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San Martín SP, Bauçà JM, Martinez-Morillo E. Determination of aluminum concentrations in biological specimens: application in the clinical laboratory. Adv Lab Med 2022; 3:153-166. [PMID: 37361866 PMCID: PMC10197291 DOI: 10.1515/almed-2022-0056] [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] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/31/2022] [Indexed: 06/28/2023]
Abstract
Aluminum enters the body primarily through diet or occupational exposure, and is cleared through urine. However, this trace element may accumulate and cause toxicity in subjects with renal insufficiency, and even in dialysis patients. The mechanism of aluminum toxicity is related to increased oxidative and inflammatory stress, iron and calcium dyshomeostasis, or cholinergic dysregulation, among other. A review was conducted on the specimens and analytical methods used to determine aluminum in biological specimens and dialysis water. This paper describes the most relevant aspects related to quality assurance. This is a practical guideline for the development and implementation of a reliable method for determination of aluminum in the clinical laboratory. Serum aluminum is the main biomarker of toxicity. For cases of chronic exposure, urine testing is recommended. At present, inductively coupled plasma mass spectrometry (ICP-MS) is the gold-standard determination method, since it has been proven to have the best quantification limits, selectivity and robustness. Clear recommendations are provided in relation to the specimens used for aluminum determination. Relevant pre-analytical, analytical, and post-analytical considerations are also presented.
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Affiliation(s)
- Sonia Pérez San Martín
- Servicio de Análisis Clínicos, Hospital Universitario de Cabueñes, Gijón, Spain
- Comisión de Elementos traza, Sociedad Española de Medicina de Laboratorio, Barcelona, Spain
| | - Josep Miquel Bauçà
- Comisión de Elementos traza, Sociedad Española de Medicina de Laboratorio, Barcelona, Spain
- Servicio de Análisis Clínicos, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Eduardo Martinez-Morillo
- Comisión de Elementos traza, Sociedad Española de Medicina de Laboratorio, Barcelona, Spain
- Servicio de Análisis Clínicos y Bioquímica Clínica, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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2
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Badal B, Ballesteros A, Crespo M, Morell-Garcia D, Bauçà JM, Pastor M, Ruiz de Gopegui R, Martín I. Quality control of ultrasonography markers for Down's syndrome screening: a retrospective study by the laboratory. Diagnosis (Berl) 2021; 0:dx-2021-0007. [PMID: 34090321 DOI: 10.1515/dx-2021-0007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/27/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Quality control of ultrasonography markers is necessary to ensure greater efficacy of prenatal aneuploidy screening. The aim of this study was to assess the quality of the crown-rump length (CRL) and nuchal translucence (NT) measurement accuracy by the laboratory according to quality indicators. METHODS Retrospective observational study on 4,908 single-foetus pregnant women who underwent prenatal aneuploidy screening in the first trimester of pregnancy. Euploid foetuses with CRL between 45 and 84 mm were included, while those with NT≥3.5 mm were excluded. CRL measurement was considered to be accurate if the median multiples of the median (MoM) for pregnancy-associated plasma protein A (PAPP-A) was between 0.90 and 1.10. Fifteen sonographers participated in the study, six of whom comprised the control group. Systematic error for a sonographer was considered when CRL measurement was greater than ±2 mm with respect to the control group. Quality for NT was assured by means of the WHIRI method and each sonographer cumulative sum control chart (CUSUM). RESULTS For CRL accuracy, five sonographers underestimated the measurements, while another four overestimated them, with no statistical differences. For smaller sized foetuses, all sonographers met the established specifications. Regarding NT control, three sonographers did not meet the quality criteria for the median MoM. All sonographers met the specifications for the logarithmic standard deviation of the NT MoM levels. Thirteen sonographers met the CUSUM specifications. CONCLUSIONS Evaluation of a quality control of ultrasonography parameters by laboratory professionals is necessary to avoid under- or overestimation tendencies for CRL and NT measurements. CUSUM is a useful tool for the immediate correction of errors in NT measurements.
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Affiliation(s)
- Blanca Badal
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Antonieta Ballesteros
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Miriam Crespo
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Daniel Morell-Garcia
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
- Institut de Recerca Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Josep Miquel Bauçà
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
- Institut de Recerca Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Maria Pastor
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Rosa Ruiz de Gopegui
- Gynecology and Obstetrics Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Inmaculada Martín
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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3
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Cadamuro J, Hillarp A, Unger A, von Meyer A, Bauçà JM, Plekhanova O, Linko-Parvinen A, Watine J, Leichtle A, Buchta C, Haschke-Becher E, Eisl C, Winzer J, Kristoffersen AH. Presentation and formatting of laboratory results: a narrative review on behalf of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group "postanalytical phase" (WG-POST). Crit Rev Clin Lab Sci 2021; 58:329-353. [PMID: 33538219 DOI: 10.1080/10408363.2020.1867051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In laboratory medicine, much effort has been put into analytical quality in the past decades, making this medical profession one of the most standardized with the lowest rates of error. However, even the best analytical quality cannot compensate for errors or low quality in the pre or postanalytical phase of the total testing process. Guidelines for data reporting focus solely on defined data elements, which have to be provided alongside the analytical test results. No guidelines on how to format laboratory reports exist. The habit of reporting as much diagnostic data as possible, including supplemental information, may lead to an information overload. Considering the multiple tasks physicians have to do simultaneously, unfiltered data presentation may contribute to patient risk, as important information may be overlooked, or juxtaposition errors may occur. As laboratories should aim to answer clinical questions, rather than providing sole analytical results, optimizing formatting options may help improve the effectiveness and efficiency of medical decision-making. In this narrative review, we focus on the underappreciated topic of laboratory result reporting. We present published literature, focusing on the impact of laboratory result report formatting on medical decisions as well as approaches, potential benefits, and limitations for alternative report formats. We discuss influencing variables such as, for example, the type of patient (e.g. acute versus chronic), the medical specialty of the recipient of the report, the display of reference intervals, the medium or platform on which the laboratory report is presented (printed paper, within electronic health record systems, on handheld devices, etc.), the context in which the report is viewed in, and difficulties in formatting single versus cumulative reports. Evidence on this topic, especially experimental studies, is scarce. When considering the medical impact, it is of utmost importance that laboratories focus not only on the analytical aspects but on the total testing process. The achievement of high analytical quality may be of minor value if essential results get lost in overload or scattering of information by using a non-formatted tabular design. More experimental studies to define guidelines and to standardize effective and efficient reporting are most definitely needed.
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Affiliation(s)
- Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Hillarp
- Department of Clinical Chemistry, Halland Hospital, Halmstad, Sweden
| | | | - Alexander von Meyer
- Institute for Laboratory Medicine and Medical Microbiology, Medizet, München-Klinik, Munich, Germany
| | - Josep Miquel Bauçà
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain
| | - Olga Plekhanova
- Laboratory Diagnostics Center, State Clinical Hospital No. 67 named after L.A. Vorokhobov Moscow Healthcare Department, Moscow, Russia
| | - Anna Linko-Parvinen
- Laboratory of Haematology, Tykslab, Laboratory Division, Turku University Hospital, Turku, Finland
| | - Joseph Watine
- Laboratoire de Biologie Médicale, Hôpital de Villefranche-de-Rouergue, France
| | - Alexander Leichtle
- University Institute of Clinical Chemistry, Inselspital - Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christoph Buchta
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | | | - Christoph Eisl
- School of Business & Management, University of Applied Sciences Upper Austria, Steyr, Austria
| | - Johannes Winzer
- School of Business & Management, University of Applied Sciences Upper Austria, Steyr, Austria
| | - Ann Helen Kristoffersen
- Department of Medical Biochemistry and Pharmacology, Laboratory Clinic, Haukeland University Hospital and Noklus, Haraldsplass Deaconess Hospital, Bergen, Norway
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Bauçà JM, Imperiali CE, Robles J, Díaz-Garzón J, Vuljanic D, Begovic E, Tikhonov A, Alic L, Nikler A, Simundic AM. Thoughts and expectations of young professionals about the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). Clin Chem Lab Med 2021; 59:71-77. [DOI: 10.1515/cclm-2020-0717] [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: 05/14/2020] [Accepted: 06/07/2020] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Young laboratory medicine professionals (YLMPs) are the future of clinical laboratories. Although everyday practice shows significant differences among countries, especially during residency training, most of them face the same challenges. Besides promoting scientific, professional and clinical aspects of laboratory medicine in Europe, the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) should take into consideration YLMPs’ concerns and interests to help them achieve excellence. The aim of this survey was to assess the opinion and expectations of YLMPs about their involvement in the activities of EFLM.
Methods
An online survey was distributed to YLMPs in Europe through different channels. The questionnaire consisted of 21 items grouped into five sections: demographic questions, opinion about the current status of YLMPs within EFLM, YLMPs network, suggestions and opportunities, and scientific training and exchange. Where appropriate, responses from residents and specialists were compared.
Results
A total of 329 valid responses were obtained from 53 different countries. Countries with the highest number of participants were Spain, Turkey, Croatia and Romania. A significant percentage would like to know more about EFLM and their activities (86%) and wish EFLM promoted networking and scientific exchanges (95%), for instance by means of a European YLMPs network (93%). EFLMLabX project was widely unknown (75%).
Conclusions
YLMPs demand better connection to share concerns about daily healthcare duties, to keep updated and to advance professionally. EFLM needs to improve their advertising through national societies to increase YLMPs’ participation. In addition to international meetings and congresses, respondents have emphasized that workshops and other small group activities would significantly help promote laboratory medicine practice in Europe.
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Affiliation(s)
- Josep Miquel Bauçà
- Department of Laboratory Medicine , Hospital Universitari Son Espases , Palma , Spain
| | | | - Juan Robles
- Department of Laboratory Medicine , Hospital Universitari Son Espases , Palma , Spain
| | - Jorge Díaz-Garzón
- Department of Laboratory Medicine , Hospital Universitario La Paz , Madrid , Spain
| | - Dora Vuljanic
- Department of Medical Laboratory Diagnostics , University Hospital “Sveti Duh” , Zagreb , Croatia
| | - Ermin Begovic
- Department of Medical Biochemistry and Immunology , Clinical Center University of Sarajevo , Sarajevo , Bosnia and Herzegovina
| | - Aleksei Tikhonov
- Laboratory of Biological Microchips , Engelhardt Institute of Molecular Biology, Russian Academy of Sciences , Moscow , Russia
| | - Lejla Alic
- Department of Medical Biochemistry, Faculty of Medicine , University of Sarajevo , Sarajevo , Bosnia and Herzegovina
| | - Ana Nikler
- Department of Medical Laboratory Diagnostics , University Hospital “Sveti Duh” , Zagreb , Croatia
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics , University Hospital “Sveti Duh” , Zagreb , Croatia
- Faculty of Pharmacy and Biochemistry , University of Zagreb , Zagreb , Croatia
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Mrazek C, Simundic AM, Salinas M, von Meyer A, Cornes M, Bauçà JM, Nybo M, Lippi G, Haschke-Becher E, Keppel MH, Oberkofler H, Felder TK, Cadamuro J. Inappropriate use of laboratory tests: How availability triggers demand - Examples across Europe. Clin Chim Acta 2020; 505:100-107. [PMID: 32084382 DOI: 10.1016/j.cca.2020.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 02/05/2020] [Revised: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The appropriate use of laboratory diagnostics is increasingly at stake. The aim of this study was to depict some paradigmatic examples of under- and overutilization, as well as possible solutions across Europe. METHODS We collected six examples from five European countries where a rise or decline of orders for specific laboratory parameters was observed after organizational changes but without evidence of changes in patient collective characteristics as source of this variation. RESULTS The collected examples were the following: 1-Germany) Switch from a Brain-Natriuretic-Peptide assay to NT-pro Brain-Natriuretic-Peptide assay, resulting in a 374% increase in these analytics; 2-Spain) Implementation of a gatekeeping strategy in tumor marker diagnostics, resulting in a 15-61% reduction of these diagnostics; 3-Croatia) Stepwise elimination of creatine-kinase-MB assay from the laboratory portfolio; 4-UK) Removal of γ-glutamyl transferase from a "liver function" profile, resulting in 82% reduction of orders; 5-Austria) Implementation of a new device for rapid Influenza-RNA detection, resulting in a 450% increase of Influenza testing; 6-Spain) Insourcing of 1,25-(OH)2-Vitamin D measurements, leading to a 378% increase of these analyses. CONCLUSION The six paradigmatic examples described in this manuscript show that availability of laboratory resources may considerably catalyze the demand, thus underscoring that inappropriate use of laboratory resources may be commonplace in routine laboratories all across Europe and most probably beyond. They also demonstrate that the application of simple strategies may assist in overcoming this issue. We believe that laboratory specialists need to refocus on the extra-analytical parts of the testing process and engage more in interdisciplinary patient-care.
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Affiliation(s)
- Cornelia Mrazek
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia; Faculty of Pharmacy and Biochemistry, University of Zagreb, Croatia
| | - Maria Salinas
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Alexander von Meyer
- Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany
| | - Michael Cornes
- Biochemistry Department, Worcester Acute Hospitals NHS Trust, Worcester, UK
| | - Josep Miquel Bauçà
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain
| | - Mads Nybo
- Dept. of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | | | - Martin H Keppel
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Hannes Oberkofler
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Thomas K Felder
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria.
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Gómez-Rioja R, Segovia Amaro M, Diaz-Garzón J, Bauçà JM, Martínez Espartosa D, Fernández-Calle P. A protocol for testing the stability of biochemical analytes. Technical document. ACTA ACUST UNITED AC 2019; 57:1829-1836. [DOI: 10.1515/cclm-2019-0586] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 01/01/2023]
Abstract
Abstract
Stability of a measurand in a specimen is a function of the property variation over time in specific storage conditions, which can be expressed as a stability equation, and is usually simplified to stability limits (SLs). Stability studies show differences or even inconsistent results due to the lack of standardized experimental designs and heterogeneity of the chosen specifications. Although guidelines for the validation of sample collection tubes have been published recently, the measurand stability evaluation is not addressed. This document provides an easy guideline for the development of a stability test protocol based on a two-step process. A preliminary test is proposed to evaluate the stability under laboratory habitual conditions. The loss of stability is assessed by comparing measurement values of two samples obtained from the same patient and analyzed at different time points. One of them is analyzed under optimal conditions (basal sample). The other is stored under specific stability conditions for a time set by the laboratory (test sample). Differences are expressed using percentage deviation (PD%) to facilitate comparison with specifications. When the preliminary test demonstrates instability, a comprehensive test is proposed in order to define the stability equation and to specify SLs. Several samples are collected from a set of patients. The basal sample is analyzed under optimal conditions, whereas analysis of test samples is delayed at time intervals. For each patient PD% is calculated as the difference between measurements for every test sample and its basal one and represented in a coordinate graph versus time.
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Affiliation(s)
- Rubén Gómez-Rioja
- Laboratory Medicine Department , La Paz-Cantoblanco-Carlos III University Hospital , Madrid , Spain
| | - Marta Segovia Amaro
- Laboratory Medicine Department , La Paz-Cantoblanco-Carlos III University Hospital , Madrid , Spain
| | - Jorge Diaz-Garzón
- Laboratory Medicine Department , La Paz-Cantoblanco-Carlos III University Hospital , Madrid , Spain
| | - Josep Miquel Bauçà
- Laboratory Medicine Department , Hospital Universitari Son Espases , Palma , Spain
| | | | - Pilar Fernández-Calle
- Laboratory Medicine Department , La Paz-Cantoblanco-Carlos III University Hospital , Madrid , Spain
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Scrimini S, Pons J, Agustí A, Clemente A, Sallán MC, Bauçà JM, Soriano JB, Cosio BG, Lopez M, Crespi C, Sauleda J. Expansion of myeloid-derived suppressor cells in chronic obstructive pulmonary disease and lung cancer: potential link between inflammation and cancer. Cancer Immunol Immunother 2015; 64:1261-70. [PMID: 26122358 PMCID: PMC11029165 DOI: 10.1007/s00262-015-1737-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 10/09/2014] [Accepted: 06/15/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a risk factor for lung cancer (LC). Myeloid-derived suppressor cells (MDSCs) down-regulate the T cell receptor ζ chain (TCR ζ) through L-arginine deprivation and lead to T cell dysfunction and deficient antitumor immunity. We hypothesized that abnormally high levels of MDSCs in COPD patients may alter tumor immunosurveillance. METHODS We compared the proportion of circulating MDSCs (Lin-HLA-DR-/CD33+/CD11b+) (by flow cytometry), arginase I (ARG I) serum levels (by ELISA), and expression levels of TCR ζ on circulating lymphocytes (by flow cytometry) in 28 patients with LC, 62 subjects with COPD, 41 patients with both LC and COPD, 40 smokers with normal spirometry and 33 non-smoking controls. T cell proliferation assays were performed in a subgroup of participants (CFSE dilution protocol). RESULTS We found that: (1) circulating MDSCs were up-regulated in COPD and LC patients (with and without COPD); (2) MDSCs expansion was associated with TCR ζ down-regulation in the three groups; (3) in LC patients, these findings were independent of COPD and tobacco smoking exposure; (4) TCR ζ down-regulation correlates with T cell hyporesponsiveness in COPD and LC patients. CONCLUSIONS These results suggest that tumor immunosurveillance might be impaired in COPD and may contribute to the increased risk of LC reported in these patients.
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Affiliation(s)
- Sergio Scrimini
- Instituto de Investigación Sanitaria de Palma, (IdISPa), Hospital Universitari Son Espases, C/Valldemossa 79, Planta 0, Mod. C, 07010 Palma de Mallorca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Palma de Mallorca, Spain
- Servicio de Neumología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Jaume Pons
- Instituto de Investigación Sanitaria de Palma, (IdISPa), Hospital Universitari Son Espases, C/Valldemossa 79, Planta 0, Mod. C, 07010 Palma de Mallorca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Palma de Mallorca, Spain
- Servicio de Inmunología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Alvar Agustí
- Instituto de Investigación Sanitaria de Palma, (IdISPa), Hospital Universitari Son Espases, C/Valldemossa 79, Planta 0, Mod. C, 07010 Palma de Mallorca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Palma de Mallorca, Spain
- Institut Clínic del Tòrax, Hospital Clinic, Institut D’investigacions Biomdiques August PI i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Antonio Clemente
- Instituto de Investigación Sanitaria de Palma, (IdISPa), Hospital Universitari Son Espases, C/Valldemossa 79, Planta 0, Mod. C, 07010 Palma de Mallorca, Spain
- Servicio de Inmunología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Marta Crespí Sallán
- Instituto de Investigación Sanitaria de Palma, (IdISPa), Hospital Universitari Son Espases, C/Valldemossa 79, Planta 0, Mod. C, 07010 Palma de Mallorca, Spain
| | - Josep Miquel Bauçà
- Servicio de Análisis Clínicos, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Joan B. Soriano
- Instituto de Investigación Sanitaria de Palma, (IdISPa), Hospital Universitari Son Espases, C/Valldemossa 79, Planta 0, Mod. C, 07010 Palma de Mallorca, Spain
| | - Borja G. Cosio
- Instituto de Investigación Sanitaria de Palma, (IdISPa), Hospital Universitari Son Espases, C/Valldemossa 79, Planta 0, Mod. C, 07010 Palma de Mallorca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Palma de Mallorca, Spain
- Servicio de Neumología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Meritxel Lopez
- Instituto de Investigación Sanitaria de Palma, (IdISPa), Hospital Universitari Son Espases, C/Valldemossa 79, Planta 0, Mod. C, 07010 Palma de Mallorca, Spain
- Servicio de Neumología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Catalina Crespi
- Instituto de Investigación Sanitaria de Palma, (IdISPa), Hospital Universitari Son Espases, C/Valldemossa 79, Planta 0, Mod. C, 07010 Palma de Mallorca, Spain
| | - Jaume Sauleda
- Instituto de Investigación Sanitaria de Palma, (IdISPa), Hospital Universitari Son Espases, C/Valldemossa 79, Planta 0, Mod. C, 07010 Palma de Mallorca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Palma de Mallorca, Spain
- Servicio de Neumología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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Barceló A, Esquinas C, Bauçà JM, Piérola J, de la Peña M, Arqué M, Sánchez-de-la-Torre M, Alonso-Fernández A, Barbé F. Effect of CPAP treatment on plasma high sensitivity troponin levels in patients with obstructive sleep apnea. Respir Med 2014; 108:1060-3. [PMID: 24797213 DOI: 10.1016/j.rmed.2014.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with an increased prevalence of cardiovascular diseases. New generations of highly sensitive assays for cardiac troponin (hs-cTnT) have been introduced recently, and a number of clinical observations have challenged the notion that troponins are only increased in blood following irreversible necrosis. OBJECTIVE The aims of this study were to compare the levels of hs-cTnT between a group of healthy controls and a group of patients with OSA without co-existent coronary artery disease, and to assess the possible influence of the treatment with Continuous positive airway pressure (CPAP) on these levels. METHODS The study population included 200 male participants. The case (n = 133) or control (n = 67) status was defined by an apnea-hypopnea index of 10 or greater. The hs-cTnT assay was validated as reported previously, with a limit of detection of 3 ng/L and an upper reference limit (99th percentile) of 14 ng/L. RESULTS The proportion of subjects with detectable plasma hs-cTnT was higher in patients with OSA than in controls (61 vs 75%, p = 0.04). In patients, a significant increase in hs-cTnT levels was observed after an effective treatment with CPAP (7.3 ± 3.4 vs 10.1 ± 4.9 ng/L; p < 0.01). CONCLUSION This study shows that the percentage of subjects with detectable hs-cTnT is associated with the presence of OSA. It also evidences that treatment with CPAP is followed by a rise in hs-cTnT concentrations. It is reasonable to suggest that CPAP therapy might induce a potential degree of cardiac stress, resulting in deleterious consequences for the heart.
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Affiliation(s)
- Antonia Barceló
- Servei d'Anàlisis Cliniques Hospital Universitari Son Espases, Palma de Mallorca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.
| | - Cristina Esquinas
- Servei de Pneumologia, Hospital Arnau de Vilanova, IRB Lleida, Spain
| | - Josep Miquel Bauçà
- Servei d'Anàlisis Cliniques Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Javier Piérola
- Unitat d'Investigació, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Mónica de la Peña
- Servei de Pneumologia, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Meritxell Arqué
- Servei de Pneumologia, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Manuel Sánchez-de-la-Torre
- Servei de Pneumologia, Hospital Arnau de Vilanova, IRB Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Alberto Alonso-Fernández
- Servei de Pneumologia, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Ferran Barbé
- Servei de Pneumologia, Hospital Arnau de Vilanova, IRB Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
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Barceló A, Piérola J, Esquinas C, de la Peña M, Arqué M, Alonso-Fernández A, Bauçà JM, Robles J, Barceló B, Barbé F. Relationship between aldosterone and the metabolic syndrome in patients with obstructive sleep apnea hypopnea syndrome: effect of continuous positive airway pressure treatment. PLoS One 2014; 9:e84362. [PMID: 24465407 PMCID: PMC3896347 DOI: 10.1371/journal.pone.0084362] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 11/21/2013] [Indexed: 02/04/2023] Open
Abstract
Background Metabolic syndrome (MS) occurs frequently in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). We hypothesized that aldosterone levels are elevated in OSAHS and associated with the presence of MS. Methods We studied 66 patients with OSAHS (33 with MS and 33 without MS) and 35 controls. The occurrence of the MS was analyzed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) clinical criteria. Measurements of plasma renin activity (PRA), aldosterone, aldosterone:PRA ratio, creatinine, glucose, triglycerides, cholesterol and HDL cholesterol were obtained at baseline and after CPAP treatment. Results Aldosterone levels were associated with the severity of OSAHS and higher than controls (p = 0.046). Significant differences in aldosterone levels were detected between OSAHS patients with and without MS (p = 0.041). A significant reduction was observed in the aldosterone levels in patients under CPAP treatment (p = 0.012). Conclusion This study shows that aldosterone levels are elevated in OSAHS in comparison to controls, and that CPAP therapy reduces aldosterone levels. It also shows that aldosterone levels are associated with the presence of metabolic syndrome, suggesting that aldosterone excess might predispose or aggravate the metabolic and cardiovascular complications of OSAHS. Trial registration The study is not a randomized controlled trial and was not registered.
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Affiliation(s)
- Antonia Barceló
- Servei d'Anàlisis Cliniques, Hospital Universitari Son Espases, Palma de Mallorca; Servei de Pneumologia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Mallorca, Illes Balears, Spain
- * E-mail:
| | - Javier Piérola
- Unitat d'Investigació Hospital Universitari Son Espases, Palma de Mallorca; Servei de Pneumologia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Mallorca, Illes Balears, Spain
| | | | - Mónica de la Peña
- Pneumologia, Hospital Universitari Son Espases, Palma de Mallorca; Servei de Pneumologia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Mallorca, Illes Balears, Spain
| | - Meritxell Arqué
- Unitat d'Investigació Hospital Universitari Son Espases, Palma de Mallorca; Servei de Pneumologia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Mallorca, Illes Balears, Spain
| | - Alberto Alonso-Fernández
- Pneumologia, Hospital Universitari Son Espases, Palma de Mallorca; Servei de Pneumologia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Mallorca, Illes Balears, Spain
| | - Josep Miquel Bauçà
- Servei d'Anàlisis Cliniques, Hospital Universitari Son Espases, Palma de Mallorca; Servei de Pneumologia, Spain
| | - Juan Robles
- Servei d'Anàlisis Cliniques, Hospital Universitari Son Espases, Palma de Mallorca; Servei de Pneumologia, Spain
| | - Bernardino Barceló
- Servei d'Anàlisis Cliniques, Hospital Universitari Son Espases, Palma de Mallorca; Servei de Pneumologia, Spain
| | - Ferran Barbé
- Hospital Arnau de Vilanova/Santa Maria, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Mallorca, Illes Balears, Spain
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