Volume 41, Issue 2

Zusammenfassung: Die Nierentransplantation stellt die Therapie der Wahl für eine bedeutende Zahl an Patienten mit terminaler Niereninsuffizienz dar. Dabei kommt der Prophylaxe, Diagnostik und Therapie von Infektionen eine besondere Bedeutung zu. Neben den bekannten nosokomial und ambulant erworbenen Infektionen bei hospitalisierten Patienten finden sich darüber hinaus im Kollektiv der Immunsupprimierten eine ganze Reihe opportunistischer und seltener Erreger, deren Kenntnis für eine optimierte und gezielte Behandlung erforderlich ist. Da das immunsuppressive Regime entsprechend der Phasen nach der Transplantation angepasst und reduziert wird und darüber hinaus erst mit einer gewissen Verzögerung latente Erkrankungen reaktiviert werden, kann in definierten Zeitintervallen nach der Transplantation mit dem Vorkommen bestimmter Infektionen gerechnet werden. Der vorliegende Übersichtsartikel soll dabei helfen, die häufigen und einige der seltenen Erkrankungen in dem breiten mikrobiologischen Spektrum der infektiologischen Transplantationsnachsorge zu erkennen und die Diagnostik und Therapie zu strukturieren.

Abstract: Quantitative steroid analysis via liquid chromatography-tandem mass spectrometry (LC-MS/MS) is applicable to clinical routine diagnostics by now, substituting immunoassays due to its superior selectivity and comparable sensitivity. Multiplexed assays covering a multitude of analytes represent the gold standard in this regard. There are commercially available kits which are easily adapted to individual LC-MS/MS systems required. Prior to and even after their appearance, in-house method development represented the flexible alternative in terms of solving specific analytical problems or focusing on a narrower steroid profile while maximizing sensitivity and high throughput applicability. In this work, commercial assays and in-house methods are discussed in relation to a benchmark LC-MS/MS method. Thereby, prerequisites and results are compared. Furthermore, the effect of concomitant medication on steroid assays was tested and requirements regarding quality assurance in routine steroid analysis are discussed. Most of the different commercially available or in-house LC-MS/MS methods for steroid analysis show a good or reasonable agreement of results. However, the harmonization in the methodology of mass spectrometric assays has to be improved to further reduce their variability. Such a procedure would facilitate the performance of diagnostic tests that involve the measurement of steroid hormones by the tremendous improvement of diagnostic sensitivity and specificity.

Zusammenfassung: Im Rahmen des Anbieterwechsels erfolgte im Zentrum für Diagnostik am Klinikum Chemnitz eine umfassende Validation des STA R Max ® der Firma Stago. Neben der Ermittlung von Intra- und Interassay – Präzisionen wurden umfassende Vergleichsmessungen mit der bisherigen Routinemethode (BCS XP von Siemens) mit gepoolten Patientenplasmen durchgeführt. In dieser Publikation werden die Ergebnisse für Parameter der Basis – und Notfallversorgung vorgestellt. Die Ergebnisse waren gut bis sehr gut und ließen eine zügige Umstellung zu. Darüber hinaus wurden Anwenderfreundlichkeit von System und Reagenzien, die durchschnittliche Bearbeitungszeit sowie die allgemeine Störanfälligkeit des neuen Systems getestet. Nach verschiedenen Anpassungen im diagnostischen Prozess erfolgte die Überführung der neuen Geräte in die Routine.

Background: Recurrent pregnancy loss (RPL) is a heterogeneous condition consisting of two or more consecutive abortions occurring before 20 weeks of gestation. One of the clotting factor genes encodes factor XIII ( FXIII ), which is involved in fibrin formation. The most common polymorphism in the FXIII genes is the conversion of G to T in exon 2 (val34leu) of the FXIIIA gene, which leads to the substitution of valine with leucine. The objective of this study was to investigate the association between RPL and FXIII val34leu polymorphisms in a sample population of Iranian Azeri women. Methods: A prospective case-control study was performed on a cohort of 310 RPL patients and 290 healthy controls. DNA was extracted from the whole blood and fragments of the Val34Leu polymorphism were amplified by polymerase chain reaction (PCR), followed by DNA sequencing. Genotyping was performed using the Sequenom MassArray system. Results: The genotype frequencies of FXIII in the case group were 60.64% GG, 34.83% GT, and 4.41% TT, whereas the frequencies in the control group were 58.96% GG, 36.5% GT, and 4.48% TT. T allele frequencies in the case and control groups were 78.06% and 21.93%, respectively, and G allele frequencies were 77.24% and 22.75%, respectively. Conclusions: No significant association was observed between the Val34Leu polymorphism and RPL among Iranian Azeri women.

Abstract: The rapid increase to digitalize whatever is possible in human lives will lead to electronic storage of medical data probably during the whole life of most individuals. This requires standardization and condensation of an enormous amount of data. Most laboratory data are already reported in digitalized form, but they are far from being sufficiently standardized. Several attempts for standardization have been suggested. The most common standardizing approach is the z-transformation of laboratory data. It is proposed to modify the z-value to a quantity quotient in analogy to the intelligence quotient well known even to laymen.

Background: The aim was to study the regional variability in the request of the ten most frequently ordered laboratory tests in primary care in Spain. Methods: Spain is divided into autonomous communities (AACC), first level health care divisions. Every AACC is divided into health departments (HDs). A laboratory attends the needs of every HD inhabitant. Laboratories from different HDs participated in the study. They reported the request of the ten most commonly requested laboratory tests in primary care during the year 2014 according to prior evidence: alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol, creatinine, γ-glutamyl transpeptidase (GGT), glucose, HDL-cholesterol, triglycerides, uric acid and urinalysis. Test-utilization rates were calculated as tests per 1000 inhabitants. Laboratories were grouped in the different AACC and the results for each region were compared using the coefficient of quartile dispersion (CQD), calculated using the first (Q1) and third (Q3) quartiles for each data set, as follows: (Q3−Q1)/(Q3+Q1). Results: One hundred and ten laboratories participated, corresponding to 27,798,262 inhabitants (59.8% Spanish population) from 15 AACC. 82,710,869 tests were requested. AST, GGT and uric acid showed the greatest variation. Conclusions: There were significant regional differences in how the most common laboratory tests were ordered in Spain.

Background: Atherosclerosis (AS) is a vascular disease which causes cardiovascular diseases such as stroke, heart attack and acute coronary syndrome. It is a major cause of death worldwide, especially in developed countries. In AS, the artery walls become thickened due to the accumulation and invasion of white blood cells (foam cells) and form a fibro-fatty plaque. Hence, these investigations aim to identify the potential applications of herbal compounds targeting the AMPK signalling pathway for AS therapy. Methods: In this investigation, in vitro kinase activity was determined for a set of herbal compounds present in herbal plants and herbal medicines against 5′ AMP-activated protein kinase (AMPK). This enzyme plays a vital role in AS, having an effect on the invasion and accumulation of white blood cells, leading to the thickening of artery walls and vascular remodelling. In addition, a molecular docking simulation study was carried out for the AMPK enzyme (PDB ID: 3AQV) against the herbal compounds. Results: The in vitro kinase activity showed that 10 of the herbal compounds possessed IC 50 values lower than 10 μM, which showed the potent inhibitory effect of the AMPK enzyme. In addition, a molecular docking simulation carried out on the AMPK enzyme (PDB ID: 3AQV) against the herbal compounds observed a positive correlation with IC 50 values and docking scores of the docked compounds with an IC 50 <10 μM. The subsequent protein-ligand interaction analyses for the best docking hits showed favourable interactions. Also, the molecular dynamics simulation enabled the generation of a trajectory file for the RMSD backbone, illustrating the stability of the docked protein-ligand complex without any structural fluctuations. Conclusions: The study concludes that baicalin, curcumin, campesterol, emodin and gingerol provide a promising lead for AS and can therefore be prescribed for the treatment of AS.