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Tim Cao Z, Rej R, Vesper H, Rex Astles J. Accuracy-based proficiency testing for estradiol measurements. Clin Biochem 2024; 124:110700. [PMID: 38043696 DOI: 10.1016/j.clinbiochem.2023.110700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/26/2023] [Accepted: 11/30/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Accuracy of estradiol measurements is important but conventional proficiency testing (PT) cannot assess accuracy when possibly non-commutable samples are used and method peer-group means are the targets. Accuracy-based assessment of estradiol measurements is needed. DESIGN AND METHODS Five serum samples were prepared from single donors, frozen, and distributed overnight to 76 New York State Department of Health (NYSDOH)-certified laboratories. Participants analyzed samples for estradiol. The biases of group means were assessed against the Centers for Disease Control and Prevention (CDC)-defined targets, evaluated using the Hormone Standardization Program (HoSt) E2 performance criterion of ±12.5 %. Each laboratory's performance was evaluated using total allowable error (acceptance limits) of target ±25 % or ±15 pg/mL (55 pmol/L) (whichever was greater, NYSDOH), target ±30 % (Clinical Laboratory Improvement Amendments [CLIA]), and target ±26 % (minimal limit based on biological variation [BV]). RESULTS The biases (range) were 34 % (-17 % to 175 %), 40 % (-33 % to 386 %), 16 % (-45 % to 193 %), 5 % (-27 % to 117 %), and -4% (-31 % to 21 %), for samples at estradiol of 24.1, 28.4, 61.7, 94.1, and 127 pg/mL, or 89, 104, 227, 345, and 466 pmol/L, respectively. Large positive method/analytical systematic biases were revealed for 9 commonly used method/analytical systems in the United States at low estradiol concentrations. Of the 9 analytical systems, 0, 0, 3, 7 and 6 met the HoSt criterion for the samples with estradiol at the five respective concentrations. PT evaluation showed that 59 %, 69 % and 87 % of laboratories would receive a PT event passing (satisfactory) score when the CDC-defined target and a criterion of NYSDOH, CLIA or BV was used, respectively. However, >95 % laboratories would obtain PT passing score if method peer-group means were used as targets regardless of the criterion used. CONCLUSIONS Improvement in accuracy of estradiol measurements is needed, particularly at low estradiol concentrations. Accuracy-based PT provides unambiguous information about the accuracy of methods/analytical systems.
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Affiliation(s)
- Zhimin Tim Cao
- Wadsworth Center, New York State Department of Health, Albany, NY, United States; Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Robert Rej
- Wadsworth Center, New York State Department of Health, Albany, NY, United States; Department of Biomedical Sciences, School of Public Health, University at Albany, State University of New York, Albany, NY, United States
| | - Hubert Vesper
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - J Rex Astles
- Centers for Disease Control and Prevention, Atlanta, GA, United States.
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2
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Sandberg S, Fauskanger P, Johansen JV, Keller T, Budd J, Greenberg N, Rej R, Panteghini M, Delatour V, Ceriotti F, Deprez L, Camara JE, MacKenzie F, Lyle AN, van der Hagen E, Burns C, Greg Miller W. Recommendations for Setting a Criterion and Assessing Commutability of Sample Materials Used in External Quality Assessment/Proficiency Testing Schemes. Clin Chem 2023; 69:1227-1237. [PMID: 37725906 DOI: 10.1093/clinchem/hvad135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023]
Abstract
It is important for external quality assessment materials (EQAMs) to be commutable with clinical samples; i.e., they should behave like clinical samples when measured using end-user clinical laboratory in vitro diagnostic medical devices (IVD-MDs). Using commutable EQAMs makes it possible to evaluate metrological traceability and/or equivalence of results between IVD-MDs. The criterion for assessing commutability of an EQAM between 2 IVD-MDs is that its result should be within the prediction interval limits based on the statistical distribution of the clinical sample results from the 2 IVD-MDs being compared. The width of the prediction interval is, among other things, dependent on the analytical performance characteristics of the IVD-MDs. A presupposition for using this criterion is that the differences in nonselectivity between the 2 IVD-MDs being compared are acceptable. An acceptable difference in nonselectivity should be small relative to the analytical performance specifications used in the external quality assessment scheme. The acceptable difference in nonselectivity is used to modify the prediction interval criterion for commutability assessment. The present report provides recommendations on how to establish a criterion for acceptable commutability for EQAMS, establish the difference in nonselectivity that can be accepted between IVD-MDs, and perform a commutability assessment. The report also contains examples for performing a commutability assessment of EQAMs.
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Affiliation(s)
- Sverre Sandberg
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- Norwegian Porphyria Centre, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Pernille Fauskanger
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | | | | | - Jeffrey Budd
- Jeff Budd Consulting, St. Paul, MN, United States
| | - Neil Greenberg
- Neil Greenberg Consulting, LLC, Rochester, NY, United States
| | - Robert Rej
- Department of Biomedical Sciences, School of Public Health, State University of New York at Albany, Albany, NY, United States
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine, University of Milan, Milan, Italy
| | | | | | - Liesbet Deprez
- European Commission, Joint Research Centre, Directorate F, Geel, Belgium
| | - Johanna E Camara
- National Institute of Standards and Technology, Gaithersburg, MD, United States
| | - Finlay MacKenzie
- Birmingham Quality/UK NEQAS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Alicia N Lyle
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Chris Burns
- National Institute for Biological Standards and Control, A Centre of the MHRA, Hertfordshire, United Kingdom
| | - W Greg Miller
- Virginia Commonwealth University, Richmond, VA, United States
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3
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Miller WG, Keller T, Budd J, Johansen JV, Panteghini M, Greenberg N, Delatour V, Ceriotti F, Deprez L, Rej R, Camara JE, MacKenzie F, Lyle AN, van der Hagen E, Burns C, Fauskanger P, Sandberg S. Recommendations for Setting a Criterion for Assessing Commutability of Secondary Calibrator Certified Reference Materials. Clin Chem 2023; 69:966-975. [PMID: 37566391 DOI: 10.1093/clinchem/hvad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023]
Abstract
A secondary higher-order calibrator is required to be commutable with clinical samples to be suitable for use in the calibration hierarchy of an end-user clinical laboratory in vitro diagnostic medical device (IVD-MD). Commutability is a property of a reference material that means results for a reference material and for clinical samples have the same numeric relationship, within specified limits, across the measurement procedures for which the reference material is intended to be used. Procedures for assessing commutability have been described in the literature. This report provides recommendations for establishing a quantitative criterion to assess the commutability of a certified reference material (CRM). The criterion is the maximum allowable noncommutability bias (MANCB) that allows a CRM to be used as a calibrator in a calibration hierarchy for an IVD-MD without exceeding the maximum allowable combined standard uncertainty for a clinical sample result (umaxCS). Consequently, the MANCB is derived as a fraction of the umaxCS for the measurand. The suitability of an MANCB for practical use in a commutability assessment is determined by estimating the number of measurements of clinical samples and CRMs required based on the precision performance and nonselectivity for the measurand of the measurement procedures in the assessment. Guidance is also provided for evaluating indeterminate commutability conclusions and how to report results of a commutability assessment.
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Affiliation(s)
- W Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, United States
| | | | - Jeffrey Budd
- Jeff Budd Consulting, St. Paul, MN, United States
| | | | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine, University of Milan, Milan, Italy
| | - Neil Greenberg
- Neil Greenberg Consulting, LLC, Rochester, NY, United States
| | | | | | - Liesbet Deprez
- European Commission, Joint Research Centre, Directorate F, Geel, Belgium
| | - Robert Rej
- Department of Biomedical Sciences, School of Public Health, University at Albany, State University of New York, Albany, NY, United States
| | - Johanna E Camara
- National Institute of Standards and Technology, Gaithersburg, MD, United States
| | - Finlay MacKenzie
- Birmingham Quality/UK NEQAS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Alicia N Lyle
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Chris Burns
- National Institute for Biological Standards and Control, A Centre of the MHRA, Hertfordshire, United Kingdom
| | - Pernille Fauskanger
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- Norwegian Porphyria Centre, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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4
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Hsu WH, Zheng Y, Savadatti SS, Liu M, Lewis-Michl EL, Aldous KM, Parsons PJ, Kannan K, Rej R, Wang W, Palmer CD, Wattigney WA, Irvin-Barnwell E, Hwang SA. Biomonitoring of exposure to Great Lakes contaminants among licensed anglers and Burmese refugees in Western New York: Toxic metals and persistent organic pollutants, 2010-2015. Int J Hyg Environ Health 2022; 240:113918. [PMID: 35016143 DOI: 10.1016/j.ijheh.2022.113918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/31/2021] [Accepted: 01/02/2022] [Indexed: 12/20/2022]
Abstract
Between 2010 and 2015, the New York State Department of Health (NYSDOH) conducted a biomonitoring program to gather exposure data on Great Lakes contaminants among licensed anglers and Burmese refugees living in western New York who ate locally caught fish. Four hundred and nine adult licensed anglers and 206 adult Burmese refugees participated in this program. Participants provided blood and urine samples and completed a detailed questionnaire. Herein, we present blood metal levels (cadmium, lead, and total mercury) and serum persistent organic pollutant concentrations [polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), dichlorodiphenyldichloroethylene (DDE), and trans-nonachlor]. Multiple linear regression was applied to investigate the associations between analyte concentrations and indicators of fish consumption (locally caught fish meals, store-bought fish meals, and consuming fish/shellfish in the past week). Licensed anglers consumed a median of 16 locally caught fish meals and 22 store-bought fish meals while Burmese refugees consumed a median of 106 locally caught fish meals and 104 store-bought fish/shellfish meals in the past year. Compared to the general U.S. adult population, licensed anglers had higher blood lead and mercury levels; and Burmese refuges had higher blood cadmium, lead, and mercury, and higher serum DDE levels. Eating more locally caught fish was associated with higher blood lead, blood mercury, and serum ∑PCBs concentrations among licensed anglers. Licensed anglers and Burmese refugees who reported fish/shellfish consumption in the past week had elevated blood mercury levels compared with those who reported no consumption. Among licensed anglers, eating more store-bought fish meals was also associated with higher blood mercury levels. As part of the program, NYSDOH staff provided fish advisory outreach and education to all participants on ways to reduce their exposures, make healthier choices of fish to eat, and waters to fish from. Overall, our findings on exposure levels and fish consumption provide information to support the development and implementation of exposure reduction public health actions.
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Affiliation(s)
- Wan-Hsiang Hsu
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, 12237, USA; Department of Health Policy, Management and Behavior, School of Public Health, The University at Albany, State University of New York, Albany, NY, 12144, USA.
| | - Yue Zheng
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, 12237, USA
| | - Sanghamitra S Savadatti
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, 12237, USA; Department of Epidemiology and Biostatistics, School of Public Health, The University at Albany, State University of New York, Albany, NY, 12144, USA
| | - Ming Liu
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, 12237, USA
| | - Elizabeth L Lewis-Michl
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, 12237, USA
| | - Kenneth M Aldous
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA; Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, Albany, NY, 12144, USA
| | - Patrick J Parsons
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA; Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, Albany, NY, 12144, USA
| | - Kurunthachalam Kannan
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA; Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, Albany, NY, 12144, USA
| | - Robert Rej
- Division of Translational Medicine, Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA; Department of Biomedical Sciences, School of Public Health, The University at Albany, State University of New York, Albany, NY, 12144, USA
| | - Wei Wang
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA
| | - Christopher D Palmer
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA; Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, Albany, NY, 12144, USA
| | - Wendy A Wattigney
- Office of Community Health and Hazard Assessment, Agency for Toxic Substances and Disease Registry, Atlanta, GA, 30341, USA
| | - Elizabeth Irvin-Barnwell
- Office of Community Health and Hazard Assessment, Agency for Toxic Substances and Disease Registry, Atlanta, GA, 30341, USA
| | - Syni-An Hwang
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, 12237, USA; Department of Epidemiology and Biostatistics, School of Public Health, The University at Albany, State University of New York, Albany, NY, 12144, USA
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5
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Miller WG, Budd J, Greenberg N, Weykamp C, Althaus H, Schimmel H, Panteghini M, Delatour V, Ceriotti F, Keller T, Hawkins D, Burns C, Rej R, Camara JE, MacKenzie F, van der Hagen E, Vesper H. IFCC Working Group Recommendations for Correction of Bias Caused by Noncommutability of a Certified Reference Material Used in the Calibration Hierarchy of an End-User Measurement Procedure. Clin Chem 2021; 66:769-778. [PMID: 32335671 DOI: 10.1093/clinchem/hvaa048] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/06/2020] [Indexed: 11/14/2022]
Abstract
Establishing metrological traceability to an assigned value of a matrix-based certified reference material (CRM) that has been validated to be commutable among available end-user measurement procedures (MPs) is central to producing equivalent results for the measurand in clinical samples (CSs) irrespective of the clinical laboratory MPs used. When a CRM is not commutable with CSs, the bias due to noncommutability will be propagated to the CS results causing incorrect metrological traceability to the CRM and nonequivalent CS results among different MPs. In a commutability assessment, a conclusion that a CRM is commutable or noncommutable for use with a specific MP is made when the difference in bias between the CRM and CSs meets or does not meet a criterion for that specific MP when compared to other MPs. A conclusion regarding commutability or noncommutability requires that the magnitude of the difference in bias observed in the commutability assessment remains unchanged over time. This conclusion requires the CRM to be stable and no substantive changes in the MPs. These conditions should be periodically reverified. If an available CRM is determined to be noncommutable for a specific MP, that CRM can be used in the calibration hierarchy for that MP when an appropriately validated MP-specific correction for the noncommutability bias is included. We describe with examples how a MP-specific correction and its uncertainty can be developed and applied in a calibration hierarchy to achieve metrological traceability of results for CSs to the CRM's assigned value.
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Affiliation(s)
| | | | | | - Cas Weykamp
- Queen Beatrix Hospital, Winterswijk, the Netherlands
| | - Harald Althaus
- Siemens Healthcare Diagnostics Products GmbH, Marburg, Germany
| | - Heinz Schimmel
- European Commission, Joint Research Centre, Directorate F, Geel, Belgium
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Vincent Delatour
- Laboratoire national de métrologie et d'essais (LNE), Paris, France
| | | | | | - Douglas Hawkins
- School of Statistics, University of Minnesota, Minneapolis, MN
| | - Chris Burns
- National Institute for Biological Standards and Control, A Centre of the MHRA, Hertfordshire, UK
| | - Robert Rej
- Wadsworth Center for Laboratories and Research, New York State Department of Health, and School of Public Health State University of New York at Albany, Albany, NY
| | - Johanna E Camara
- National Institute of Standards and Technology, Gaithersburg, MD
| | - Finlay MacKenzie
- Birmingham Quality/UK NEQAS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Hubert Vesper
- Centers for Disease Control and Prevention, Atlanta, GA
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6
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Savadatti SS, Liu M, Caglayan C, Reuther J, Lewis-Michl EL, Aldous KM, Parsons PJ, Kannan K, Rej R, Wang W, Palmer CD, Steuerwald AJ, Wattigney WA, Irvin-Barnwell E, Hwang SA. Biomonitoring of populations in Western New York at risk for exposure to Great Lakes contaminants. Environ Res 2019; 179:108690. [PMID: 31491725 PMCID: PMC6842667 DOI: 10.1016/j.envres.2019.108690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 05/31/2023]
Abstract
The New York State Department of Health conducted the Healthy Fishing Communities Program in collaboration with the Agency for Toxic Substances and Disease Registry to assess human exposure to contaminants common to Lake Ontario, Lake Erie and surrounding rivers and waterways among populations in western New York State who eat locally caught fish. The program enrolled licensed anglers and Burmese refugees and immigrants, living near four designated Great Lakes Areas of Concern: Buffalo River, Niagara River, Eighteenmile Creek, and the Rochester Embayment. These target populations were sampled and enrolled independently into the program between February and October of 2013. A core set of contaminants were measured in blood and urine of 409 licensed anglers and 206 Burmese refugees and immigrants which included lead, cadmium, mercury, PCBs, PBDEs, organochlorine pesticides (hexachlorobenzene, mirex, DDT, DDE, and chlordane and its metabolites oxychlordane and trans-Nonachlor), and PFOS and PFOA. Biomonitoring results showed that both groups had higher geometric means for blood lead, total blood mercury, and serum PFOS compared to the 2013-2014 NHANES reference levels. The Burmese refugee group also showed higher geometric means for creatinine-adjusted urine mercury and lipid-adjusted serum DDE compared to national levels. Licensed angler participants reported eating a median of 16 locally caught fish meals in the past year. Burmese participants consumed local fish throughout the year, and most frequently in the summer (median 39 fish meals or 3 times a week). The study results provide valuable information on populations at high risk of exposure to contaminants in the Great Lakes Basin of western New York. The results provide the foundation for developing and implementing public health actions to reduce potential exposures to Great Lakes pollutants.
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Affiliation(s)
- Sanghamitra S Savadatti
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY 12237, USA; Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Albany, NY 12144, USA.
| | - Ming Liu
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY 12237, USA
| | - Cihan Caglayan
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY 12237, USA
| | - Julie Reuther
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY 12237, USA
| | - Elizabeth L Lewis-Michl
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY 12237, USA
| | - Kenneth M Aldous
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, Albany, NY 12144, USA
| | - Patrick J Parsons
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, Albany, NY 12144, USA
| | - Kurunthachalam Kannan
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, Albany, NY 12144, USA
| | - Robert Rej
- Division of Translational Medicine, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; Department of Biomedical Sciences, School of Public Health, The University at Albany, State University of New York, Albany, NY 12144, USA
| | - Wei Wang
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA
| | - Christopher D Palmer
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, Albany, NY 12144, USA
| | - Amy J Steuerwald
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA
| | - Wendy A Wattigney
- Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry, Atlanta, GA 30341, USA
| | - Elizabeth Irvin-Barnwell
- Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry, Atlanta, GA 30341, USA
| | - Syni-An Hwang
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY 12237, USA; Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Albany, NY 12144, USA
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7
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Affiliation(s)
- R Rej
- Department of Chemistry, McGill University, Montreal, PQ H3A 2A7, Canada
| | - M Jaseja
- Department of Chemistry, McGill University, Montreal, PQ H3A 2A7, Canada
| | - A S Perlin
- Department of Chemistry, McGill University, Montreal, PQ H3A 2A7, Canada
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8
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Miller WG, Schimmel H, Rej R, Greenberg N, Ceriotti F, Burns C, Budd JR, Weykamp C, Delatour V, Nilsson G, MacKenzie F, Panteghini M, Keller T, Camara JE, Zegers I, Vesper HW. IFCC Working Group Recommendations for Assessing Commutability Part 1: General Experimental Design. Clin Chem 2018; 64:447-454. [PMID: 29348163 DOI: 10.1373/clinchem.2017.277525] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 12/14/2017] [Indexed: 11/06/2022]
Abstract
Commutability is a property of a reference material (RM) that relates to the closeness of agreement between results for an RM and results for clinical samples (CSs) when measured by ≥2 measurement procedures (MPs). Commutability of RMs used in a calibration traceability scheme is an essential property for them to be fit for purpose. Similarly, commutability of trueness controls or external quality assessment samples is essential when those materials are used to assess trueness of results for CSs. This report is part 1 of a 3-part series describing how to assess commutability of RMs. Part 1 defines commutability and addresses critical components of the experimental design for commutability assessment, including selection of individual CSs, use of pooled CSs, qualification of MPs for inclusion, establishing criteria for the determination that an RM is commutable, generalization of commutability conclusions to future measurements made with the MPs included in the assessment, and information regarding commutability to be included in the certificate for an RM. Parts 2 and 3 in the series present 2 different statistical approaches to commutability assessment that use fixed criteria related to the medical decisions that will be made using the laboratory test results.
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Affiliation(s)
- W Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, VA;
| | - Heinz Schimmel
- European Commission, Joint Research Centre (JRC), Directorate F, Geel, Belgium
| | - Robert Rej
- Wadsworth Center for Laboratories and Research, New York State Department of Health, and School of Public Health, State University of New York at Albany, Albany, NY
| | | | | | - Chris Burns
- National Institute for Biological Standards and Control, A Centre of the MHRA, Hertfordshire, UK
| | | | - Cas Weykamp
- Queen Beatrix Hospital, Winterswijk, the Netherlands
| | - Vincent Delatour
- Laboratoire national de métrologie et d'essais (LNE), Paris, France
| | | | - Finlay MacKenzie
- Birmingham Quality/UK NEQAS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | | | - Johanna E Camara
- National Institute of Standards and Technology, Gaithersburg, MD
| | - Ingrid Zegers
- European Commission, Joint Research Centre (JRC), Directorate F, Geel, Belgium
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9
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Nilsson G, Budd JR, Greenberg N, Delatour V, Rej R, Panteghini M, Ceriotti F, Schimmel H, Weykamp C, Keller T, Camara JE, Burns C, Vesper HW, MacKenzie F, Miller WG. IFCC Working Group Recommendations for Assessing Commutability Part 2: Using the Difference in Bias between a Reference Material and Clinical Samples. Clin Chem 2018; 64:455-464. [PMID: 29348165 DOI: 10.1373/clinchem.2017.277541] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 12/15/2017] [Indexed: 11/06/2022]
Abstract
A process is described to assess the commutability of a reference material (RM) intended for use as a calibrator, trueness control, or external quality assessment sample based on the difference in bias between an RM and clinical samples (CSs) measured using 2 different measurement procedures (MPs). This difference in bias is compared with a criterion based on a medically relevant difference between an RM and CS results to make a conclusion regarding commutability. When more than 2 MPs are included, the commutability is assessed pairwise for all combinations of 2 MPs. This approach allows the same criterion to be used for all combinations of MPs included in the assessment. The assessment is based on an error model that allows estimation of various random and systematic sources of error, including those from sample-specific effects of interfering substances. An advantage of this approach is that the difference in bias between an RM and the average bias of CSs at the concentration (i.e., amount of substance present or quantity value) of the RM is determined and its uncertainty estimated. An RM is considered fit for purpose for those MPs for which commutability is demonstrated.
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Affiliation(s)
| | | | | | - Vincent Delatour
- Laboratoire national de métrologie et d'essais (LNE), Paris, France
| | - Robert Rej
- Wadsworth Center for Laboratories and Research, New York State Department of Health, and School of Public Health, State University of New York at Albany, Albany, NY
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | | | - Heinz Schimmel
- European Commission, Joint Research Centre (JRC), Directorate F, Geel, Belgium
| | - Cas Weykamp
- Queen Beatrix Hospital, Winterswijk, the Netherlands
| | | | - Johanna E Camara
- National Institute of Standards and Technology, Gaithersburg, MD
| | - Chris Burns
- National Institute for Biological Standards and Control, A Centre of the MHRA, Hertfordshire, UK
| | | | - Finlay MacKenzie
- Birmingham Quality/UK NEQAS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - W Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, VA.
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Budd JR, Weykamp C, Rej R, MacKenzie F, Ceriotti F, Greenberg N, Camara JE, Schimmel H, Vesper HW, Keller T, Delatour V, Panteghini M, Burns C, Miller WG. IFCC Working Group Recommendations for Assessing Commutability Part 3: Using the Calibration Effectiveness of a Reference Material. Clin Chem 2018; 64:465-474. [PMID: 29348164 DOI: 10.1373/clinchem.2017.277558] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 12/18/2017] [Indexed: 11/06/2022]
Abstract
A process is described to assess the commutability of a reference material (RM) intended for use as a calibrator based on its ability to fulfill its intended use in a calibration traceability scheme to produce equivalent clinical sample (CS) results among different measurement procedures (MPs) for the same measurand. Three sources of systematic error are elucidated in the context of creating the calibration model for translating MP signals to measurand amounts: calibration fit, calibrator level trueness, and commutability. An example set of 40 CS results from 7 MPs is used to illustrate estimation of bias and variability for each MP. The candidate RM is then used to recalibrate each MP, and its effectiveness in reducing the systematic error among the MPs within an acceptable level of equivalence based on medical requirements confirms its commutability for those MPs. The RM is declared noncommutable for MPs for which, after recalibration, the CS results do not agree with those from other MPs. When a lack of agreement is found, other potential causes, including lack of calibration fit, should be investigated before concluding the RM is noncommutable. The RM is considered fit for purpose for those MPs where commutability is demonstrated.
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Affiliation(s)
| | - Cas Weykamp
- Queen Beatrix Hospital, Winterswijk, the Netherlands
| | - Robert Rej
- Wadsworth Center for Laboratories and Research, New York State Department of Health, and School of Public Health, State University of New York at Albany, Albany, NY
| | - Finlay MacKenzie
- Birmingham Quality/UK NEQAS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Johanna E Camara
- National Institute of Standards and Technology, Gaithersburg, MD
| | - Heinz Schimmel
- European Commission, Joint Research Centre (JRC), Directorate F, Geel, Belgium
| | | | | | - Vincent Delatour
- Laboratoire national de métrologie et d'essais (LNE), Paris, France
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Chris Burns
- National Institute for Biological Standards and Control, A Centre of the MHRA, Hertfordshire, UK
| | - W Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, VA.
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Cao ZT, Botelho JC, Rej R, Vesper H. Accuracy-based proficiency testing for testosterone measurements with immunoassays and liquid chromatography-mass spectrometry. Clin Chim Acta 2017; 469:31-36. [PMID: 28288785 DOI: 10.1016/j.cca.2017.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Accurate testosterone measurements are needed to correctly diagnose and treat patients. Proficiency Testing (PT) programs using modified specimens for testing can be limited because of matrix effects and usage of non-reference measurement procedure (RMP)-defined targets for evaluation. Accuracy-based PT can overcome such limitations; however, there is a lack of information on accuracy-based PT and feasibility of its implementation in evaluation for testosterone measurements. METHODS Unaltered, single-donor human serum from 2 male and 2 female adult donors were analyzed for testosterone by 142 NYSDH-certified clinical laboratories using 16 immunoassays and LC-MS/MS methods. Testosterone target values were determined using an RMP. RESULTS The testosterone target concentrations for the 4 specimens were 15.5, 30.0, 402 and 498ng/dl. The biases ranged from -17.8% to 73.1%, 3.1% to 21.3%, -24.8% to 8.6%, and -22.1% to 6.8% for the 4 specimens, respectively. Using a total error target of ±25.1%, which was calculated using the minimum allowable bias and imprecision, 73% of participating laboratories had ≥3 of the 4 results within these limits. CONCLUSIONS The variability in total testosterone measurements can affect clinical decisions. Accuracy-based PT can significantly contribute to improving testosterone testing by providing reliable data on accuracy in patient care to laboratories, assay manufacturers, and standardization programs.
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Affiliation(s)
- Zhimin Tim Cao
- Wadsworth Center, New York State Department of Health, Albany, NY, United States; College of Arts and Sciences, University at Albany, State University of New York, Albany, NY, United States
| | | | - Robert Rej
- Wadsworth Center, New York State Department of Health, Albany, NY, United States; School of Public Health, University at Albany, State University of New York, Albany, NY, United States
| | - Hubert Vesper
- Centers for Disease Control and Prevention, Atlanta, GA, United States.
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12
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Aminov Z, Haase R, Rej R, Schymura MJ, Santiago-Rivera A, Morse G, DeCaprio A, Carpenter DO. Diabetes Prevalence in Relation to Serum Concentrations of Polychlorinated Biphenyl (PCB) Congener Groups and Three Chlorinated Pesticides in a Native American Population. Environ Health Perspect 2016; 124:1376-83. [PMID: 27035469 PMCID: PMC5010411 DOI: 10.1289/ehp.1509902] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/08/2015] [Accepted: 03/07/2016] [Indexed: 05/18/2023]
Abstract
BACKGROUND Exposure to persistent organic pollutants (POPs) is known to increase risk of diabetes. OBJECTIVE To determine which POPs are most associated with prevalence of diabetes in 601 Akwesasne Native Americans. METHODS Multiple logistic regression analysis was used to assess associations between quartiles of concentrations of 101 polychlorinated biphenyl (PCBs) congeners, congener groups and three chlorinated pesticides [dichlorodiphenyldichloroethylene (DDE), hexachlorobenzene (HCB) and mirex] with diabetes. In Model 1, the relationship between quartiles of exposure and diabetes were adjusted only for sex, age, body mass index (BMI), and total serum lipids. Model 2 included additional adjustment for either total PCBs or total pesticides. RESULTS Total serum PCB and pesticide concentrations were each significantly associated with prevalence of diabetes when adjusted only for covariates (Model 1), but neither showed a significant OR for highest to lowest quartiles after additional adjustment for the other (Model 2). When applying Model 2 to PCB congener groups and individual pesticides, there were significant omnibus differences between the four quartiles (all ps < 0.042) for most groups, with the exception of penta- and hexachlorobiphenyls, DDE and mirex. However, when comparing highest to lowest quartiles only non- and mono-ortho PCBs [OR = 4.55 (95% CI: 1.48, 13.95)], tri- and tetrachloro PCBs [OR = 3.66 (95% CI: 1.37, -9.78)] and HCB [OR = 2.64 (95% CI: 1.05, 6.61)] showed significant associations with diabetes. Among the non- and mono-ortho congeners, highest to lowest quartile of dioxin TEQs was not significant [OR = 1.82 (95% CI: 0.61, 5.40)] but the OR for the non-dioxin-like congeners was [OR = 5.01 (95% CI: 1.76, 14.24)]. CONCLUSION The associations with diabetes after adjustment for other POPs were strongest with the more volatile, non-dioxin-like, low-chlorinated PCB congeners and HCB. Because low-chlorinated congeners are more volatile, these observations suggest that inhalation of vapor-phase PCBs is an important route of exposure. CITATION Aminov Z, Haase R, Rej R, Schymura MJ, Santiago-Rivera A, Morse G, DeCaprio A, Carpenter DO, and the Akwesasne Task Force on the Environment. 2016. Diabetes prevalence in relation to serum concentrations of polychlorinated biphenyl (PCB) congener groups and three chlorinated pesticides in a Native American population. Environ Health Perspect 124:1376-1383; http://dx.doi.org/10.1289/ehp.1509902.
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Affiliation(s)
- Zafar Aminov
- Department of Environmental Health Sciences, School of Public Health, and
- Institute for Health and the Environment, University at Albany, State University of New York (SUNY), Rensselaer, New York, USA
| | - Richard Haase
- Institute for Health and the Environment, University at Albany, State University of New York (SUNY), Rensselaer, New York, USA
- Department of Counseling Psychology, University at Albany, SUNY, Albany, New York, USA
| | - Robert Rej
- Wadsworth Center, New York State Department of Health and Department of Biomedical Sciences, School of Public Health, University at Albany, SUNY, Rensselaer, New York, USA
| | - Maria J. Schymura
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, SUNY, Rensselaer, New York, USA
| | - Azara Santiago-Rivera
- Department of Counseling Psychology, University at Albany, SUNY, Albany, New York, USA
| | - Gayle Morse
- Department of Counseling Psychology, University at Albany, SUNY, Albany, New York, USA
| | - Anthony DeCaprio
- Department of Environmental Health Sciences, School of Public Health, and
| | - David O. Carpenter
- Department of Environmental Health Sciences, School of Public Health, and
- Institute for Health and the Environment, University at Albany, State University of New York (SUNY), Rensselaer, New York, USA
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13
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Affiliation(s)
- Robert Rej
- Laboratory of Molecular Diagnostics, Wadsworth Center, New York State Department of Health and Department of Biomedical Sciences, School of Public Health, State University of New York, Albany, NY.
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14
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Affiliation(s)
- Robert Rej
- Wadsworth Center for Laboratories and Research New York State Department of Health Albany, NY
- Department of Biomedical Sciences School of Public Health, State University of New York Albany, NY
| | - Carol S Norton-Wenzel
- Wadsworth Center for Laboratories and Research New York State Department of Health Albany, NY
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Shrestha S, Bloom MS, Yucel R, Seegal RF, Wu Q, Kannan K, Rej R, Fitzgerald EF. Perfluoroalkyl substances and thyroid function in older adults. Environ Int 2015; 75:206-14. [PMID: 25483837 PMCID: PMC4272864 DOI: 10.1016/j.envint.2014.11.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/26/2014] [Accepted: 11/28/2014] [Indexed: 05/22/2023]
Abstract
Current understanding of the thyroid disruptive properties of perfluoroalkyl substances (PFASs), particularly in aging populations, is limited. The objectives of this study were to (i) assess associations between thyroid function, as measured by serum thyrotropin (thyroid stimulating hormone, TSH), free thyroxine (fT4), total thyroxine (T4), and total triiodothyronine (T3), and serum perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) in an aging population and (ii) determine if other persistent organic pollutants with thyroid disruptive properties including polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs) modify such associations. We conducted a cross-sectional study of 87 men and women 55 to 74years of age, without clinically-diagnosed thyroid disease, who resided in upper Hudson River communities in New York. Geometric means (standard deviations) of serum PFOS and PFOA were 31.6 (1.7) ng/mL and 9.17 (1.72) ng/mL, respectively. Multivariable linear regression analyses indicated that one interquartile range difference in PFOS corresponded to 4% and 9% increases in fT4 and T4 respectively. We detected statistical interactions between PFOA and age for effects on fT4 and T4; joint increases in PFOA and age were associated with increases in fT4 and T4, of 3% and 7%, respectively. We also detected statistical interactions between PFOS and total PCBs for the effect on T3 and between PFOA and total PBDEs for the effect on TSH. Our results suggest that PFASs are associated with subtle alterations in thyroid hormone levels in this population, and that these associations are likely to vary by age, and levels of PCBs and PBDEs.
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Affiliation(s)
- Srishti Shrestha
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144, USA
| | - Michael S Bloom
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144, USA; Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144, USA
| | - Recai Yucel
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144, USA
| | - Richard F Seegal
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144, USA; Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Empire State Plaza, P.O. Box 509, Albany, NY 12201, USA
| | - Qian Wu
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144, USA; Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Empire State Plaza, P.O. Box 509, Albany, NY 12201, USA
| | - Kurunthachalam Kannan
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144, USA; Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Empire State Plaza, P.O. Box 509, Albany, NY 12201, USA
| | - Robert Rej
- Division of Translational Medicine, Wadsworth Center, New York State Department of Health, Empire State Plaza, P.O. Box 509, Albany, NY 12201, USA; Department of Biomedical Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144, USA
| | - Edward F Fitzgerald
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144, USA; Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144, USA.
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Affiliation(s)
- Robert Rej
- Laboratory of Molecular Diagnostics, Wadsworth Center, New York State Department of Health
- Department of Biomedical Sciences, School of Public Health, State University of New York, Albany, NY
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Bloom MS, Jansing RL, Kannan K, Rej R, Fitzgerald EF. Thyroid hormones are associated with exposure to persistent organic pollutants in aging residents of upper Hudson River communities. Int J Hyg Environ Health 2014; 217:473-82. [PMID: 24138783 PMCID: PMC3965653 DOI: 10.1016/j.ijheh.2013.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 09/05/2013] [Accepted: 09/16/2013] [Indexed: 12/17/2022]
Abstract
The aim of this study was to evaluate the association between persistent organic pollutants (POPs) and thyroid hormones in an aging population. Forty-eight women and 66 men, aged 55-74 years and living in upper Hudson River communities completed a questionnaire and provided blood specimens. Serum was analyzed for thyrotropin (thyroid stimulating hormone, TSH), free (fT4) and total thyroxine (T4), total triiodothyronine (T3), and for POPs. POPs included 39 polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT) and dichlorodiphenyldichloroethylene (DDE) determined by gas chromatography with electron capture detection (GC-ECD), and nine polybrominated diphenyl ethers (PBDEs) determined by high-resolution gas chromatography with high-resolution mass spectrometry detection (HRGC-HRMS). Multivariable linear regression analysis was used to evaluate associations between thyroid hormones and sums of POPs, adjusted for covariates and stratified by sex. Effects were expressed as differences in thyroid hormone levels associated with a doubling in the level of exposure. Among women, DDT+DDE increased T4 by 0.34μg/dL (P=0.04) and T3 by 2.78ng/dL (P=0.05). Also in women, sums of PCBs in conjunction with PBDEs elicited increases of 24.39-80.85ng/dL T3 (P<0.05), and sums of PCBs in conjunction with DDT+DDE elicited increases of 0.18-0.31μg/dL T4 (P<0.05). For men estrogenic PCBs were associated with a 19.82ng/dL T3 decrease (P=0.003), and the sum of estrogenic PCBs in conjunction with DDT+DDE elicited an 18.02ng/dL T3 decrease (P=0.04). Given age-related declines in physiologic reserve, the influence of POPs on thyroid hormones in aging populations may have clinical implications and merits further investigation.
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Affiliation(s)
- Michael S Bloom
- Department of Environmental Health Sciences, University at Albany, State University of New York, School of Public Health, Rensselaer, NY, USA; Department of Epidemiology and Biostatistics, University at Albany, State University of New York, School of Public Health, Rensselaer, NY, USA.
| | - Robert L Jansing
- Department of Environmental Health Sciences, University at Albany, State University of New York, School of Public Health, Rensselaer, NY, USA; Wadsworth Center, New York State Department of Health Wadsworth Center, Albany, NY, USA
| | - Kurunthachalam Kannan
- Department of Environmental Health Sciences, University at Albany, State University of New York, School of Public Health, Rensselaer, NY, USA; Wadsworth Center, New York State Department of Health Wadsworth Center, Albany, NY, USA
| | - Robert Rej
- Wadsworth Center, New York State Department of Health Wadsworth Center, Albany, NY, USA; Department of Biomedical Sciences, University at Albany, State University of New York, School of Public Health, Rensselaer, NY, USA
| | - Edward F Fitzgerald
- Department of Environmental Health Sciences, University at Albany, State University of New York, School of Public Health, Rensselaer, NY, USA; Department of Epidemiology and Biostatistics, University at Albany, State University of New York, School of Public Health, Rensselaer, NY, USA
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Goncharov A, Rej R, Negoita S, Schymura M, Santiago-Rivera A, Morse G, Carpenter DO. Lower serum testosterone associated with elevated polychlorinated biphenyl concentrations in Native American men. Environ Health Perspect 2009; 117:1454-60. [PMID: 19750113 PMCID: PMC2737025 DOI: 10.1289/ehp.0800134] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 05/19/2009] [Indexed: 05/17/2023]
Abstract
BACKGROUND Polychlorinated biphenyls (PCBs) and chlorinated pesticides are endocrine disruptors, altering both thyroid and estrogen hormonal systems. Less is known of action on androgenic systems. OBJECTIVE We studied the relationship between serum concentrations of testosterone in relation to levels of PCBs and three chlorinated pesticides in an adult Native American (Mohawk) population. METHODS We collected fasting serum samples from 703 adult Mohawks (257 men and 436 women) and analyzed samples for 101 PCB congeners, hexachlorobenzene (HCB), dichlorodiphenyldichloroethylene (DDE), and mirex, as well as testosterone, cholesterol, and triglycerides. The associations between testosterone and tertiles of serum organochlorine levels (both wet weight and lipid adjusted) were assessed using a logistic regression model while controlling for age, body mass index (BMI), and other analytes, with the lowest tertile being considered the referent. Males and females were considered separately. RESULTS Testosterone concentrations in males were inversely correlated with total PCB concentration, whether using wet-weight or lipid-adjusted values. The odds ratio (OR) of having a testosterone concentration above the median was 0.17 [95% confidence interval (CI), 0.05-0.69] for total wet-weight PCBs (highest vs. lowest tertile) after adjustment for age, BMI, total serum lipids, and three pesticides. The OR for lipid-adjusted total PCB concentration was 0.23 (95% CI, 0.06-0.78) after adjustment for other analytes. Testosterone levels were significantly and inversely related to concentrations of PCBs 74, 99, 153, and 206, but not PCBs 52, 105, 118, 138, 170, 180, 201, or 203. Testosterone concentrations in females are much lower than in males, and not significantly related to serum PCBs. HCB, DDE, and mirex were not associated with testosterone concentration in either men or women. CONCLUSIONS Elevation in serum PCB levels is associated with a lower concentration of serum testosterone in Native American men.
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Affiliation(s)
| | - Robert Rej
- Department of Biomedical Sciences, University at Albany, Rensselaer, New York, USA
- Wadsworth Center for Laboratories and Research, New York State Department of Health, Albany, New York, USA
| | - Serban Negoita
- New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics and
| | - Maria Schymura
- New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics and
| | - Azara Santiago-Rivera
- Department of Education and Counseling Psychology, University at Albany, Albany, New York, USA
| | - Gayle Morse
- Department of Education and Counseling Psychology, University at Albany, Albany, New York, USA
| | | | - David O. Carpenter
- Department of Environmental Health Sciences and
- Department of Biomedical Sciences, University at Albany, Rensselaer, New York, USA
- Institute for Health and the Environment, University at Albany, Rensselaer, New York, USA
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Kimberly MM, Caudill SP, Vesper HW, Monsell EA, Miller WG, Rej R, Rifai N, Dati F, Myers GL. Standardization of High-Sensitivity Immunoassays for Measurement of C-Reactive Protein; II: Two Approaches for Assessing Commutability of a Reference Material. Clin Chem 2009; 55:342-50. [DOI: 10.1373/clinchem.2008.115907] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background: We evaluated the commutability of a proposed reference material (PRM), with a formulation based on dilution of Certified Reference Material 470 (CRM470), for 24 high-sensitivity C-reactive protein (hsCRP) methods. We also investigated whether calibration by use of PRM was effective in harmonizing results.
Methods: A set of 40 native clinical samples was measured along with PRM and 3 dilutions of PRM. We used weighted least-squares polynomial regression (WLS/PR) to perform comparisons between all method combinations and to calculate normalized residuals for the PRM. The PRM was considered noncommutable if any of the normalized residuals for a method pair was >2. Correspondence analysis (CA) was used to explore the multidimensional relationships between methods and samples to evaluate if the PRM had properties similar to native clinical samples. Clinical sample results from the methods for which PRM was commutable were recalibrated based on the PRM results, and ANOVA was used to estimate the CVs before and after recalibration.
Results: After omitting data for 9 methods because of poor precision or procedural flaws, we used data from the 15 remaining methods to evaluate commutability. Using both WLS/PR and CA we found that PRM was noncommutable with 1 method. We found modest improvement in total and among-method CVs when PRM was used to harmonize the results from the 14 methods for which it was commutable.
Conclusions: A PRM with a formulation based on dilution of CRM470 was commutable with native clinical samples for 14 of 15 hsCRP methods that had acceptable precision. For those methods the use of PRM may contribute to improved harmonization of results for native clinical samples.
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Affiliation(s)
- Mary M Kimberly
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Samuel P Caudill
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Hubert W Vesper
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth A Monsell
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - W Greg Miller
- Medical College of Virginia Hospitals at Virginia Commonwealth University, Richmond, VA
| | - Robert Rej
- Wadsworth Center for Laboratories and Research, New York State Department of Health, Albany, NY
| | - Nader Rifai
- Departments of Laboratory Medicine and Pathology, Children’s Hospital and Harvard Medical School, Boston, MA
| | | | - Gary L Myers
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
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Abstract
INTRODUCTION Charcoal- or resin-stripping of fetal bovine serum (FBS) or bovine calf serum (BCS) intended for supplementation of cell culture media is widely practiced to remove a variety of endogenous compounds, including steroid, peptide, and thyroid hormones. The possibility that stripping removes other biologically relevant factors from serum may not be appreciated. METHODS In this report, standardized clinical laboratory testing methods were used to assess the effects of resin- and charcoal-stripping on content in FBS and BCS of more than 25 analytes in the sera. RESULTS AND CONCLUSION In addition to hormones, the serum constituents affected by stripping are certain vitamins, electrolytes, enzyme activities, and metabolites.
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Affiliation(s)
- Zhimin Cao
- Laboratory of Molecular Diagnostics, Wadsworth Center for Laboratories and Research, New York State Department of Health, Albany, New York, USA
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Abstract
Abstract
Background: Human chorionic gonadotropin (hCG) is a heterodimeric glycoprotein hormone that exists in multiple forms. Immunoassays commonly used in clinical laboratories measure intact hCG, total β hCG (intact hCG + hCG free β-subunit), and/or hCG free β-subunit. Measurement of serum concentrations of hCG is useful for confirmation and monitoring of pregnancy, diagnosis of trophoblastic diseases and monitoring of the efficacy of treatment, and prenatal screening. Correctly reporting results for the various forms of hCG is clinically important.
Method: We prepared samples by addition of intact hCG and hCG free β-subunit to an essentially hCG-free human serum matrix. The samples were analyzed by participant laboratories using various immunoassay methods.
Results: We identified errors in participant reporting of intact hCG results as total β hCG (9.3%; 22 of 235 laboratories) and total β hCG as intact hCG (13.1%; 8 of 61 laboratories).
Conclusions: Many factors contribute to the erroneous reporting of hCG results, including (a) the complexity of hCG molecule and confusion of nomenclature on the various forms of hCG; (b) laboratory personnel’s lack of awareness of the distinctions of the forms of hCG and failure to recognize the specificity of assays for their measurement; (c) lack of clarity and uniformity in manufacturers’ reagent labeling; and (d) most product inserts’ lack of information on the specificity of each method to the various forms of hCG.
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Affiliation(s)
- Zhimin (Tim) Cao
- Division of Molecular Medicine, Wadsworth Center for Laboratories and Research, New York State Department of Health, Albany, NY
| | - Robert Rej
- Division of Molecular Medicine, Wadsworth Center for Laboratories and Research, New York State Department of Health, Albany, NY
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY
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Goncharov A, Haase RF, Santiago-Rivera A, Morse G, McCaffrey RJ, Rej R, Carpenter DO. High serum PCBs are associated with elevation of serum lipids and cardiovascular disease in a Native American population. Environ Res 2008; 106:226-39. [PMID: 18054906 PMCID: PMC2258089 DOI: 10.1016/j.envres.2007.10.006] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 09/07/2007] [Accepted: 10/04/2007] [Indexed: 05/17/2023]
Abstract
We have investigated the relationships among the concentration of total serum polychlorinated biphenyls (PCBs), various PCB congener groupings, and three pesticides to total serum lipids in humans with and without self-reported cardiovascular disease. Blood samples were obtained from 335 adult Akwesasne Mohawks, and were analyzed for 101 PCB congeners, mirex, dichloro-diphenyl-dichloro-ethylene (DDE), and hexachlorobenzene (HCB), as well as serum triglycerides and cholesterol. Structural equation modeling, following the definition of latent variables by means of confirmatory factor analysis, was used to analyze the relationships between serum lipids with PCBs and heart disease. There were significant associations among PCBs, lipids, age, and body mass index (BMI), a fact which justified the application of the structural equation model. Gender of the participant was unrelated to any of the remaining study variables. The results of this study are consistent with a model in which age is considered as both an exogenous explanatory variable and a biological driving mechanism for the acquisition of PCBs. Moreover, the results of this study are consistent with the conclusion that PCBs, acting through P450 enzymes, are directly responsible for increased synthesis of cholesterol and triglycerides, substances known to be major risk factors for cardiovascular disease.
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Affiliation(s)
- Alexey Goncharov
- Institute for Health and the Environment, University at Albany, Rensselaer, NY, 12144
| | - Richard F. Haase
- Institute for Health and the Environment, University at Albany, Rensselaer, NY, 12144
- Department of Educational and Counseling Psychology, University at Albany, 1400 Washington Avenue, Albany, NY 12222
| | - Azara Santiago-Rivera
- Institute for Health and the Environment, University at Albany, Rensselaer, NY, 12144
- Department of Educational and Counseling Psychology, University at Albany, 1400 Washington Avenue, Albany, NY 12222
| | - Gayle Morse
- Department of Educational and Counseling Psychology, University at Albany, 1400 Washington Avenue, Albany, NY 12222
- Mohawk Nation at Akwesasne via Hogansburg, NY 13655
| | | | - Robert J. McCaffrey
- Department of Psychology, University at Albany, 1400 Washington Avenue, Albany, NY 12222
| | - Robert Rej
- Wadsworth Center, New York State Department of Health, Empire State Plaza, PO Box 509, Albany, NY 12201-0509 and Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY 12201
| | - David O. Carpenter
- Institute for Health and the Environment, University at Albany, Rensselaer, NY, 12144
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Codru N, Schymura MJ, Negoita S, Rej R, Carpenter DO. Diabetes in relation to serum levels of polychlorinated biphenyls and chlorinated pesticides in adult Native Americans. Environ Health Perspect 2007; 115:1442-7. [PMID: 17938733 PMCID: PMC2022671 DOI: 10.1289/ehp.10315] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Accepted: 07/17/2007] [Indexed: 05/17/2023]
Abstract
BACKGROUND Recent research suggests that diabetes, a condition whose incidence is increasing, is associated with exposure to polychlorinated biphenyls (PCBs) and chlorinated pesticides. OBJECTIVES We investigated the potential association between diabetes and serum levels of PCBs, dichlorodiphenyldichloroethylene (DDE), hexachlorobenzene (HCB), and mirex in a cross-sectional study of an adult Native-American (Mohawk) population. METHODS Through a standardized questionnaire we collected demographic, medical, and lifestyle information from 352 adults, > or =30 years of age. We collected fasting serum samples that were analyzed for 101 PCB congeners, DDE, HCB, and mirex along with fasting glucose, triglycerides, and cholesterol. Participants who had fasting-glucose values > 125 mg/dL and/or who were taking antidiabetic medication were defined as persons with diabetes. We conducted logistic regression to assess the potential association between organochlorine serum levels and diabetes, while controlling for the potential confounding variables of age, body mass index (BMI), smoking, sex, and serum lipid levels. Organochlorine serum levels were categorized in tertiles, and the lowest tertile was used as the reference category. RESULTS The prevalence of diabetes was 20.2%. The odds ratio (OR) of having diabetes for participants in the highest tertile of total PCB concentration compared with the lowest tertile was 3.9 (95% confidence interval, 1.5-10.6). The corresponding ORs for DDE and HCB were even higher. Elevated serum mirex was not associated with diabetes. After adjustment for other analytes, the OR for HCB remained significant, whereas ORs for PCBs and DDE remained elevated but not statistically significant. In contrast, after adjustment for other analytes, the OR for mirex became statistically significant and indicated an inverse association. CONCLUSIONS In this study of adult Native Americans, elevated serum PCBs, DDE, and HCB were positively associated with diabetes after controlling for potential confounders, whereas a negative association was observed for mirex.
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Affiliation(s)
- Neculai Codru
- Department of Epidemiology and Statistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Maria J. Schymura
- Department of Epidemiology and Statistics, School of Public Health, University at Albany, Rensselaer, New York, USA
- New York State Department of Health, Albany, New York, USA
| | - Serban Negoita
- Department of Epidemiology and Statistics, School of Public Health, University at Albany, Rensselaer, New York, USA
- New York State Department of Health, Albany, New York, USA
| | - Robert Rej
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, New York, USA
| | - David O. Carpenter
- Institute for Health and the Environment, University at Albany, Rensselaer, New York, USA
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Rej R. DORA 05-07: Directory of Rare Analyses. Jocelyn M. Hicks and Donald S. Young, editors. Washington, DC: AACC Press, 2005, 650 pp., $125.00 ($99.00 AACC members), softcover. ISBN 1-594250-31-6. Clin Chem 2006. [DOI: 10.1373/clinchem.2005.058115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Robert Rej
- Wadsworth Center for Laboratories and Research New York State Department of Health Albany, NY 12201-0509
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Rej R. The Art of Scientific Writing: From Student Reports to Professional Publications in Chemistry and Related Fields, 2nd ed. Hans F. Ebel, Claus Bliefert, and William E. Russey. Weinheim: Wiley-VCH Verlag GmbH & Co. KGaA, 2004, 608 pp, $35.00, softcover. ISBN 3-527-29829. Clin Chem 2005. [DOI: 10.1373/clinchem.2004.035659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Robert Rej
- Wadsworth Center for Laboratories and Research, New York State Department of Health, State University of New York at Albany, Albany, NY 12201
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Abstract
The establishment of the modern discipline of clinical chemistry was concurrent with the foundation of the journal Clinical Chemistry and that of the American Association for Clinical Chemistry in the late 1940s and early 1950s. To mark the 50th volume of this Journal, I chronicle and highlight scientific milestones, and those within the discipline, as documented in the pages of Clinical Chemistry. Amazing progress has been made in the field of laboratory diagnostics over these five decades, in many cases paralleling-as well as being bolstered by-the rapid pace in the development of computer technologies. Specific areas of laboratory medicine particularly well represented in Clinical Chemistry include lipids, endocrinology, protein markers, quality of laboratory measurements, molecular diagnostics, and general advances in methodology and instrumentation.
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Affiliation(s)
- Robert Rej
- Laboratory of Molecular Diagnostics, Wadsworth Center for Laboratories and Research, New York State Department of Health, Albany, NY 12201, USA.
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Abstract
BACKGROUND Accurate measurement of estradiol is important in clinical settings. The quality of laboratory estimations of estradiol may be assessed through external quality-assurance surveys. METHODS Estradiol was measured by microparticle enzyme immunoassay (MEIA) and other immunoassays. Proficiency testing of medical laboratories was conducted using samples prepared from normal male human serum supplemented with exogenous estradiol and other steroid and nonsteroid hormones, and participant laboratories measured estradiol by a variety of commonly used immunoassay techniques. RESULTS The imprecision (CV) for measurement of estradiol [100-300 ng/L (367-1102 pmol/L)] was </=22% for most analytical techniques. Greater imprecision, as high as 40% for the same concentration range, was observed for the (AxSYM) MEIA method in the proficiency testing event of September 2001. Results from this method were bimodal in distribution. We found that unconjugated estriol at concentrations >1.5 microg/L (>5.2 nmol/L) interfered with the MEIA method, leading to decreased recovery of added estradiol by up to 50%. This suppression in estradiol measurement was prevented by dilution of the specimen before measurement. Addition of unconjugated estriol gave a positive bias in some other immunoassay methods for estradiol. Poor comparability among the immunoassay methods for measurement of estradiol at clinically relevant concentrations [ approximately 60 ng/L (220 pmol/L)] was revealed. CONCLUSIONS A negative interference of unconjugated estriol with the MEIA method is a source of error for estradiol measurement. Lack of specificity and lack of comparability among immunoassay methods for estradiol may have detrimental effects on medical practice.
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Affiliation(s)
- Zhimin Cao
- Laboratory of Molecular Diagnostics, Wadsworth Center for Laboratories and Research, New York State Department of Health, Albany, NY, USA.
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Affiliation(s)
- David E Bruns
- Department of Pathology, University of Virginia Health System, Charlottesville, VA 22908
| | - Robert Rej
- Laboratory of Molecular Diagnostics, Wadsworth Center for Laboratories and Research, New York State Department of Health, Department of Biomedical Sciences, State University of New York at Albany, Albany, NY 12201-0509
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Abstract
Unusually low serum activity of alanine aminotransferase (ALT) was detected in a Rottweiler dog with gastric dilatation-volvulus. Activity of ALT in the same sample was found to be much higher (estimated increase of 14,225%) when measured by methods adding the cofactor pyridoxal-5'-phosphate (P5P), indicating that nearly all serum ALT was in the apoenzyme form. An investigation was undertaken to determine the frequency of high serum aminotransferase apoenzyme levels in dogs. Eighty canine serum samples submitted to the Clinical Pathology Laboratory at Cornell University were assayed for ALT and aspartate aminotransferase (AST) in the presence or absence of exogenous P5P. In 79 dogs, inclusion of P5P in the LAT assay resulted in a median decrease in AST activity of -6.3% (range -33.3% to 25.0%) in all 80 dogs. One dog had an increase of 336% in ALT activity after inclusion of P5P in the assay, but lacked a similar increase in AST activity. The reason for the high levels of ALT apoenzyme in the 2 dogs was not determined.
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Affiliation(s)
- Christopher I. Mesher
- Department of Pathology, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
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Rej R, Norton-Wenzel CS, Cao Z. Target values and method evaluation in proficiency testing programs. Clin Chem 2001; 47:2185-6. [PMID: 11719494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Affiliation(s)
- Robert Rej
- Wadsworth Center for Laboratories and Research, New York State Department of Health, Albany, NY 12201
- Department of Biomedical Sciences, School of Public Health, State University of New York, Albany, NY 12201
| | - Carol S Norton-Wenzel
- Wadsworth Center for Laboratories and Research, New York State Department of Health, Albany, NY 12201
| | - (Tim) Zhimin Cao
- Wadsworth Center for Laboratories and Research, New York State Department of Health, Albany, NY 12201
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Rej R, Norton-Wenzel CS. EP Evaluator-CLIA (EE-CLIA) for Evaluating Clinical Laboratory Methods (Consultant’s Version with Rapid Results Entry). Kennett Square, PA: David G. Rhoads Associates, Inc., 2000, 3 diskettes and manual (142 + 33 pp.), $695.00. Clin Chem 2001. [DOI: 10.1093/clinchem/47.11.2075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Carol S Norton-Wenzel
- Wadsworth Center for, Laboratories and Research, New York State, Department of Health, Albany, NY 12201-0509
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Rej R. AACC 50th anniversary retrospective. They use enzymes for everything! American Association for Clinical Chemistry. Clin Chem 1998; 44:1149-53. [PMID: 9625036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- R Rej
- Wadsworth Center for Laboratories and Research, New York State Department of Health, and State University of New York at Albany, School of Public Health, 12201-0509, USA.
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Rej R. Liver diseases and the clinical laboratory--the Twentieth Arnold O. Beckman Conference in Clinical Chemistry. Clin Chem 1997; 43:1473-5. [PMID: 9265897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- R Rej
- Laboratory of Molecular Diagnostics, Wadsworth Center for Laboratories and Research, New York State Department of Health, Albany, USA.
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Affiliation(s)
- Robert Rej
- Laboratories and Research, New York Stare Department of Health, School of Public Health-State University of New York at Albany, Albany, NY 1220 1-0509
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Abstract
Rat pups were made hypothyroid by exposure to propylthiouracil in drinking water beginning at 1 week of age, and the degree of long-term potentiation (LTP) in hippocampal area CA1 determined from brain slices of animals ranging in age from 2 to 6 weeks. Serum T3 levels were less than 20% of that of age matched controls after 3 weeks of treatment, and remained at that level. Relative to the age-matched controls, LTP was reduced significantly after 2 weeks of treatment. These observations are consistent with the conclusion that LTP magnitude is a reflection of cognitive function, which is known to be depressed in hypothyroid conditions in both animals and man.
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Affiliation(s)
- W D Niemi
- Wadsworth Center for Laboratories and Research, New York State Department of Health, Albany 12201, USA
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Rej R. Proficiency testing, matrix effects, and method evaluation. Clin Chem 1994; 40:345-6. [PMID: 8131266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Ravkilde J, Bøtker HE, Søgaard P, Selmer J, Rej R, Jørgensen PJ, Hørder M, Thygesen K. Human ventricular myosin light chain isotype 1 as a marker of myocardial injury. Cardiology 1994; 84:135-44. [PMID: 8174143 DOI: 10.1159/000176532] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A monoclonal enzyme immunoassay for measuring human ventricular myosin light chain isotype 1 (HVMLC1) in serum has been developed. To evaluate the method in patients with suspected myocardial injury, we studied 51 patients (16 acute myocardial infarction (AMI), 19 unstable angina pectoris (UAP), 9 stable angina pectoris, 3 nonischemic heart disease, 4 hip surgery patients), and 190 controls (blood donors). Serial blood-samples were drawn from patients; a single blood-sample from controls. The diagnostic value of the HVMLC1 assay was compared with total creatine kinase (CK), CKMB activity, CKMB mass concentration, lactate dehydrogenase isoenzyme 1 (LD1), troponin T (TnT) and mitochondrial-aspartate aminotransferase (m-ASAT). The detection limit of HVMLC1 was 0.4 microgram/l (linear range 0-20 micrograms/l). Sera from 190 reference persons did not contain detectable levels of HVMLC1 (< 0.4 microgram/l; 99% percentile). The coefficients of variation were 13% (1.0 microgram/l) and 3.1% (17.7 micrograms/l). Cross-reactivity with myosin from skeletal muscle was seen. Times to peak value were: CK 19.3 +/- 2.0, LD1 43.4 +/- 3.2, HVMLC1 72.9 +/- 7.0, and m-ASAT 67.3 +/- 5.6 h. Time-curves of HVMLC1 and m-ASAT were similar, whereas time-curves for HVMLC1 and TnT were quite different in most cases. Peak value of HVMLC1 was five times higher than CK peak value and eight times that of LD1. HVMLC1 appeared in the blood within hours after the onset of chest pain and in the majority remained for more than a week after AMI. Among patients with UAP 16% (3/19) had elevated HVMLC1 in serum, whereas elevated TnT was seen in 26% (5/19) and elevated CKMB mass in 26% (5/19). We conclude that the new HVMLC1 assay offers a sensitive diagnosis of myocardial injury. It is characterized by a wide diagnostic time window. The similarity of the HVMLC1 and m-ASAT curves indicates that it may be used to estimate the extent of myocardial necrosis.
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Affiliation(s)
- J Ravkilde
- Department of Medicine and Cardiology, Aarhus University Hospital, Denmark
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Rej R. Accurate enzyme activity measurements. Two decades of development in the commutability of enzyme quality control materials. Arch Pathol Lab Med 1993; 117:352-64. [PMID: 8466397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Commercial serum preparations are integral components of both internal and external quality control programs for enzyme activity measurements. However, properties of these materials may differ significantly from those of clinical specimens. Differences from clinical specimens may include the following: species origin of the enzyme; isoenzyme form(s); integrity of the molecular species; matrix of the solution; processes such as lyophilization; and addition of preservatives. There are also significant differences among methods measuring the activity of a single enzyme including a diversity of compounds that may serve as substrate(s); variable cofactor or metal supplementation; and differences in the substrate concentration(s), buffer substances, pH, and temperature. The measured response to each of these variations in assay technique may differ among these types of specimens. To be acceptable, quality control materials must have properties similar to those of clinical specimens. Thus, the concept of commutability that we originated and first applied to enzyme activity measurements remains useful, and its further application to the problem of "matrix effects" is reviewed here. Multivariate display techniques are applied to the specific examples of aspartate aminotransferase, alpha-amylase, and alkaline phosphatase to judge the commutability of quality control materials for these enzymes.
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Affiliation(s)
- R Rej
- Biochemistry Laboratory, Wadsworth Center for Laboratories and Research, New York State Department of Health, Albany 12201-0509
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Rej R, Jenny RW. How good are clinical laboratories? An assessment of current performance. Clin Chem 1992; 38:1210-7; discussion 1218-25. [PMID: 1623585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The Clinical Laboratory Improvement Act of 1967 and Amendments of 1988 (CLIA '67 and CLIA '88) were enacted to ensure that clinical laboratories within the U.S. provide a quality of service that meets clinical needs for good patient care. Approved proficiency-testing programs are to judge the quality of laboratory testing by promulgated performance criteria. We examine the quality of analytical results reported in 1991 to the New York State Department of Health Proficiency Testing program in light of these criteria and analytical goals, based on medical usefulness. Analytical performance is examined for cholesterol, potassium, sodium, calcium, glucose, aspartate aminotransferase, digoxin, and theophylline. In general, proposed CLIA '88 performance standards are compatible with the current state of practice for the population of laboratories examined. Exceptions appear to be digoxin and sodium (failure rate exceeding average) and most therapeutic substances (low failure rate). Sources of analytical bias relative to an accuracy-based target value must be characterized as method-, laboratory-, or matrix-dependent if regulatory programs are to achieve the objective of improving analytical accuracy across all testing sites.
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Affiliation(s)
- R Rej
- Wadsworth Center for Laboratories and Research, New York State Department of Health, Albany
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