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Hematologic values of New Zealand white rabbits determined by automated flow cytometry.

Hematologic values of peripheral blood from normal adult New Zealand White rabbits were determined by five different automated flow cytometers in use in a routine clinical hematology laboratory: Technicon H1, Coulter Counter CC540, Coulter Counter VCS, Sysmex NE8000 and Sysmex R1000. The software designed for human blood analysis was used in all instances without adaptation. The total numbers of white blood cells, red blood cells, reticulocytes and platelets were measured with high precision and accuracy. Except for hemoglobin content, concordance was excellent for all measured and calculated values among the different automated flow cytometers. Determining the white blood cell differential count was more complex. Eosinophils and lymphocytes were quantified reliably by all the automated flow cytometers used. However, the results were rejected by Technicon H1 and Sysmex NE8000 in 50% of the cases. Rabbit basophils were recognized with accuracy by Technicon H1 only. The proportion of polymorphonuclear versus mononuclear white cells was identical when measured with Technicon H1 and Coulter Counter VCS. These results show that the new generation of automated flow cytometers designed for human blood can be used with some limitations for animal studies. They allow the standardization of normal values and comparison of results among or between laboratories. They also introduce new parameters, the value of which is as yet undefined.

Animals↗

Autologous bone marrow processing for autotransplantation using an automated cell processor and a semiautomated procedure.

Twenty bone marrow aspirates harvested for autotransplantation from 20 patients suffering from several oncohematological diseases were processed using the automated Du Pont SteriCell processor. In 15 bone marrow harvests, the interface buffy coat cells were collected using the SteriCell processor in manual mode with a semiautomated procedure. The procedure yielded an average red cell removal of 84% and an average mononuclear cell (MNC) recovery of 86%. Cloning efficiencies of hematopoietic progenitor cells (CFU-GM and BFU-e) did not differ between processed and recovered MNCs. Four cryopreserved bone marrow buffy coats were thawed and reinfused into four patients who had undergone high dose chemotherapy. Stable engraftment was observed in all cases. In five bone marrow harvests, the SteriCell automated density gradient MNC isolation procedure was performed after buffy coat collection. The whole two-step procedure allowed an average MNC recovery of 69%. CFU-GM and BFU-e assays did not show a significant difference in cloning efficiency between processed and recovered bone marrow MNCs. We conclude that the SteriCell processor offers rapid, safe and feasible procedures for the semiautomated processing of human bone marrow for transplantation. The clinical efficacy of density gradient separated bone marrow employing the automated step and the opportunity to use fully automated processing must be investigated.

Adult↗

Automated and conventional ABR screening techniques in high-risk infants.

Test validity is determined by the proportion of results that are diagnostically confirmed and predicted on the measures used to identify the disease process. This article summarizes the results of a series of 224 stable high-risk infants who were screened by automated (ALGO-1) and conventional (Bio-logics LT) ABR instrumentation. Failure criteria was defined as the absence or prolongation of a replicable wave V response (conventional) or Refer by the automated system. The overall failure rates at a 35 dB screening level were comparable between devices. Sensitivity and specificity measures for the ALGO-1 unit were 100 and 96 percent, respectively. Permanent hearing loss was demonstrated in 5 percent of the newborns screened in this study. Advantages of the automated system include a dual artifact rejection system, attenuating ear couplers, and a battery operated design. These findings suggest that the automated ABR screener is a viable alternative to conventional ABR instrumentation for the limited purpose of neonatal auditory screening.

Algorithms↗

Evaluation of automated urinary iodine methods: problems of interfering substances identified.

We evaluated automated methods for measurement of urinary iodine (UI) over a range expected in iodine-replete and iodine-deficient populations. Results obtained with Technicon AutoAnalyzer II systems, based on either dialysis or acid digestion, were compared with those obtained by a manual alkaline ashing technique. Results of automated dialysis were consistently higher than those obtained by the other methods. The apparently higher concentrations of UI we measured were due to interfering substances crossing the dialysis membrane and participating in the catalytic reaction. Thiocyanate (SCN) was one endogenous substance contributing to the increased measurement of UI. For urinary SCN concentrations of 5 to 15 mg/L, the amount of overestimation in the UI measurement attributable to SCN ranged from 21.8 to 61 micrograms/L. However, SCN may account for only 40-50% of the apparent increase in UI. In samples with lower UI (less than 50 micrograms/L), interfering substances produced a 100% error in results. We conclude that the automated dialysis system should not be used to assess iodine-deficient populations. This leaves a major dilemma for researchers wanting to assess the iodine status of populations, because the automated digestion method is no longer commercially available.

Adult↗

A novel, fully automated rotometer for the study of turning behavior. Comparison of results under different experimental conditions.

The turning or circling activity of the rat is a very useful experimental model for the study of dopaminergic cerebral pathways. Quantification of turning makes it applicable to follow changes of pattern evolution in the same subject or for comparison between animals under different experimental conditions. Automated quantitative evaluation of turning has the advantage of its reliability, eliminates subjective inaccuracies and allows longer periods of observation. Therefore a fully automated rotometer aimed to accomplish these objectives was developed. It consists of a sensor box to transduce the circling movement of animals into computed information to be processed by a microprocessor and a printer for recording of results. The sensor was designed with a 16 holes perforated disc and two infrared receiver/emitter units. Pulses generated in the sensor box are computed and stored by the microprocessor. Reading of results may be made in manual or automated mode from the display or listed through the printer connected on-line. The reliability and validity of the rotometer were tested in animals submitted to different experimental conditions. Rats with unilateral chemical lesions (6-hydroxy-dopamine or kainic acid) of substantia nigra pars compacta rotated vigorously contraversive to lesion side after apomorphine injection (0.5 and 1 mg/kg, s.c.). Electrolytic lesion of the same nucleus made animals rotate ipsiversive to the lesion after apomorphine. To attain significant level of circling activity, the electrolytic lesion should be placed in the external boundaries of substantia nigra (265.8 +/- 53.4 turns/60 min for group with external placed lesion; (n = 5); 97.3 +/- 19.5 for group with internal placed lesion (n = 3); t = 2.31; p less than 0.05). Unilateral striatal lesion with ibotenic acid made animals rotate ipsilaterally with apomorphine as well as with the selective D-2 agonist bromocriptine (10 and 30 mg/kg, i.p.). Qualiquantitative differences in circling were observed between these two dopaminergic agonists. Comparison of circling activity on semispherical and flat surfaces showed a non significant trend to rotate more intensively on spherical surfaces but only in those animals turning greater than or equal to 3 turns/min. The results obtained with the automated rotometer herein described agree with those currently reported in the literature about the subject. They demonstrate also that this apparatus is adequate and reliable for the study of turning behavior under different experimental conditions. Interestingly enough, our observation on the specificity of electrolytic lesions placed in the lateral boundaries of substantia nigra to induce rotation is worth further investigation.

Animals↗

Automated differential leukocyte counts.

Automated differential counts have the advantage of precision, efficiency, safety, and economy. They could potentially serve effectively in 90 percent of patients with normal counts or in 75 percent of patients with anemia only (64 percent of the total in this study). Even patients with increased white blood cell counts and major population shifts (toward granulocytes or lymphocytes) could be followed with automated differential counts. Such a tactic would decrease turnaround time for results, be less expensive, and reduce exposure of technologists to direct contact with patients' blood. However, presently available instruments fail to detect patients' blood samples with small numbers of abnormal cells, e.g., blasts in early relapse of acute leukemia, atypical lymphocytes in viral diseases such as infectious mononucleosis, eosinophils in allergic or parasitic disease, and band forms in early infectious diseases. Clinical judgment should be used in selectively ordering manual differential counts for these patients. While automated differential counts can be very useful in screening general medical and surgical patients in the ambulatory setting, in referral centers where hematologic abnormalities are more prevalent, the manual differential count and further examination of a smear is particularly necessary at least on initial presentation. Selective manual differential counts may improve efficiency, economy, and safety while not compromising patient care. Further studies of the correlation of clinical disease with automated differential counts are necessary.

Autoanalysis↗

[A complex of automated systems for processing information in an oncologic service].

The increasing amount of medical and executive work of oncologic institutions stimulates the development of automated information systems for evaluation of cancer service performance, its management and planning. A complex of automated information systems was developed and integrated with practice. It is based on the automated system for processing information of a republican cancer service patterned after a population cancer registry. It also incorporates systems for controlling cancer patients follow-up, information retrieval, cancer statistics prognosis, modelling of planning of development and control of cancer service effectiveness and an automated bank of data.

Cancer Care Facilities↗

Recovery of endotoxin from human plasma by acid oxidative treatments as monitored by an automated microtiter plate-chromogenic substrate Limulus amebocyte lysate (LAL) assay method.

Methods to detect endotoxin in human plasma for LAL testing have been developed by use of a perchloric acid (PCA) or a trifluoroacetic acid (TFA) treatment. These acid oxidative treatments eliminate interferences present in plasma. The mode of action of the acids for the elimination of the interferences is indicated to be by their oxidative actions. The treated plasma is assayed by use of an automated microtiter plate-chromogenic substrate LAL assay method employing a modified Cetus Pro/Pette EXPRESS system. The automated system assays 96 samples in approximately 22 minutes. Assay sensitivity of the automated Pro/Pette system is approximately 0.01 endotoxin units (EU) per ml with a linear range from 0.03 to 0.14 EU/ml. The relative standard deviation (RSD) of the assay system is approximately 6%. The improved precision of the LAL assay by the automated system has been attributed to its fast speed (2 minutes) in dispensing the unstable LAL reagent to all 96 samples in one assay block. The total operation, including the acid oxidative treatments and the 96 sample LAL assay, takes approximately 45 minutes. The recovery of spiked endotoxin from plasma ranged from 75 to approximately 100% by adding 0.4 ml of either 0.1-0.2 N PCA or 0.2-0.35 N TFA to 0.2 ml plasma and reacting for 15 minutes at 37 degrees C. The standard deviation of the assay is approximately 0.1 EU/ml plasma. The method has been proven to be rugged, simple, rapid, and cost effective thus would be suitable for clinical application.

Autoanalysis↗

[Automated evaluation of the central hemodynamic status using the RKA 3-01 Radiocardioanalyzer].

The authors presented the results of a clinical use of a new radiocardioanalyzer RKA 3-01 (manufactured in the USSR) providing for automated measurements and computations of indices of the central hemodynamics during studies using a method of dilution of radioactive nuclides. The main technical potentialities of the device designed on the basis of microprocessor technology, were described. The authors also provided the results of automated computation of the circulating blood volume and the main hemodynamic indices in a group of patients. Values of the hemodynamic indices were shown to correspond to actual ones and comparable to control ones and clinical evidence. The comparison of automated processing with a manual method of calculation indicated a significant coincidence of index values. The clinical use of the radiocardioanalyzer RKA 3-01 for automated assessment of the indices of the cardiovascular system was shown to hold promise among various groups of patients.

Heart Function Tests↗

Design and validation of an automated hydrostatic weighing system.

The purpose of this study was to design and evaluate the validity of an automated technique to assess body density using a computerized hydrostatic weighing system. An existing hydrostatic tank was modified and interfaced with a microcomputer equipped with an analog-to-digital converter. Software was designed to input variables, control the collection of data, calculate selected measurements, and provide a summary of the results of each session. Validity of the data obtained utilizing the automated hydrostatic weighing system was estimated by: evaluating the reliability of the transducer/computer interface to measure objects of known underwater weight; comparing the data against a criterion measure; and determining inter-session subject reliability. Values obtained from the automated system were found to be highly correlated with known underwater weights (r = 0.99, SEE = 0.0060 kg). Data concurrently obtained utilizing the automated system and a manual chart recorder were also found to be highly correlated (r = 0.99, SEE = 0.0606 kg). Inter-session subject reliability was determined utilizing data collected on subjects (N = 16) tested on two occasions approximately 24 h apart. Correlations revealed high relationships between measures of underwater weight (r = 0.99, SEE = 0.1399 kg) and body density (r = 0.98, SEE = 0.00244 g X cm-1). Results indicate that a computerized hydrostatic weighing system is a valid and reliable method for determining underwater weight.

Adult↗

Automating the purchasing and inventory control functions.

Factors involved in computerizing the purchasing and inventory control functions in hospital pharmacies are described. When initiating an automated purchasing and inventory control system, a feasibility study should first be conducted to determine the extent of automation needed to develop a cost-effective system. The design of the system will depend on the extent to which the department of materials management is involved with other hospital departments. The advantages and disadvantages of decentralized versus centralized systems are discussed, and criteria for selecting hardware and software vendors are presented. A return-on-investment analysis should be performed to validate the benefits or savings expected from implementing the new automated system. Factors to consider during implementation of the new system and future developments affecting purchasing and inventory control systems, such as bar coding, are discussed. With the current concern about rapidly rising health-care costs and the need to enhance productivity, the development and implementation of automated purchasing and inventory control systems are important strategies for institutions to pursue now.

Computers↗

[Automated and semiautomated perimetry. Comparative trial of 3 devices (Baylor programmer, Friedmann Mark II campimeter, Octopus 2000 R.)].

Modern perimetry involves automated or semi-automated procedures, this computer assisted perimetry (CAP) providing results independent of the examiner, and with marked discrimination of light sensibility through quantification of points tested. A wide variety of CAP devices are available, and a comparative study was conducted in 50 patients using 3 perimetric apparatuses with similar supraliminal static techniques but with variable automated potentials: The Goldman perimeter modified by "Baylor visual fields programmer": static technique for the middle area and kinetic for the peripheral area. The Friedmann Mark II Visual Fields Analyser with a multiple stimulus static technique for the middle area. The Fankhauser Octopus 2000 R perimeter with a precise static technique for middle and peripheral areas. This perimeter, highly automated, also allows statistical evaluation of defects changes, owing to storage of results on magnetic discs. Patients studied had either: glaucoma (25 cases) or neuro-ophthalmologic and retinal disorders (24 cases). Conclusions drawn from the experience acquired by the authors during more than one year of use of the 3 devices were: Rate of detection of defects is excellent with the Octopus and quite good with the Friedmann MKII, but limited in the middle area. The Baylor program does not allow quantification of defects. The image is clear with the Octopus as far as the gray scale is concerned, and more exact as far as the comparative tables are concerned; is not clear with the Friedmann MKII; is typical and clear with the Baylor. The length of examination (which varies with the programs used as far as the Octopus is concerned, and with the patient's reaction time) is usually long with the Octopus and the Friedmann, but short with the Baylor. Time and energy can be gained by the use of the Octopus, since it supplies data obtained from use of the Baylor program associated with that of the Friedmann MKII. The authors prefer to follow up campimetric evolution of glaucomatous patients with the Octopus because it offers more sensibility and precision in quantifying losses. The application of the statistical evaluation delta program on the 2000 R device, which will soon be tested in the Ophthalmological Department, could in an objective way indicate whether there is stabilization or a real progression of glaucomatous defects.

Adenoma↗

Automated flow-cytometric identification of colo-rectal tumour cells by simultaneous DNA, CEA-antibody and cell volume measurements.

A new method for the automated flow-cytometric identification of colo-rectal tumour cells was developed. Fresh tissue is cut mechanically to obtain single cell suspensions. The cells are then incubated with antibodies in an indirect immunofluorescence assay for CEA (carcino-embryonic antigen) on the cell surface, and counterstained with the DNA stain propidium iodide. Monosized latex particles are added as internal standard, then cell volume, antibody fluorescence and DNA are measured simultaneously in a FLUVO-METRICELL flow cytometer. A FORTRAN IV computer program was used to determine whether aneuploid cells or cells with high density of CEA on their surface were present in the sample. All relevant data were stored automatically in a self updating data base, which is important for quality control and automated thresholding. The samples were taken from 120 different patients. A tumour sample and a sample of healthy adjacent mucosa of the same patient were available in 88 patients. 97.5% of all tumours and 88.6% of the normal mucosa samples were correctly identified. This shows for the first time that the majority of colo-rectal tumour samples can be identified by a flow cytometric measurement with automated data evaluation. The identification of tumour samples was substantially better when based on the measurement of the three parameters, compared with identification by aneuploidy (59%) or by the CEA antibody alone (91%). It will be possible to automate the measurement of the samples.

Antibodies↗

[Cytophotometric and automated cytodiagnosis].

The different validity of DNA-cytophotometric parameters to morphometric ones for the automated cytological diagnosis of cancer is discussed and demonstrated for prostatic-, cervical- and lymph-node cytology by own measurements. Nuclear-DNA-cytophotometry used for the automation of cytological diagnosis of malignancy has the following advantages compared to image analysis: 1) DNA-cytophotometry mostly yields more sensitive parameters for the diagnosis of malignancy than image analysis does and thus results in greater diagnostic accuracy. 2) Cytological diagnosis of malignancy may often be possible in earlier stages of the tumor-history with nuclear-DNA-parameters compared to morphological parameters. 3) The prognostic validity of nuclear-DNA-distribution is probably greater than of cytomorphological parameters. 4) The parameters of nuclear-DNA-distribution for cytodiagnosis and grading of malignancy are the same for most of the human tumors in contrast to morphological parameters which are different for histogenetically different tumor. 5) Processing time for the automated diagnostic procedure of the slides will be much shorter if the Feulgen-stain for DNA is used instead of the Papanicolaou-stain for image analysis. One disadvantage of nuclear DNA-measurements as a diagnostic toll is the fact that cytopathologists cannot fully control the diagnostic process and results with their own eyes in Feulgen-stained slides. Meanwhile, however, even in other medical disciplines diagnosis are made by objective measurements of parameters which are not discernible by the human eye. That diagnostic procedure has to be accepted which yields the most accurate and reproducible diagnosis in the shortest time. It is recommended to combine cytomorphological and DNA-cytophotometric parameters as diagnostic tools for automated cytodiagnosis in Feulgen-stained slides.

Autoanalysis↗

[A system of automated radiation treatment of malignant tumors using optimal irradiation programs].

The authors sum up their clinical experience in the implementation of optimized irradiation programs for tumors of different sites (the esophagus, lung, female genital organs, ear-nose-throat, rectum and urinary bladder) with the help of the first serial specimen of the system of automated control over irradiation--Altai-MT. The utilization of the system makes it possible to save time and avoid an error in the implementation of complex irradiation programs as well as to lower the exposure of medical personnel to radiation. Tumors with average and low radiosensitivity, biologically highly active and located in the vicinity of organs and tissues with a low limit of tolerance to ionising radiation were used as clinical models. Automated programs of irradiation meet the requirements of the conformity and homogeneity of a dose field within a focus of lesion, gradient conditions on the border with normal tissues, the minimization of radiation exposure in critical organs. The purpose of the automation of gamma-beam therapy of tumors is to unite within the common system automated information topometric units and a gamma-therapeutic computer controlled device.

Computers↗

Automated sample cleanup for pesticide multiresidue determination. I. Evaluation of solvent partitioning module.

An automated continuous flow procedure is described that improves the cost effectiveness and precision of AOAC methodology for multiresidue pesticide determinations in nonfatty foods. Individual modules capable of performing automated solvent partitioning and automated column chromatography were constructed and integrated into a continuous flow system. Data are presented comparing the recoveries and precision for the determination of 8 pesticides (aldrin, dieldrin, p,p'-DDT, ethion, heptachlor epoxide, lindane, parathion, and ronnel) partitioned from 2 food crops (spinach and tomatoes) by both the manual and automated procedures.

Autoanalysis↗

Shuval automated problem-oriented record: an off-line record for a primary care clinic.

An off-line system for automating the problem-oriented record implemented at Kibbutz Shuval is described. The Shuval problem-oriented record consists of acute and chronic problem lists, a preprinted data base collected by patients and nurses, problem-oriented plan flow sheets, problem-oriented progress notes and a regular record audit. The mean conversion time from a traditional record to a problem-oriented record was 17 min for a child's record and 25 min for an adult's. The automated problem-oriented record consists of three data processing forms that contain almost all data in the record. Transfer of data took, on the average, 10 min (range, 5 to 30 min) for a child's record. The following five types of analysis can be performed with the Shuval automated problem-oriented record: administrative, patient care, epidemiologic, demographic and clinical research. Coupled with the manual problem-oriented record, the Shuval automated record provides many advantages of an on-line problem-oriented record at considerably less cost.

Computers↗

Automated hospital information system functions for dietetics.

Utilization of computer technology in health care is expanding, and managers need information regarding existing automated functions when making decisions relative to system design or acquisition. The Automated Hospital Information System (AHIS) Component Catalog, compiled by the Health Services Research Center/Health Care Technology Center (HSRC/HCTC) at the University of Missouri-Columbia, describes the features of software packages offered by vendors and utilized in hospitals. On the basis of an analysis of the contents of the Catalog relative to automated functions for dietetic departments, charge capturing and diet change notification were the functions used most frequently in hospitals. Although a stores inventory was not included as a component offered by any of the responding vendors, 23 of the hospital systems described in the catalog included a stores inventory component. Menu planning and meal scheduling were functions which were both available from vendors and utilized in hospitals. The nutrient analysis function was implemented in some of the larger hospitals. The information in the Catalog reflects the availability and adoption of automated hospital information system components for dietetic functions.

Dietetics↗