Immunofluorimetric Assay Research Articles

Haplotype Structures and Protein Levels of TGFB1 in HPV Infection and Cervical Lesion: A Case-Control Study.

This study aimed to verify the role of TGFB1 variants (c.-1638G>A, c.-1347C>T, c.29C>T, and c.74G>C) in HPV infection susceptibility and cervical lesions development, and their impact on TGFB1 cervical and plasma levels. TGFB1 genotypes were assessed with PCR-RFLP and haplotypes were inferred for 190 HPV-uninfected and 161 HPV-infected women. TGFB1 levels were determined with immunofluorimetric assay. Case-control analyses were performed with logistic regression adjusted for possible confounders. Women carrying -1347TT or -1347CT+TT as well as those with 29CT, 29CC, or 29CT+CC were more likely to have HPV than -1347CC and 29TT carriers, respectively. Regarding haplotypes, the most frequent were *4 (GCTG) and *3 (GTCG). Women *4/*4 were less likely to have HPV than those with no *4 copy. Comparing the inheritance of *3 and *4, carriers of *3/*4 or *3/*3 were more susceptible to HPV than *4/*4. The TGFB1 plasma and cervical levels were higher in the infected patients. Plasma levels were also higher in infected women with low-grade lesions. HPV-infected patients carrying *3/Other and *3/Other+*3/*3 presented lower TGFB1 plasma levels than those with no copy of *3. TGFB1 variants could contribute to the comprehension of the TGFB1 role in HPV-caused cervical disease.

FOXP3 variants are independently associated with transforming growth factor Β1 plasma levels in female patients with inflammatory bowel disease

ObjectiveThe aim of this study was to evaluate the association of -924 G>A (rs2232365) and -3279 C>A (rs3761548) FOXP3 variants with IBD susceptibility, clinical and endoscopic activity, and IL-10 and TGF-β1 plasma levels. MethodThe study included 110 IBD female patients, 60 with Ulcerative Colitis (UC) and 50 with Crohn's Disease (CD), and 154 female controls. FOXP3 variants were determined with Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). Plasma levels of IL-10 and TGF-β1 were determined using immunofluorimetric assay. ResultsAA genotype of rs2232365 and rs3761548 was associated with CD (OR = 3.147, 95% CI 1.015–9.758, p = 0.047) and UC (OR = 3.221, 95% CI 1.050–9.876, p = 0.041) susceptibility, respectively. However, were not associated with TGF-β1 and IL-10 levels, and endoscopic/clinical activity disease. GAGA haplotype was associated with IBD (OR = 4.003, 95% CI 1.100–14.56, p = 0.035) and UC susceptibility (OR = 6.107, 95% CI 1.609–23.18, p = 0.008). In addition, IBD patients with the GAGA haplotype had lower TGF-β1 levels (p = 0.041). Moreover, G/C haplotype (dominant model) had a protective effect of 60% in CD susceptibility and lower Endoscopic Severity Index. ConclusionsThese results suggest that FOXP3 variants could exert a role in the Treg, which could be one of the factors involved in the susceptibility and pathogenesis of IBD.

TGFB1 +869 T > C (rs1800470) variant is independently associated with susceptibility, laboratory activity, and TGF-β1 in patients with systemic lupus erythematosus

The aim of this study was to evaluate the association of the +869 T > C (rs1800470) and −509 C > T (rs1800469) TGFB1 variants, individually or in haplotypes structure, with susceptibility, autoantibodies, disease activity, and TGF-β1 plasma levels in patients with systemic lupus erythematosus (SLE). The study included 203 patients with SLE and 165 healthy controls. TGFB1 variants were determined by real-time polymerase chain reaction (qPCR). Plasma levels of TGF-β1 were determined using immunofluorimetric assay. The TGFB1 + 869 CC genotype was associated with SLE susceptibility (OR: 1.710, 95%CI: 1.020–2.866, p = 0.042) and with reduction of C4 (p = 0.040) and TGF-β1 levels (p = 0.044). In addition, patients with TGFB1 + 869 TC and CC genotypes and positive anti-dsDNA had lower TGF-β1 levels than those with TT (p = 0.004). TGFB1 −509 TT genotype was associated with reduced levels of C4 (p = 0.032). There was no association between haplotypes and clinical and laboratory parameters. Our data demonstrated that the TGFB1 + 869 T > C variant could be used as a genetic marker for SLE susceptibility and both variants as predictors of laboratory activity. This is the first study to demonstrate that TGF-β1 levels could be modulated by the interaction between TGFB1 + 869 C allele, in homozygosity, or heterozygosity, and the presence of anti-dsDNA.

Haplotypes of FOXP3 genetic variants are associated with susceptibility, autoantibodies, and TGF-\u03b21 in patients with systemic lupus erythematosus

The aim of this study was to evaluate the association of rs2232365 (-924 G > A) and rs3761548 (-3279 C > A) FOXP3 variants with systemic lupus erythematosus (SLE) susceptibility, TGF-β1 plasma levels, autoantibodies, and LN nephritis, and SLE disease activity index (SLEDAI). The study included 196 SLE female patients and 157 female controls. FOXP3 variants were determined with polymerase chain reaction-restriction fragment length polymorphism (PCR–RFLP). Plasma levels of TGF-β1 were determined using immunofluorimetric assay. The AA genotype [OR: 2.650, CI 95%(1.070–6.564), p = 0.035] and A allele [OR: 2.644, CI 95%(1.104–6.333), p = 0.029] were associated with SLE diagnosis in the -3279 C > A. The A/A haplotype was associated with SLE [OR: 3.729, CI 95%(1.006–13.820), p = 0.049]. GCGC haplotype patients had higher TGF-β1 levels (p = 0.012) than other haplotypes. Patients with -924 AA genotype showed higher frequency of anti-dsDNA (p = 0.012) and anti-U1RNP (p = 0.036). The A/C haplotype had higher SLEDAI score [OR: 1.119, CI 95%(1.015–1.234), p = 0.024] and ACAC haplotype higher frequency of anti-dsDNA [OR: 3.026, CI 95%(1.062–8.624), p = 0.038], anti-U1RNP [OR: 5.649, CI 95%(1.199–26.610), p = 0.029] and nephritis [OR: 2.501, CI 95%(1.004–6.229), p = 0.049]. Our data demonstrate that the G/C haplotype provides protection for SLE. While the presence of allele A of both variants could favor autoimmunity, disease activity, and LN.

Wide range detection of C-Reactive protein with a homogeneous immunofluorimetric assay based on cooperative fluorescence quenching assisted by gold nanoparticles

Homogeneous sandwich immunofluorimetric assays are valued for the rapid, low-cost and accurate detection of analytes in liquid phase. However, their exploitation with analytes covering a wide range of concentrations is limited by low sensitivity and the hook effect. Here, we describe a homogeneous immunofluorimetric system based on the quenching of fluorescence in a Förster resonance energy transfer (FRET) donor/acceptor couple of antibody functionalized with two different dyes, respectively fluorescein (donor) and eosin (acceptor), which form a sandwich multi-component assembly with antibody-functionalized gold nanoparticles (GNPs) in the presence of the analyte. The resulting cooperative fluorescence quenching is assisted by the GNPs scaffold through the nanomaterial-surface energy transfer (NSET) effect, which gives an extended linear response versus the antigen concentration that is not possible with the bi-component assays. This immunofluorimetric method allows accurate, reproducible and immediate detection of C-reactive protein (CRP) in the wide concentration range of clinical interest (over two orders of magnitude from 3.5 to 455 nM, 0.4–52 mg/L), without the hook effect. Moreover, the method does not require sample treatment or washing steps. The concept of this multi-component FRET/NSET fluorescence quenching system can be extended to any analyte amenable to the detection with homogeneous sandwich assays.

OR27-01 Combining Clinical and Genetic Approaches in Diagnosing a Large Brazilian Cohort of Patients with 46,XY Differences/Disorders of Sex Development (DSD)

Background: It is recommended a multidisciplinary approach consisted of clinical, hormonal and genetic workups for diagnosing 46,XY DSD. However, no previous study has quantified how useful is this combined approach. Objectives: To retrospectively review the clinical and genetic findings for diagnosing a large cohort of patients with 46,XY DSD from a single Brazilian center. Methods: 247 non-syndromic 46,XY DSD individuals (159 sporadic and 88 familial cases from 39 families) were studied. Clinical and hormonal data were collected from medical files. Testosterone (T), androstenedione (A) were measured by immunoradiometric or immunofluorimetric assays and dihydrotestosterone (DHT) by RIA after celite chromatography or by liquid chromatography tandem mass spectrometry; T/DHT and T/A ratios were calculated. Analysis of sensitivity (SE), specificity (SP) of T/DHT was performed, being the molecular diagnosis considered the gold standard for diagnosing SRD5A2 deficiency. A T/A>0.8 was considered indicative of 17ß-HSDB3 deficiency. The patients were clinically classified into four subgroups: 1) androgen insensitivity syndrome (AIS), 2) gonadal dysgenesis (GD); 3) defects in androgen synthesis (DAS) and 4) DSD of unknown etiology. Molecular studies were performed by Sanger sequencing and/ or massively parallel sequencing (MPS). Results: The median age at first visit was 14 years (range 0.1 to 59 years). The molecular diagnosis was established in 96.5% of the cases with AIS (n=28/29), in 96% of the subjects with DAS (n=46/48), in 36% of the patients with GD (n=21/57) and in 26.7% (n=15/56) with DSD of unknown etiology. The best cut-off for T/DHT in basal state and hCG stimulated was 12.5 (SE=100%; SP=78.57%) and 24 (SE=87.5%; SP=95.7%) respectively. A T/A<0.8 was observed in 13/16 (81%) of the patients with molecular diagnosis of 17ß-HSDB3 deficiency and also in 1/49 patients with other diagnose. Classification according to the phenotype matched with the genetic diagnosis in most cases. The molecular evaluation allowed that 16% (9/56) of the patients that were classified as DSD of unknow etiology had a definitive diagnosis, including six GD cases, two individuals with SRD5A2 deficiency and one with 17ß-HSDB3 deficiency. A clear AIS phenotype of five patients allowed us to consider and prove the pathogenicity of two synonymous and one promoter region variants as the cause of AIS. The combination of clinical and molecular diagnosis led to an increase in 8% the diagnosis in a total of 116 index-cases (58.5%) with a molecular diagnosis. Conclusion: Considering the phenotype heterogeneity, pitfalls of the hormonal assessment and number of genes involved, it is reasonable to consider MPS as a first test for diagnosing patients with 46,XY DSD. However, the combination of clinical and molecular diagnosis is more accurate than either strategies alone in diagnosing 46,XY DSD.

The rs3761548 FOXP3 variant is associated with multiple sclerosis and transforming growth factor β1 levels in female patients.

The aim of this study was to evaluate the association between rs3761548 FOXP3 (-3279 C > A) variant and multiple sclerosis (MS), disability, disability progression, as well as transforming growth factor (TGF)-β1 and interleukin (IL)-10 plasma levels in MS patients. The study included 170 MS patients and 182 controls. Disability was evaluated using Expanded Disability Status Scale (EDSS) and categorized as mild (EDSS ≤ 3) and moderate/high (EDSS > 3). Disability progression was evaluated using Multiple Sclerosis Severity Score (MSSS). The rs3761548 variant was determined with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Plasma levels of TGF-β1 and IL-10 were determined using immunofluorimetric assay. CA and AA genotypes were associated with MS [odds ratio (OR) 2.03, 95% confidence interval (CI) 1.66-3.53, p = 0.012; OR 8.19, 95% CI 3.04-22.07, p < 0.001, respectively). With the dominant model, the CA + AA genotypes were associated with MS (OR 2.57, 95% CI 1.50-4.37, p < 0.001). In the recessive model, the AA genotype was also associated with MS (OR 5.38, 95% CI 2.12-13.64, p < 0.001). After adjustment by age, ethnicity, BMI and smoking, all these results remained significant, as well as female patients carrying the CA + AA genotypes showed higher TGF-β1 than those carrying the CC genotype (OR 1.35, 95% CI 1.001-1.054, p = 0.043). No association was observed between the genotypes and disability, disability progression and IL-10 levels. These results suggest that the A allele of FOXP3 -3279 C > A variant may exert a role in the T regulatory cell function, which could be one of the factors involved in the susceptibility for MS in females.

Canine C-Reactive Protein Measurements in Cerebrospinal Fluid by a Time-Resolved Immunofluorimetric Assay

In the current study, the quantification of C-reactive protein (CRP) in cerebrospinal fluid (CSF) of dogs using an adapted time-resolved immunofluorimetric assay (TR-IFMA) was investigated, as well as whether the assay could be used to detect the range of CRP concentrations found in different clinical situations. Intra- and interassay coefficients of variation were below 15% in all cases. The TR-IFMA measured the CRP values in a proportional and linear manner (r = 0.99); also CRP concentrations measured in CSF and in serum were significantly correlated (r = 0.80, P = 0.003). The limit of detection of the method was 7.1 × 10(-6) mg/l. The assay was able to detect differences in CRP concentrations in CSF of dogs with inflammatory disorders compared with dogs with spinal cord compression or idiopathic epilepsy. In conclusion, TR-IFMA constitutes a very sensitive, precise, and accurate method for the measurement of CRP concentrations in CSF.

Parity Is Not Related to Autoimmune Thyroid Disease in a Population-Based Study of Japanese-Brazilians

It has been suggested that the female preponderance for autoimmune thyroid disease might be associated with hormonal differences, abortion, and fetal microchimerism. Findings emerging from the few epidemiological studies on this matter, however, are controversial. In this study, we investigated the hypothesis whether parity, abortion, and the use of estrogens are associated with a higher risk for thyroid autoimmunity. This cross-sectional population-based study examined 675 women from a Japanese-Brazilian population aged above 30 years. Thyroid peroxidase antibodies (TPOAbs), thyroglobulin antibodies (TgAbs), thyrotropin, and free T₄ were measured by immunofluorimetric assays. Urinary iodine concentration was measured using a colorimetric method. Data were analyzed in logistical regression models to obtain the odds ratio (OR) and 95% confidence intervals. TPOAbs and TgAbs were present in 11.6% and 13.6% of women, respectively. After adjustment for age, smoking, and urinary iodine concentration, the OR for positive TPOAb (OR, 1.22 [95% confidence interval, 0.73–2.02]) and for positive TgAb (OR, 1.01 [0.63–1.62]) among women who had one or more parities did not differ from those who had never given birth. In addition, we found no association between the presence of thyroid antibodies and previous abortions or the use of estrogens. Parity, abortion, and the use of estrogens are not associated with thyroid autoimmunity in this population. These findings reinforce previous reports that advocated against a key role of fetal microchimerism in the pathogenesis of autoimmune thyroid disease.

Validation and Application of an Immunofluorimetric Assay for Detection of Serum Free Triiodothyronine and Free Thyroxine Concentrations in Buffalo (Bubalus Bubalis) under Various Physiological Conditions

The current study was designed to validate an immunofluorimetric method to measure free triiodothyronine (fT3) and free thyroxine (fT4) concentrations in the serum of buffalo and to develop a better understanding of thyroid metabolism in buffalo (Bubalus bubalis) of different ages and reproductive statuses. Free triiodothyronine and fT4 were determined in sera from 4 groups of 10 animals, each representing 5-10-year-old lactating buffalo, 2-3-year-old first calf heifers, 1-1.5-year-old virgin heifers, and 5-10-year-old dry buffalo. The average sensitivity of the immunofluorimetric assay was 5.9 pmol/l for fT3 and 14.7 pmol/l for fT4. Intra-assay and interassay coefficients of variation were 5.6% and 5.1% for fT3 and 1.5% and 4.3% for fT4, respectively. Virgin heifers had higher average values for fT3 and fT4, while lactating buffalo had the lowest average values. Dry buffalo and first calf heifers had intermediate fT3 and fT4 values. The findings of this study suggested that lactating buffalo were in a state of low thyroid activity, while virgin heifers had increased thyroid activity.

Unreliability of classic provocative tests for the diagnosis of growth hormone deficiency

In this study we investigated 9 prepubertal children with blunted GH response to classic pharmacological stimuli in contrast with normal auxological evaluation. The children were followed to evaluate their growth velocity for a longer period before starting replacement GH therapy. To evaluate the pituitary reserve a supraphysiologic stimulus such as GHRH plus arginine was used. Serum GH levels were measured by a time-resolved immunofluorimetric assay before and after 1 microg/kg body weight iv injection of GHRH, while serum PRL, IGF-I, and insulin were evaluated only in basal conditions using an automatic immunometric assay. Out of 9 studied subjects, 7 underwent GHRH plus arginine administration and showed a normal GH response; the parents of the remaining 2 children refused the test. Normal serum levels of PRL, IGF-I, insulin, and a normal insulin sensitivity were observed in all children. After 1 yr, the growth rate in each patient was further improved and reached almost normal values. Our results further confirm that the decision to start replacement GH therapy should be based on both auxological parameters and laboratory findings. The GHRH plus arginine test appears to be useful to identify false GH deficiency in children showing a blunted GH response to classic stimuli in contrast with normal growth rate.

The insulin tolerance test (ITT) is a reproducible test for assessment of growth hormone (GH) and cortisol secretion in hypopituitary patients

The Insulin Tolerance Test (ITT) is the gold-standard for assessment of GH and ACTH reserve. GH and cortisol responses of <9mU/l and <500nmol/l respectivly have been defined as evidence of deficiency. Using these criteria we studied the reproducibility of the ITT in patients with pituitary surgery±radiotherapy. Two ITTs were performed within 7 days in 15 patients (7 men, age 22–51, 6 patients with GHD and 5 patients with cortisol deficiency). Serum GH and cortisol were measured by immunoradiometric and immunofluorimetric assay, respectivly. The CV of the assay for cortisol and GH was 5.8% and 5.9%. All patients achieved a hypoglycemia <2.2mmol/l and were symptomatic. In our series the median GH response was 13.2±18.1 mU/l with a range of 0–84.3 mU/l. The mean difference in the peak GH response between two tests was 3.6±1.3ng/ml. In 3/15 cases GH all values were undetectable on both occasions. In 2/12 cases the detected values were within 1 CV of the assay, in 3/12 cases within 2 CVs of the assay and in 7/12 cases the observed value was ≥ than 2 CVs of the assay. There was 1 case of clinical importance where the observed values around 9ng/ml was discordant in terms of defining GHD and could have led to misclassification and different therapeutic decision. The median cortisol response was 544±210 nmol/l with a range of 262–1012 nmol/l. The mean difference in the peak cortisol response was 84.8±21.3 nmol/l. In 4/15 cases the detected values were within one CV of the assay and in 5/15 cases within 2 CVs of the assay. In 6/15 cases the observed difference was bigger than explicable by 2 CVs of the assay. 5/15 cases showed conflicting values in relation to the cut off point of 500 nmol/l and were discordant in terms of defining cortisol deficiency. In our series of patients with pituitary disease conflicting GH and cortisol results during ITT were observed in 7% and 30% of patients, respectively. This shows a good reproducibility for the GH response. There was only a low number of cases of misclassification by the arbitrary definition of GH and cortisol deficiency.

Endogenous hyperinsulinemic hypoglycemia: Diagnostic strategies, predictive features of malignancy and long-term survival

Diagnostic strategies, malignancy predictors and long-term survival were retrospectively evaluated in patients with hyperinsulinemic hypoglycemia (64 insulinomas). Lower median glycemia was 30 (range 20-53) mg/dl [1.6 (1.1-2.9) mmol/l] with concurrent insulin of 48 (13.2-217) microU/ml and 15 (2-46) microU/ml measured by radioimmunoassay (RIA) and immunofluorimetric assay (IFMA), respectively. All patients with insulinomas had a positive prolonged fast within 48 h. Sensitivity of localization methods was: ultrasonography (US) 23%, computed tomography (CT) 28%, magnetic resonance imaging (MRI) 65%, endoscopic US 75%, arteriography 38%, portal venous sampling 67%, selective arterial calcium stimulation 67%, intraoperative US 94% and palpation 92%. Nine patients (14%) had malignant insulinomas. Age at diagnosis (mean+/-SD, 53.8+/-19 vs 39.4+/-16.3 yr; p=0.03), insulin (1372+/-730 vs 785+/-659% (percentage of the method's diagnostic cut-off; 6 and 3 microU/ml for RIA and IFMA, respectively; p=0.007) and C-peptide levels (9.8+/-2.9 vs 3.9+/-2.8 ng/ml (3.2+/-0.9 vs 1.3+/-0.9 nmol/l; p=0.006), and tumor size (6.2+/-4.1 vs 1.5+/-0.6 cm; p=0.0002) were increased in malignant insulinomas. C-peptide level above 6.1 ng/ml (2.0 nmol/l) had a 100% sensitivity and 96% specificity, and tumor size above 2.6 cm yielded a sensitivity of 88% and specificity of 100% in predicting malignancy. Survival of patients with malignant insulinomas was significantly impaired (16 vs 100% at 5 yr; p=0.0000001). The diagnosis of insulinoma can be made within 48 h of fasting. The association between intraoperative US and palpation evidenced the tumor in 95% of the patients. C-peptide and tumor size were reliable malignancy predictors.

Response to Long-Term Growth Hormone Therapy in Short Children with Reduced GH Bioactivity

Background/Aims: The aim of the present study was to investigate whether short children with normal growth hormone (GH) immunoreactivity, but reduced bioactivity (bioinactive GH) could benefit from rhGH treatment as GH deficient (GHD) patients. Methods: We evaluated 12 pre-pubertal children (8 M, 4 F), with GH deficiency-like phenotype showing normal serum GH peak levels (>10 ng/ml), measured by immunofluorimetric assay (IFMA-GH), in contrast with a reduced GH bioactivity (bio-GH), evaluated using the Nb₂ cells. We also evaluated 15 age-matched GHD pre-pubertal children (11 M, 4 F) with serum GH peak <5 ng/ml. Both groups were treated with rhGH therapy at the dose of 0.23 mg/kg/week s.c. Results: Serum bio-GH/IFMA-GH ratio at peak time for each patient during the provocative test was significantly lower in bioinactive GH than in GHD children (0.29 vs. 2.05, p = 0.00001). Recombinant human GH therapy induced a significant (p < 0.001) increase in growth rate in both groups during the first 2 years. In the third year of treatment, while growth rate in GHD children is maintained, in bioinactive GH patients it decreases remaining, however higher compared to the pre-treatment one. Conclusions:Short rhGH therapy given to selected bioinactive GH children improve growth rate and might result in greater final adult height.

Specific immunofluorimetric assay detecting the chemotactic epitope of the urokinase receptor (uPAR)

The urokinase plasminogen activator receptor (uPAR) fragments D1 and D2D3 are often found in biological fluids from normal individuals and patients of cancer and other diseases. The D2D3 fragment may possess chemotactic activity depending on its N-terminal sequence. We have developed a sensitive and specific immunoassay for the chemotactic form of D2D3 and show that its level can be measured with high specificity and sensitivity in human serum and urine. Synthetic peptides (residues 84–92) derived from the linker region between domains 1 and 2 of uPAR were used as immunogens to generate mouse monoclonal antibodies. Recombinant soluble uPAR (D1D2D3 1–277) was used to immunize rabbits to obtain polyclonal antibodies. A sandwich-type immunofluorimetric assay was developed with these antibodies. The assay specifically measures D2D3 containing the 84–88 residues, has a detection limit of 0.25 ng/ml and shows no cross-reactivity with D2D3 93–274. The assay is linear at 0–30 ng/ml, with an intra-assay CV of 10% ( n = 20), inter-assay CV of 15% ( n = 9) and a recovery of D2D3 84–274 added to urine samples of between 94% and 105%. A statistically significant difference level of D2D3 84–274 was found in two groups of tumor patients versus healthy volunteers ( p ≤ 0.009 in colorectal carcinomas and p ≤ 0.036 in prostatic carcinomas). For the first time, monoclonal antibodies, detecting the chemotactic form of uPAR, D2D3 84–274, have been produced. The immunofluorimetric assay will quantitate uPAR chemotactic fragments in biological samples, including serum and urine, and evaluate their diagnostic or prognostic potential in clinical studies.

Midazolam in the reduction of surgical stress: A randomized clinical trial

The objective of this study was to assess the role of midazolam in reducing surgical stress as measured using subjective and objective variables. The study was a double-blind randomized controlled trial. Thirty-eight male patients undergoing surgical removal of third molars under general anesthesia were recruited for this study, each patient was given premedication (midazolam or placebo) and subjective variables (HAD scale) were obtained and objective variables (salivary cortisol samples and vital signs) were collected pre-, peri-, and postoperatively. The salivary samples were analyzed by direct immunofluorimetric assay using the "DELFIA" system. There were no significant differences in anxiety between the treatment group and the control group before the administration of the premedication. Following the administration of premedication, the majority of the control group showed high cortisol levels on the day of surgery, compared with relatively low cortisol levels in the majority of the treatment group. A few patients in the control group gave a placebo effect (sedative effect) and a number of the treatment group were unresponsive to the drug. There was a slight drop in the blood pressure and respiration rate with a slight increase in the heart rate in the treatment group; however these results were not statistically significant. The HAD scores were not statistically different between the 2 groups. Midazolam has proved to be very successful in reducing anxiety and stress pre-, peri-, and postoperatively with no significant effect on the vital signs of a healthy patient. Salivary cortisol technique is an easy, noninvasive method to assess anxiety and stress level in patients undergoing surgery.

Early identification of acute myocardial infarction by activated protein C–protein C inhibitor complex

Introduction Increased coagulation activity due to coronary thrombosis in a ruptured plaque should result in activation of the protein C anticoagulant system with formation of complexes between activated protein C (APC) and the protein C inhibitor (PCI), which reflects coagulation activity. We hypothesized that elevated APC-PCI concentration might allow earlier detection of ongoing myocardial infarction than traditional biochemical markers. We have evaluated a newly devised immunofluorimetric assay for measuring plasma concentration of APC-PCI complexes among patients with suspected acute coronary syndrome. Materials and methods Blood samples were taken from 340 patients (median 71 years, range 31–97) with suspected acute coronary syndrome at first presentation in the emergency department. Electrocardiogram was recorded and APC-PCI, Troponin I and Creatine kinase-MB concentrations were repeatedly measured 3 times at 6 h interval. Results The 74 patients who were eventually diagnosed with myocardial infarction had a higher median level of APC-PCI complex than those without myocardial damage; 0.27 vs. 0.20 μg/L ( p = 0.001). In a multivariate regression model, APC-PCI level in the fourth quartile (> 0.32 μg/L) independently predicted myocardial infarction with an odds ratio of 3.7 (95% CI 1.4–9.6, p < 0.01). Conclusion Early APC-PCI elevation can be detected among patients with a normal first Troponin I and non-ST-elevation myocardial infarction and provides additional risk assessment in acute coronary syndrome.

Serum leptin concentration during puberty in healthy nonobese adolescents.

Data obtained during the past five years have indicated that there are important age- and gender-based differences in the regulation and action of leptin in humans. To study the physiological changes of leptin during puberty in both sexes, and its relationship with body composition and sexual maturation, we measured leptin concentrations in 175 healthy adolescents (80 girls, 95 boys, 10-18 years of age), representing all pubertal stages. We excluded individuals with a body mass index (BMI) below the 5th or above the 95th percentile relative to age. Serum concentrations of leptin were determined by a monoclonal antibody-based immunofluorimetric assay, developed in our laboratory. Body composition was determined by dual-energy X-ray absorptiometry. Pubertal stage was assigned by physical examination, according to Tanner criteria for breast development in females and genital development in males. Leptin concentration in girls (N = 80) presented a positive linear correlation with age (r = 0.35, P = 0.0012), BMI (r = 0.65, P < 0.0001) and %fat mass (r = 0.76, P < 0.0001). In boys (N = 95) there was a positive correlation with BMI (r = 0.49, P < 0.0001) and %fat mass (r = 0.85, P < 0.0001), but a significant negative linear correlation with Tanner stage (r = -0.45, P < 0.0001) and age (r = -0.40, P < 0.0001). The regression equation revealed that %fat mass and BMI are the best parameters to be used to estimate leptin levels in both sexes. Thus, the normal reference ranges for circulating leptin during adolescence should be constructed according to BMI or %fat mass to assure a correct evaluation.

Usefulness of a rapid immunometric assay for intraoperative parathyroid hormone measurements.

Intraoperative parathyroid hormone (IO-PTH) measurements have been proposed to improve operative success rates in primary, secondary and tertiary hyperparathyroidism (PHP, SHP and THP). Thirty-one patients requiring parathyroidectomy were evaluated retrospectively from June 2000 to January 2002. Sixteen had PHP, 7 SHP and 8 THP. Serum samples were taken at times 0 (before resection), 10, 20 and 30 min after resection of each abnormal parathyroid gland. Samples from 28 patients were frozen at -70 C for subsequent tests, whereas samples from three patients were tested while surgery was being performed. IO-PTH was measured using the Elecsys immunochemiluminometric assay (Roche, Mannheim, Germany). The time necessary to perform the assay was 9 min. All samples had a second measurement taken by a conventional immunofluorimetric method. We considered as cured patients who presented normocalcemia in PHP and THP, and normal levels of PTH in SHP one month after surgery and who remained in this condition throughout the follow-up of 1 to 20 months. When rapid PTH assay was compared with a routine immunofluorimetric assay, excellent correlation was observed (r = 0.959, P < 0.0001). IO-PTH measurement showed a rapid average decline of 78.8% in PTH 10 min after adenoma resection in PHP and all patients were cured. SHP patients had an average IO-PTH decrease of 89% 30 min after total parathyroidectomy and cure was observed in 85.7%. THP showed an average IO-PTH decrease of 91.9%, and cure was obtained in 87.5% of patients. IO-PTH can be a useful tool that might improve the rate of successful treatment of PHP, SHP and THP.

Increased sensitivity of heterogeneous fluoroimmunoassays employing fluorescein-labeled antibodies by simple treatment of the wells with glycerin solution

Here we present a simple and rapid procedure that enhances and stabilizes the fluorescence signal determined directly onto the solid phase and increases the sensitivity of heterogeneous fluoroimmunoassays which employ fluorescein as label. The evaluation of the proposed procedure was performed through a heterogeneous immunofluorimetric assay for mouse γ-globulins in white-opaque microtitration wells. The proposed fluorescence enhancement and stabilization method consists of a 3-min treatment of the wells with a glycerin solution, after completion of the assay, followed by a 15-min incubation of the emptied wells at 37 °C. Following this protocol, an approximately 50% increase of the fluorescence signal was achieved compared with the signal determined without treatment of the wells (control assay). In addition, the proposed protocol resulted in considerable stabilization of the fluorescence signal. The assay sensitivity achieved following this protocol was improved by twofold compared to the control assay, whereas the precision and the dynamic range of the assay were unaffected.