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PubMed2006

Fifty years of development in the endocrinology laboratory.

The hormone assay laboratory has seen incredible changes over the last 50 years. In this historical review, we describe how the evolution of fundamental concepts in endocrinology and in hormone assay technology have faceted the laboratory as we know it today. The discovery of neurohormones, hormone receptors and the evolution of the concept of free hormones had a very significant impact on our understanding of the mechanisms of hormone action in health and disease and therefore on how physicians currently prescribe endocrine tests. In the analytical field, modern hormone assays rapidly replaced crude colorimetric methods and bioassays. Starting with the pioneering work of Yalow and Berson, hormone assays have gradually evolved through improvements in all aspects of assay design. This is best exemplified by the evolution of thyroid and parathyroid hormone assays. After reviewing some of the limitations of actual hormone immunoassays, we present some reflections on what the future of the hormone laboratory may look like considering all the developments in automation, point-of-care testing, molecular biology and array technologies.

Automation↗
PubMed1997

Telerobotic surgery: applications on human patients and training with virtual reality.

This paper deals with the developed researches and applications on telerobotic surgery, devoted to human patients and with training by virtual reality. The researches have been developed in cooperation between Telerobotics Laboratory, Department of Mechanics, Politecnico di Milano, Italy, and Automation and Control Section, Jet Propulsion Laboratory, Pasadena, USA. The researches carried to a telesurgery robotic operation on a dummy on 7th July 1993, by means of satellites communications, to a prostatic biopsy on a human patient on 1st September 1995 with optical fibers, to results on time delay effects, to results on virtual reality applications for training on laparoscopy and surgery. The search implied time delay when the control input originated in Politecnico di Milano, Italy. The results were satisfactory, but also pointed out the need for specific new control transformations to ease the operator's or surgeon's visual/mental workload for hand-eye coordination. In the same research, dummy force commands from JPL to Milan were sent, and were echoed immediately back to JPL, measuring the round-trip time of the command signal. This, to some degree, simulates a contact force feedback situation. The results were very surprising; despite the fact that the ISDN calls are closed and "private" calls, the round-trip time exhibited great variations not only between calls but also within the same call. The results proved that telerobotics and telecontrol may be applied to surgery. Time latency variations are caused by features of communication network, of sending and receiving end computer software. The problem and its solution is also an architectural issue, and considerable improvements are possible. Virtual reality in the application of the research is a strong support to training on virtual objects and not on living beings.

General Surgery↗
PubMed1994

Blood smear examination.

Despite recent advances in the automation of clinical hematology laboratories, a careful microscopic examination of an appropriately prepared and stained blood smear continues to maintain its status as the most informative and useful diagnostic procedure, and offers a simple, reliable means of verifying results generated by automated analyzers. A systematic approach to a comprehensive evaluation of blood cells and related findings is described.

Blood Cell Count↗
PubMed2005

Maintenance of the ENFSI proficiency test program on identification of GSR by SEM/EDX (GSR2003).

Within the framework of the ENFSI Expert Working Group "Firearms," every second year, a proficiency test on the detection and identification of GSR by SEM/EDX is carried out. This proficiency test is a development and extension of the previous proficiency test GSR2001. The test material was again designed by the organization panel and manufactured by an external company for SEM accessories. This time the participating laboratories were requested to determine the total number of PbSbBa containing particles on a test sample following their own laboratory specific methods of automated GSR particle search and detection by SEM/EDX. One synthetic particle sample (SPS) with artificial GSR particles was dispatched to all participants. This paper summarizes the results of the study and assesses the overall performance of the participating laboratories. Furthermore an extended statistical evaluation and a comparison with previous studies was carried out.

Journal Article↗
PubMed2006

Preanalytical variability: the dark side of the moon in laboratory testing.

Remarkable advances in instrument technology, automation and computer science have greatly simplified many aspects of previously tedious tasks in laboratory diagnostics, creating a greater volume of routine work, and significantly improving the quality of results of laboratory testing. Following the development and successful implementation of high-quality analytical standards, analytical errors are no longer the main factor influencing the reliability and clinical utilization of laboratory diagnostics. Therefore, additional sources of variation in the entire laboratory testing process should become the focus for further and necessary quality improvements. Errors occurring within the extra-analytical phases are still the prevailing source of concern. Accordingly, lack of standardized procedures for sample collection, including patient preparation, specimen acquisition, handling and storage, account for up to 93% of the errors currently encountered within the entire diagnostic process. The profound awareness that complete elimination of laboratory testing errors is unrealistic, especially those relating to extra-analytical phases that are harder to control, highlights the importance of good laboratory practice and compliance with the new accreditation standards, which encompass the adoption of suitable strategies for error prevention, tracking and reduction, including process redesign, the use of extra-analytical specifications and improved communication among caregivers.

Clinical Laboratory Techniques↗
PubMedDate not supplied

The role of technology in the clinical laboratory of the future.

Advances in automation and informatics will drive the implementation of new technology as we enter the 21st century. Five technologies which will have the greatest impact on the practice of laboratory medicine during the next decade include molecular diagnostics, near patient testing, image analysis, robotics, and information management. The list of molecular pathology tests with potential clinical utility expands daily. Some, such as tests for human immune deficiency virus (HIV) and hepatitis C virus, already are available as commercial kits. Quality assessment and proficiency testing programs still are evolving. DNA tests in oncology, such as T- and B-cell gene rearrangements and t(9;22) translocation, have proven useful in detecting small numbers of tumor cells and have demonstrated clinical utility in some circumstances. Tests for monogenetic diseases, such as sickle cell disease, are useful in planning antenatal management of mothers at risk. Screening tests for the genetic predisposition for certain forms of colon and breast cancer and Alzheimer's Disease are now possible. This suggests the potential for large scale screening of populations at risk. Continued improvements in biosensor technology and miniaturization will increase the ability to test for many analytes at or near the patient. The generally increased cost per test must be reconciled with the potential to decrease the overall cost of care by improved turnaround time. Computerized image analysis will radically change, and in some cases eliminate, manual clinical microscopy in urinalysis, hematology, immunohistochemistry, and cytology. Robotics will greatly decrease personnel requirements for repetitive tasks, such as specimen transport, processing, and aliquoting. We will process many specimens from start to finish without human intervention. Image management systems will allow archiving of diagnostic gross and microscopic images along with the traditional text descriptions and diagnosis. Telepathology will link smaller centers with expert consultants in tertiary centers. Voice recognition systems will obviate the need for transcriptionists. Modern database architectures will allow the clinical laboratory to measure performance effectiveness and clinical outcomes and will place laboratorians at the forefront of outcomes research. Hand-held devices will allow physicians to conveniently order laboratory tests and retrieve results, further decreasing the functional turnaround time for laboratory testing. All of these technologies will be expensive to implement, but well-planned deployment will both decrease cost and improve the quality of medical care.

Autoanalysis↗
PubMed2000

[Pursuit of economic efficiency in the hospital laboratory--full automatic re-test system of clinical chemistry, hematology, immunology and cost control system].

Further business improvement is requested due to finance-based fluctuation and the influence of the revision in the medical treatment law. Therefore, new laboratories are needed. To achieving this in our hospital, economic efficiency is being pursued. The first issue is the use of space, the second issue is labor-saving. The third issue is the simplification of business procedures. There is individual quality control by the zonal verification method that we developed, as well as the quality control of the batch method using controlled substances. The four issue is cost control. By controlling the delivery and use of reagents and materials including the term of validity control, we made an effort to abolition defective stock. The fifth issue is correspondence to circulation style society. The disposal of laboratory garbage is a major issue. We controlled garbage that occurs unnecessarily. Furthermore, we are improving the demand for reagents that exceeds the specification and use reagent containers.

Automation↗
PubMed2003

Laboratory diagnosis of von Willebrand disorder. Current practice in the southern hemisphere.

A survey of 44 laboratories was conducted to evaluate current testing proficiency in the diagnosis of von Willebrand disorder (vWD) and to assess recent changes in test practices. Laboratories performed their usual panel of tests for vWD and interpreted results for the likelihood of vWD and potential subtype. Samples were as follows: normal plasma; borderline normal or abnormal levels of von Willebrand factor (vWF) and factor VIII; type 3 vWD; type 2A vWD; and 2 samples from a healthy person, processed after handling at 22 degrees C and 4 degrees C, respectively. Interassay and within-method coefficients of variation were similar for all assays (approximately 15%-25%). Most laboratories reported test values consistent with expected findings and made correct interpretations, although discrepant results for 5% to 10% of responses are of concern. For the sample stored at 4 degrees C, all laboratories detected low or borderline levels of vWF and factor VIII coagulant, and no laboratory identified this sample as from a healthy person. In contrast, for the sample stored at 22 degrees C, most laboratories reported normal results. Compared with previous results, performance of some assays has declined while that of others has increased. Laboratories generally are proficient in tests for vWD, and transport of samples at 4 degrees C before processing may lead to false identification of vWD, suggesting that NCCLS guidelines should be reviewed.

Antigens↗
PubMed2006

Performance characteristics of two immunoassays for the measurement of urinary luteinizing hormone.

Urine luteinizing hormone (LH) concentration is routinely measured in all anti-doping laboratories to exclude recombinant LH abuse and to test any potential alteration of the hypophyseal-gonadal axis. Before establishing proper reference values among professional top level athletes, an extended validation of two commercial immunoassays for LH measurements was performed. Elecsys 1010 and Access are two automated immunoanalyzers for central laboratories. The limit of detection, the limit of quantification, intra-laboratory, inter-technique correlation, precision, accuracy were determined. Furthermore, reference urinary LH distribution values for male and female top level athletes were determined. Stability studies of LH in urine following freezing and thawing cycles (n=3) as well as storage conditions at room temperature, 4 degrees C and -20 degrees C were performed. Male and female subjects showed important urinary corrected (specific gravity correction) LH distribution differences. Intra-assay precision for the Access analyzer was less than 8.0% whereas inter-assay was close to 11%. Intra and inter-assay precision for the Elecsys 1010 analyzer was slightly better. A good inter-technique correlation was obtained ([Elecsys 1010]=1.0434[Access]+1.146, R=0.953). No urinary LH loss was observed after two freezing and thawing cycles. On the other hand, time and bad storage conditions such as elevated temperature can deteriorate rapidly urinary LH. In conclusion, both analyzers showed acceptable performances and are suitable for screening anti-doping analyses. Each anti-doping laboratory has to settle its own reference distribution values and then determine when to launch a confirmation procedure. This takes place then depending on the positivity criteria the anti-doping laboratory has established and validated. This study also clearly showed that the time delay between the urine collection and the analysis should be reduced as much as possible and urine samples should be transported in optimal conditions (low temperature and quickly) to decrease urinary LH deterioration.

Adult↗
PubMed1996

Sample preparation with an automated robotic workstation for organic acid analysis by gas chromatography-mass spectrometry.

We attempted to automate sample preparation for analysis of organic acids by gas chromatography-mass spectrometry using a computer-controlled, automated robotic workstation that is integrated and connected to the gas chromatography-mass spectrometry (HP-5890/5971) system. Of the two methods developed, one employed solvent extraction, while the other utilized a silica, solid-phase extraction cartridge. Both automated methods were compared to a manual, solvent extraction procedure used routinely in our laboratory. Normal, spiked urine, and urine from patients with a variety of metabolic abnormalities were analyzed. The robotic workstation did not meet all our requirements for a rapid, reliable, laboratory device. Recoveries with the automated procedures were less than with the manual method, and some organic acids important in the diagnosis of inborn errors of metabolism were not detected. Additionally, the robotic device had mechanical and design problems that made it slower and less reliable than the manual procedure.

Automation↗
PubMed1997

Prognostic value of MIB-1 in advanced ovarian carcinoma as determined using automated immunohistochemistry and quantitative image analysis.

BACKGROUND AND OBJECTIVES: The monoclonal antibody MIB-1 is an immunohistochemical marker reacting most strongly with cells in late S phase, G2, and M portions of the cell cycle. This antibody, reactive in formalin-fixed, paraffin-embedded tissue, allows the quantitation of a proliferation index (PI) in both current clinical cases and archival material using a computerized image analyzer (CIA). METHODS: Since many laboratories make use of automated immunohistochemistry (AIH), this study was performed to explore the technical feasibility of using AIH (Ventana ES 320) in combination with CIA (CAS 200) to evaluate MIB-1 PI as a prognostic marker as assessed by overall survival in 50 archival (formalin-fixed, paraffin-embedded), advanced stage primary ovarian carcinomas. RESULTS: Exploratory methods confirmed that 15% was a cutpoint that could dichotomize these 50 patients into two prognostic groups based on overall survival. The median survival of patients whose carcinoma had a high MIB-1 expression (> or = 15%) was 16 months compared with 30 months in the patients whose tumors demonstrated low MIB-1 expression (< 15%, P = 0.01). After adjustment for age, MIB-1 retained its prognostic significance (P = 0.02). Patients 60 years and older had shorter survival than younger patients (P = 0.06), but these two groups did not differ with respect to PI (P = 0.76). Those patients with a negative second look laparotomy had a longer median survival of 70 months compared with 18.5 months in patients with a positive second look (P < 0.001); the median PIs were 17% and 27%, respectively (P = 0.36). There were no significant relationships between clinical stage, nuclear grade, DNA ploidy, p53, and either survival or PI. CONCLUSIONS: In this study, we concluded that the combination of AIH and CIA yielded a reliable quantitation of MIB-1 proliferative index and that this proliferative marker had prognostic significance in late stage ovarian carcinoma. Further studies in a larger group of patients are needed to confirm the relationship between proliferation index and other known clinicopathologic and genetic variables.

Antibodies, Monoclonal↗
PubMed1983

[Automation of immunohematologic testing activities at French blood transfusion centers].

In May 1982, a questionnaire was sent to all of the 170 French Blood Transfusion Services (BTS), on behalf of the French Society of Blood Transfusion. The purpose was to determine the types of automated equipment used for immunohematological controls, the way in which they are used and the result of automation and computerization in daily laboratory operations. We received 135 replies (80%). A generalized conclusion can be drawn from the collected information. 50% of the respondents are neither automated nor computerized. 30% are both automated and computerized. 10% are automated but not computerized and 8% are not automated but are computerized. In the field of automated serology there is an increased tendency to complete the ABO/Rh testing by Cc D Ee and Kell phenotyping. The use of computers allows the current test determination to be compared with previous donation data. However, no fully automated equipment, which can conduct antibody screening, exists, cost effectively, in small or average BTS. In France, there has been a significant increase in automation between 1970 and 1980 but only the most important BTS have carried out automation at the same time as computerization. The smaller BTS have usually become automated without becoming computerized. In 1978, Codabar was first used. This has been one of the principal advances of the last 10 years, allowing all the users of automation to start moving towards complete computerization. This advance was assisted by the use of prepackaged software. This questionnaire also determined that the current emphasis is now to computerize administrative and management activities before laboratory activities. This survey has been conducted during a turning point of the automation of French BTS. It shows that they are, on the whole, satisfied with their automation. As far as the safety and the efficiency of the service are concerned, it is only fair to consider that the main purposes of the automation have been achieved. But in terms of cost, and serological accuracy for antibody screening, a new generation of automated equipment should appear to satisfy the users in the nineties.

ABO Blood-Group System↗
PubMed1993

Automated determination of cross-linked fibrin derivatives in plasma.

Automated assays for the measurement of cross-linked fibrin derivatives in plasma (XL-FbDP) have been developed utilizing latex beads coated with anti-D dimer monoclonal antibody (DD-3B6/22) for both the Cobas Fara Chemistry Centrifugal and the Cobas Mira analysers (Roche, Basle, Switzerland). The analysers were programmed to mix plasma and latex reagent simultaneously and analyse absorbance changes over a 10-15 min period. Results were interpolated by the analyser from a standard curve derived from a polymer of D-dimer. Both assays had high precision (< 5% CV) for values between 100 and 1000 ng/ml and provided clear discrimination between normal samples and samples from patients suffering from the thrombotic diseases, DVT/PE and DIC. The results obtained for XL-FbDP determination with both methods compared well with established methods: a high correlation was obtained with a semi-quantitative manual latex method for both the Fara (r = 0.92) and Mira (r = 0.83) and correlations (r) of 0.81 (Fara) and 0.84 (Mira) were obtained with an enzyme immunoassay (EIA). Correlation between the two automated procedures was high (r = 0.96). The automated method will enable laboratories to provide a rapid and accurate quantitation of XL-FbDP.

Antibodies, Monoclonal↗
PubMed1998

Automated analysis of mitochondrial enzymes in cultured skin fibroblasts.

We report automated methods for assaying the activities of the mitochondrial respiratory chain enzyme cytochrome c oxidase (COX), the matrix enzyme citrate synthase (CS), and the cytoplasmic enzyme lactate dehydrogenase (LDH) on a random access analyzer, the Roche Mira S. COX activity was assayed by measuring the initial rate of oxidation of reduced cytochrome c. The CS assay was based on the reaction of this enzyme with oxaloacetate and acetyl-CoA to produce CoASH, which further reacts with dithionitrobenzoic acid producing a free thionitrobenzoate ion. LDH activity was assayed by measuring the reduction of nicotinamide adenine dinucleotide during the oxidation of lactate to pyruvate. Precision of the COX assay was 2. 3%, CS assay 0.7%, and LDH 5.6%. These automated methods were faster by as much as 80%, cheaper by 50%, and used less than half the sample material needed for traditional manual methods. While these assays are often performed by specialized laboratories using dedicated staff, the automated methods presented here are easily performed by staff trained in the regular diagnostic laboratory.

Automation↗