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Cell culture quality control by rapid isoenzymatic characterization.

Procedures that involve cell cultures require careful quality control to avoid inter- and intraspecies contamination. We have developed an electrophoresis technique that can be used routinely in cell culture laboratories to monitor cell line integrity. The method involves the isoenzymatic separation of nine polymorphic enzymes, three of which can be used for cell line species determinations and seven of which can be used for human cell line characterizations. Examples of how the system has been applied to both inter- and intraspecies identifications are described. The routine application of this protocol would be a valuable asset for laboratories concerned with establishing effective cell culture quality control.

Animals↗

Quality control and diagnostic reference levels in intraoral dental radiographic facilities.

OBJECTIVES: A quality control program in intraoral radiographic equipment was conducted aiming to verify compliance with the latest legal requirements and to measure radiation dose in order to contribute to the establishment of appropriate diagnostic reference levels. METHODS: This study was performed in 191 intraoral radiographic facilities in Northern Greece. The quality control program included visual inspection of the unit, registration of its characteristics, measurement and calculation of several radiological parameters, including entrance surface dose, and overall compliance with legislation requirements. RESULTS: Most units (61.8%) were found to perform within their corresponding specifications. Exposure timer accuracy was the parameter that the dental units showed the poorest performance. Inadequate beam filtration was found in almost half of the older 50 kVp units. Entrance surface dose showed significant discrepancies, varying from 0.30 mGy to 16.09 mGy with a third quartile value of 3.37 mGy. CONCLUSIONS: A diagnostic reference level of 3.5 mGy is considered to be a realistic value for all intraoral equipment currently operating in Greece. However, for newly installed units, a value of 2.8 mGy is considered to be more appropriate.

Filtration↗

Dilated cardiomyopathy caused by aberrant endoplasmic reticulum quality control in mutant KDEL receptor transgenic mice.

Aberrant protein folding beyond the capacity of endoplasmic reticulum (ER) quality control leads to stress response in the ER. The Lys-Asp-Glu-Leu (KDEL) receptor, a retrieval receptor for ER chaperones in the early secretory pathway, contributes to ER quality control. To elucidate the function of the KDEL receptor in vivo, we established transgenic mice expressing a mutant KDEL receptor. We found that the mutant KDEL receptor sensitized cells to ER stress and that the mutant mice developed dilated cardiomyopathy. Ultrastructural analyses revealed expanded sarcoplasmic reticulums and protein aggregates that obstructed the adjacent transverse tubules of the mutant cardiomyocytes. Cardiomyocytes from the mutant mice were sensitive to ER stress when treated with tunicamycin and showed a functional defect in the L-type Ca(2+) current. We observed ubiquitinated protein aggregates, enhanced expression of CHOP (a death-related transcriptional factor expressed upon ER stress), and apoptosis in the mutant hearts. These findings suggest that impairment of the KDEL receptor disturbs ER quality control, resulting in accumulation of misfolded proteins in the ER in an in vivo system, and that the dilated cardiomyopathy found in the mutant KDEL receptor transgenic mice is associated with ER stress.

Animals↗

[Education, postgraduate and continuing education in surgery--data for quality control].

Despite intensive educational training during medical school, there is hardly any occupational group like physicians that tries to keep further education on a very high level. However, under the aspect of quality control, there is a need for different certificates. The education itself needs quality control; the laying down of rules as a rational basis is to advance, but facts that deal with quality control are not easy to find. The analysis of the committee of education of the Ruhr University Bochum must be considered as ideal; the results have to be transferred. Objective medical care results and patient satisfaction are influenced by many factors.

Clinical Competence↗

Validated micellar electrokinetic capillary chromatography method for quality control of the drug substances hydrochlorothiazide and chlorothiazide.

A stability-indicating, quality control analysis method was developed and validated for the diuretic drug substances hydrochlorothiazide (HCTZ) and chlorothiazide (CTZ). Micellar electrokinetic capillary chromatography employing the anionic detergent sodium dodecyl sulfate at 30 mM in 20 mM sodium borate buffer pH 9.5 was utilized to separate and quantify the active drug substance HCTZ from CTZ and the common impurity, 4-amino-6-chloro-1,3-benzenedisulfonamide (DSA). A 100 microns I.D. uncoated fused-silica capillary was necessary to provide the sensitivity, i.e. 1 microgram/ml, for quantification of the DSA impurity. In this study, the linearity, precision, selectivity, accuracy, reproducibility and limit of quantitation for the method were investigated for HCTZ, CTZ and DSA. As the first validation of a drug substance method by capillary electrophoresis in this laboratory, unusual care was taken to insure reliability and ruggedness with multiple instruments, capillaries and analysts. Precision and reproducibility in the range of 1% R.S.D. was achieved by controlling subtle injection factors. These included minimizing the time in which the capillary ends were not immersed in buffer or sample during the injection process and minimizing the number of assays for each anode or inlet buffer vial. Stacking induced by differences in ionic strength between sample and capillary buffer was reduced by using a sample buffer concentration similar to that of the capillary buffer. Although stacking accomplished by using lower sample buffer concentrations increased sensitivity, reproducibility was decreased. Achievement of the 1% R.S.D. precision level means that many quality control assays for drugs with good absorbance characteristics can be validated with HPLC reproducibility and CE efficiency. These micellar electrokinetic capillary chromatography methods conform to the USA and European Pharmacopoeial validation guidelines.

Chlorothiazide↗

Formation of 99mTc-immunoglobulin G complexes free from radiocolloids, quality controlled by radioimmunoelectrophoresis.

A method for the formation of 99mTc-human immunoglobulin G(99mTc-IgG) complexes free from radiocolloids is described. A concentrated hydrochloric acid reduction/vacuum evaporation/gentisic acid method was applied. Although no preparative chromatography was performed, no sign of 99mTc-radiocolloids was observed in the chemical quality controls of the 99mTc-IgG formation. High radiochemical purities of 99mTc-IgG were obtained either by precipitation in 32 vol.% ethanol in water at -10 degrees C, or by removal of other 99mTc-complexes by simply adding a suspension of sterilized Dowex 1 in gentisic acid solution. Besides gel chromatography and thin layer chromatography, the 99mTc-IgG formation was quality controlled by radioimmunoelectrophoresis in agarose gel with rabbit anti-human IgG-antibodies present in the gel. The 99mTc-IgG complexes were complex bound to the rabbit anti-human IgG antibodies, and precipitated as rockets in the gel. These rockets could be scintigraphed and their radioactivities could be quantified, thereby a quantitatively radio-chemical quality control based on the antigenicities of the 99mTc-IgG complexes was obtained. The 99mTc-IgG complexes were highly stable with no sign of dissociation even when the radioimmunoelectrophoresis was performed for 24 h. Improvements of the radioimmunoelectrophoretic system for the quality control of 99mTc-complexes with specific purified antibodies, are proposed.

Humans↗

Comparability and Quality Control in Cancer Registration; Karachi (data monitoring 1995-2001).

INTRODUCTION: Comparability and Quality Control in Cancer Registration remains an essential component of standardisation of cancer incidence data. The information provided by registries is used as a base-line data for cancer control and cancer research. As such misleading information will encourage fictious cancer patterns with over or under registration of some cancer sites. METHODOLOGY: The registration in Karachi started in 1995 and was confined to a single district of Karachi, the South District. Since 1998 the registration has extended to Karachi Division. For both the data sets, recommendations of the International Agency for Research on Cancer (IARC) and the International Association of Cancer Registries (IACR) have been followed to assure comparability and Quality Control of the results. RESULTS: The 2 data sets from Karachi show well-recorded demographic details of cases. Age was not a true indicator of validity in our case, as we have approximate ages of patients aggregated around quintiles and decades. All the cancer cases were reported from a minimum of 3 sources. Microscopic verifications (MV) were high. Cancers with the highest histological verification (HV) were those located in easily accessible sites e.g. breast, oral cavity and cervix. The age specific incidence rates (ASR) for Karachi South, all sites (1995-1999) was 148.1 males and 175.5 females. The same for Karachi Division (1998-99) was 132.4 males and 133.0 females. CONCLUSION: The cancer data in 1995 during the initial phase of registration was incomplete and suffered from inaccuracies associated with a lack of awareness in early years of registration. By the year 2001, the data (1995-1999) showed improved completion and accuracy. The incidence rates have shown no dramatic changes during the past 2 years. The malignancies also show a stable pattern, despite the possibility of under-registration of clinically diagnosed cases. The microscopic verification is high compared with the world region and similar to those observed in developed countries. This may be due to the widely available diagnostic facilities in Karachi and should therefore be considered an indicator of validity of registered data.

Adolescent↗

An overview of quality control practices in Ontario with particular reference to cholesterol analysis.

BACKGROUND: The Laboratory Proficiency Testing Program (LPTP) assesses the analytical performance of all licensed laboratories in Ontario. The LPTP Enzymes, Cardiac Markers, and Lipids Committee conducted a "Patterns of Practice" survey to assess the in-house quality control (QC) practices of laboratories in Ontario using cholesterol as the QC paradigm. DESIGN AND METHODS: The survey was questionnaire-based seeking information on statistical calculations, software rules, review process and data retention, and so on. Copies of the in-house cholesterol QC graphs were requested. A total of 120 of 210 laboratories were randomly chosen to receive the questionnaires during 1995 and 1996; 115 laboratories responded, although some did not answer all questions. RESULTS: The majority calculate means and standard deviations (SD) every month, using anywhere from 4 to >100 data points. 65% use a fixed mean and SD, while 17% use means calculated from the previous month. A few use a floating or cumulative mean. Some laboratories that do not use fixed means use a fixed SD. About 90% use some form of statistical quality control rules. The most common rules used to detect random error are 1(3s)/R4s while 2(2s)/4(1s)/10x are used for systematic errors. About 20% did not assay any QC at levels >5.5 mmol/L. CONCLUSIONS: Quality control data are reviewed daily (technologists), weekly and monthly (supervisors/directors). Most laboratories retain their QC records for up to 3 years on paper and magnetic media. On some QC graphs the mean and SD, QC product lot number, or reference to action logs are not apparent. Quality control practices in Ontario are, therefore, disappointing. Improvement is required in the use of clinically appropriate concentrations of QC material and documentation on QC graphs.

Chemistry, Clinical↗

Quality control of storage phosphor digital radiography systems.

Quality control (QC) of storage phosphor devices is important in assuring that the image information entered into an Image management and communication (IMAC) system is sufficient for diagnosis. QC of storage phosphor digital radiography systems is complex because of the self-corrective nature of the image-processing software used in these machines. Currently, one must produce hard copy to perform adequate QC. Inspection of images with reject analysis and inspection of cassettes and imaging plates has helped us in our QC program. For those QC tests using control limits, the appropriate settings for these limits are unknown. Starting approximations are given. Recommended tests are described.

Equipment Failure↗

Quality control and artifacts in mammography.

Effective mammography requires rigorous quality control, mandated by the Mammography Quality Standards Act of 1992 (MQSA). This article reviews MQSA's requirements and the elements of the imaging chain that affect mammogram quality. Major classes and sources of artifacts also are presented.

Artifacts↗

Interpretive criteria and quality control guidelines for Neisseria gonorrhoeae susceptibility test standardization for cefotetan.

Cefotetan was tested in a multilaboratory study to standardize susceptibility testing criteria and quality control guidelines for Neisseria gonorrhoeae. Cefotetan was most active against penicillinase-producing and penicillin-susceptible strains (MIC for 50% of strains tested, 0.5 micrograms/ml) and was least active against the chromosomally resistant isolates (MIC for 50% of strains tested, 2 micrograms/ml). The recommended 30-micrograms disk cefotetan interpretive criteria were as follows: susceptible at greater than or equal to 26 mm (less than or equal to 2 micrograms/ml), intermediate at 20 to 25 mm (4 micrograms/ml), and resistant at less than or equal to 19 mm (greater than or equal to 8 micrograms/ml). Quality control guidelines for agar dilution and disk diffusion tests were established by using numerous GC agar lots, three cefotetan 30-micrograms disk lots, two quality control organisms, and a volume of tests consistent with National Committee for Clinical Laboratory Standards M23-T guidelines.

Cefotetan↗

Quality control in breast cancer surgery.

Quality assurance is the process by which quality care can be assessed. The general principles include setting a standard with the aim of achieving particular outcomes, followed by the evaluation of parameters that allow for quality assessment. Locoregional and survival outcomes are the major parameters but require years to evaluate and have other limitations. Other parameters therefore may assist in evaluation, such as the availability of the structures and processes required to achieve desired outcomes. Unlike chemotherapy and radiotherapy the quality of surgery is difficult to quantify, yet it is central to the issue of locoregional control and survival. In breast cancer surgery, quality control starts at the diagnostic service; from referral by the family practitioner to the appropriate triage of patients thereby preventing diagnostic delays. The surgical oncologist is pivotal in the multidisciplinary input necessary with both radiologists and pathologists in achieving the correct preoperative diagnoses of symptomatic and screen detected lesions as specified by many of the guidelines. Quality control of the operative surgery addresses issues such as training, volume and life audit of the surgeon. Standardisation of operative technique, pathology reporting with emphasis on specimen orientation and margins, management of the axilla and how it impacts on adjuvant treatment are other important issues. More recently, the availability of breast reconstruction services and the development of the oncoplastic surgeon is becoming an important quality issue. Finally, the quality of the follow up process provides the tools to assess the outcome of both the patient and the service.

Breast Neoplasms↗

Analytical quality control of cadmium and lead in blood and cadmium in urine: results of its implementation during a five-year epidemiological study.

Quality-control programmes are very important in assessing the reliability of biological analyses. Such programmes are essential if misleading results in epidemiological studies dealing with low levels of exposure to heavy metals present in the general environment (e.g., cadmium, lead) are to be avoided. Internal and external quality-control programmes for the measurement of cadmium and lead in blood and of cadmium in urine were implemented from 1985 to 1989 in support of a national epidemiological study, Cadmibel (2327 participants), conducted in Belgium to assess the effects of environmental exposure to cadmium and lead on the general population. Apart from these programmes, inter-comparisons between the two participating laboratories were carried out on 10% of the samples. The results of these quality-control programmes met external acceptability criteria, emphasizing the analytical proficiency of these measurements at the relatively low concentrations in the Cadmibel study.

Cadmium↗

Quality control and data-handling in multicentre studies: the case of the Multicentre Project for Tuberculosis Research.

BACKGROUND: The Multicentre Project for Tuberculosis Research (MPTR) was a clinical-epidemiological study on tuberculosis carried out in Spain from 1996 to 1998. In total, 96 centres scattered all over the country participated in the project, 19935 "possible cases" of tuberculosis were examined and 10053 finally included. Data-handling and quality control procedures implemented in the MPTR are described. METHODS: The study was divided in three phases: 1) preliminary phase, 2) field work 3) final phase. Quality control procedures during the three phases are described. RESULTS: Preliminary phase: a) organisation of the research team; b) design of epidemiological tools; training of researchers. Field work: a) data collection; b) data computerisation; c) data transmission; d) data cleaning; e) quality control audits; f) confidentiality. Final phase: a) final data cleaning; b) final analysis. CONCLUSION: The undertaking of a multicentre project implies the need to work with a heterogeneous research team and yet at the same time attain a common goal by following a homogeneous methodology. This demands an additional effort on quality control.

Confidentiality↗

Quality control and transfusion reactions.

The relative safety of homologous blood transfusion is in large part due to constant surveillance by blood bankers and clinicians. Quality control of blood supply and transfusion includes collection, documentation, storage, serological testing, administration and follow-up. The provision of serologically compatible blood requires meticulous monitoring of grouping, screening and crossmatching techniques. A hospital transfusion committee should be an integral part of any quality control programme to ensure effective communication between clinical, laboratory and administrative staff.

Blood Grouping and Crossmatching↗

Understanding quality control.

Most of us have trouble defining "quality," but we all know what competency means. Rules, regulations and guidelines have been established to ensure competency among the members of our profession. Quality control is a common, easy way to demonstrate competency. It is not aimed at individuals; it is aimed at processes. Our goal, then, should be to develop QC programs that allow us to demonstrate that we are competent in the operation of our business--the production of consistently acceptable radiographs.

Humans↗

Quality control of the prothrombin time and international normalized ratios. National and international schemes.

The international normalized ratios (INR) system allows valid comparisons in results and quality of performance to be made between users of different thromboplastin reagents. In the international quality control surveys currently over 80% of the 53 countries participating report INR. Stated local international sensitivity index (ISI) values show fair agreement with values calculated from quality control returns obtained with local and reference reagents. The coefficient of variations (CV) of the INR in these surveys are between 11-22% depending upon INR values. In comparison, CV of the UK national scheme are currently 7-13%. However, analysis of UK results has shown high CV with high ISI reagents. This is due to the ISI effect as CV of INR is CV of prothrombin ratio (PR) multiplied by the ISI. Ideal thromboplastins should show good precision of PR and a low ISI to prevent this apparent deterioration when PR results are transformed into the INR scale. Instrumentation has a further effect on the INR result. Unfortunately, the effect is not uniform even within instrument type and model or even between normal and therapeutic results. Local instrument adjustment or local calibration is therefore necessary. Thus, quality control surveys continue to highlight problems in prothrombin time standardization.

Automation↗

Albumin determination with bromocresol purple: imprecision, comparison of methods and quality control.

The bromocresol purple methods for the determination of serum albumin on the Du Pont aca and on the KONE CD show very acceptable linear ranges and imprecision data. Comparison of methods showed good agreement between albumin determinations on the two instruments. Human based quality control materials are required in order to monitor the accuracy of bromocresol purple methods, and to obtain results that are independent of method or instrument. Assigned values in assayed controls and external quality control schemes based on the bromocresol green method are not suitable.

Autoanalysis↗