured in a scintillation counter and compared with a zero standard milk. If the sample is statistically different from the zero standard, it is positive. The assay takes about 15 min. The binding reaction occurs between the receptor site and the drug functional group, so all members of a drug family are detected. In this case, beta-lactams, tetracyclines, macrolides, aminoglycosides, novobiocin, chloramphenicol, and sulfonamides, including p-aminobenzoic acid (PABA) and its other analogs, are detectable. The incidence of false negative determinations among samples is about 1%; the incidence of false positives is about 3%. For negative cases, the relative standard deviations for repeatability ranged from 0 to 5% and for reproducibility from 0 to 6%. For positive cases, relative standard deviations ranged from 0 to 13% for repeatability and from 0 to 14% for reproducibility. The method has been adopted official first action.

4-Aminobenzoic Acid↗

A comparison of EF-18 agar and modified brilliant green agar with lutensit for isolation of Salmonella from poultry samples.

Two selective plating media were compared to determine their performance in a three-step protocol for isolation of Salmonella from faecal, litter, and fluff samples. The enrichment protocol consisted of: 1) Preenrichment in buffered peptone water (BPW), 2) Selective enrichment in Rappaport-Vassiliadis broth, and 3) Plating onto EF-18 agar and BGA/L simultaneously. From a total of 1101 samples, Salmonella was isolated from 158, 157 of which were faecal samples. Thirty-one of these isolates were recovered on one medium only, 18 could not be found on BGA/L and 13 could not be found on EF-18 agar. The relative specificity and sensitivity of each plating agar was determined by enumeration of false-positive and false-negative reactions. EF-18 agar compared favourably with BGA/L, displaying a sensitivity of 0.92 as opposed to 0.89 for BGA/L, calculated for the "fecal samples" group only. The calculated specificities for each group of samples were likewise considerably higher for EF-18 agar (0.75-0.91) than for BGA/L (0.35-0.55). Though EF-18 agar is slightly more expensive than BGA/L, the routine use of the former may result in a considerable reduction in overall laboratory costs due to its superior selectivity. On the other hand the combination of the 2 media clearly would reduce the number of false negative results, with little extra cost.

Agar↗

Minimum eliciting patch test concentrations of cobalt.

In sensitized subjects, minimum eliciting levels of cobalt were estimated using patch tests with aqueous cobalt chloride on both normal skin and on skin pretreated in various ways to enhance penetration and reactivity. 6 reacted to 10,000 ppm and 1 gave an equivocal reaction to 1000 ppm aq. cobalt. Pretreatment of the patch test site for 24 h with surfactant enhanced reactivity, reducing the minimum eliciting concentration to 1000 ppm cobalt chloride in 1 subject, to 100 ppm in 2 subjects, and in 3 subjects to 10 ppm aqueous cobalt chloride. No reactions were obtained at 1 ppm. EDTA was effective in reducing the response to aqueous cobalt.

Adult↗

Detection of mycoplasma in leukemia-lymphoma cell lines using polymerase chain reaction.

The specific, sensitive and reliable detection of mycoplasma contamination in cell cultures is an important part of mycoplasma control. We have sought to develop and validate a method for mycoplasma detection which is sensitive and accurate, but also practical in the sense of time spent, costs, and applicability in the standard laboratory; finally, the method should be suitable for screening large numbers of test specimens. To that end, we adapted a previously developed polymerase chain reaction (PCR) method for daily routine application. This single-step PCR uses a mixture of primers annealing to gene sequences coding for evolutionarily conserved 16S rRNA of different mycoplasma species, including the ones most commonly found in cell cultures. An internal control was introduced to exclude any false-negative tests resulting from technical PCR problems. This mycoplasma detection by PCR has been validated prospectively on 201 consecutive leukemia-lymphoma cell lines received at the institute over a 3-year period and on 118 initially positive cell lines after anti-mycoplasma treatment with antibiotics. The sensitivity (detection of true positives) of this PCR detection assay was 96% and the specificity (detection of true negatives) was also 96%, with positive and negative predictive values (probability of correct result) of 86% and 99%, respectively. PCR defined the mycoplasma status with 96% accuracy (detection of true positives and true negatives). Besides the high sensitivity and specificity, further attractive features of the PCR approach are the ease and speed with which large numbers of specimens can be tested. PCR mycoplasma analysis provides a readily available, quick and reliable test system with which to manage the important issue of mycoplasma contamination of cell lines.

Anti-Bacterial Agents↗

[A specific stimulation test of the peripheral blood lymphocytes in the diagnosis of syphilis].

The authors analyze the results of laboratory studies on the diagnosis of syphilis with the use of this test. T. pallidum has been used as an antigen. The study has involved 234 patients with active and latent forms of syphilis, as well as donors and subjects with nonspecific positive serologic reactions. The test has yielded negative results in 27 (12%) patients; of these, in only 1 of the 170 patients with active syphilis.

Evaluation Studies as Topic↗