[Factor XI deficiency: actuality and review of the literature]

Although two clusters have been identified in France, constitutional factor XI deficiency is a rare disorder. Acquired factor XI deficiency is extremely rare. The management of factor XI deficiency is not staightforward because of the unpredictable bleeding tendency that does not clearly relate to the factor XI level. Other haemostastis parameters have to be taken into account to evaluate the bleeding tendency. We report the cases of a congenital factor XI deficiency, an acquired factor XI deficiency and a von Willebrand disease associated to a factor XI deficiency. On the other hand, some interferences can lead to underestimation of factor XI and we report the case of an interference by lupus anticoagulant. The objective of this review is to better understand how to manage a reduced factor XI level.

Establishing hemolysis, icterus, and lipemia interference limits for body fluid chemistry analytes measured on the Roche cobas instrument

OBJECTIVES

The aims of this study were to (1) establish the maximum allowable interference limits for hemolysis, lipemia, and icterus for chemistry analytes tested in body fluid samples and (2) assess the effectiveness of serial dilution to mitigate spectral interferences.

METHODS

Residual body fluids from clinically ordered testing were mixed (<10% by volume) with stock solutions of interferent (spiked) and compared with a control spiked with an equal volume of 0.9% saline. The analytes were measured on the Roche cobas c501 instrument. Difference and percentage difference were calculated and compared with allowable total error limits. A subset of samples were serially diluted with 0.9% saline. Mean (SD) difference and percentage difference were calculated.

RESULTS

The interference thresholds were lower than the package insert for lactate dehydrogenase, cholesterol, triglycerides, and total protein for hemolysis; amylase, cholesterol, and total protein for icterus; and albumin for lipemia. Only cholesterol and triglyceride results returned to baseline upon dilution of icteric samples.

CONCLUSIONS

Interference thresholds in body fluids were lower than blood for 6 analytes. Diluting interferences that surpass these limits does not produce reliable results that are comparable to the baseline results before spiking in the interferent.

Evusheld, a SARS-CoV-2 spike protein-directed attachment inhibitor, appears in serum protein electrophoresis and immunofixation: a case study

Serum protein electrophoresis (SPE) and immunofixation (IFE) assays are commonly used to diagnose and monitor patients with multiple myeloma (MM). Identifying analytical interferences in SPE and IFE caused by therapeutic monoclonal antibodies (tmAbs) can be challenging. Here we report the case of a 72-year-old male with a long history of relapsed immunoglobulin (Ig)G kappa MM. A follow-up SPE showed the original peak plus 2 additional cathode peaks. Immunofixation was ordered as a reflex test to investigate the new peaks that showed initial patient monoclonal IgG kappa in addition to 2 restricted bands of the IgG kappa type. Therapeutic monoclonal antibody interference was suspected and the patient's chart was reviewed. The patient was not on any antimyeloma monoclonal antibody therapy. However, preexposure prophylaxis therapeutic monoclonal antibodies tixagevimab plus cilgavimab (Evusheld) for severe acute SARS-CoV-2 was administered approximately 45 minutes before sample collection, which led to the identifiable spikes and correlated bands. After 2 days, the IgG kappa bands disappeared, confirming this therapy's effect on SPE and IFE. Therefore, clinical pathologists should be aware of when providers prescribe new monoclonal antibody therapy and become familiar with the position of commonly prescribed (tmAbs) therapies at their institutions.

Best Practice for Identification of Classical 21-Hydroxylase Deficiency Should Include 21 Deoxycortisol Analysis with Appropriate Isomeric Steroid Separation

There are mixed reports on the inclusion and use of 21 deoxycortisol (21DF) as the primary decision marker for classical 21-hydroxylase deficiency. We hypothesize that this may be due to insufficient recognition of the presence and chromatographic separation of isomeric steroids. The aim of this study was to determine the comparative utility of 21DF for screening and diagnosis of CAH due to classical 21-hydroxylase deficiency using a second-tier LC-MS/MS method that included the separation of isomeric steroids to 17OHP and 21DF. For each baby sample, one 3.2 mm dried blood spot was eluted in a methanolic solution containing isotopically matched internal standards. Data were interrogated by univariate and receiver operator characteristic analysis. Steroid profile results were generated for 924 non-CAH baby samples (median gestational age 37 weeks, range 22 to 43 weeks) and 17 babies with 21-hydroxylase deficiency. The ROC curves demonstrated 21DF to have the best sensitivity and specificity for the diagnosis of classical 21-hydroxylase deficiency with an AUC = 1.0. The heatmap showed the very strong correlation (r = 0.83) between 17OHP and 21DF. Our data support 21DF as a robust marker for CAH due to 21-hydroxylase deficiency. We recommend that 21DF be incorporated into routine newborn screening panels as part of the second-tier LC-MS/MS method, follow-up plasma steroid panels, and external quality assurance material.

Adsorptive Stripping Voltammetry for Determination of Vanadium: A Review

The main purpose of this review is to present methods of adsorptive stripping voltammetry that can be used to determine trace amounts of VO₂⁽⁺⁾ in various types of samples. The detection limits achieved using different working electrodes are presented. The factors influencing the obtained signal, including the selection of the complexing agent and the selection of the working electrode, are shown. For some methods, in order to increase the range of applied concentrations in which vanadium can be detected, a catalytic effect is introduced to adsorptive stripping voltammetry. The influence of the foreign ions and organic matter contained in natural samples on the vanadium signal is analyzed. This paper presents methods of elimination associated with the presence of surfactants in the samples. The methods of adsorptive stripping voltammetry for the simultaneous determination of vanadium with other metal ions are also characterized below. Finally, the practical use of the developed procedures, mainly for the analysis of food and environmental samples, is summarized in a tabular version.

Cross-Linkable Polymer-Based Multi-layers for Protecting Electrochemical Glucose Biosensors against Uric Acid, Ascorbic Acid, and Biofouling Interferences

The lifetime of implantable electrochemical glucose monitoring devices is limited due to the foreign body response and detrimental effects from ascorbic acid (AA) and uric acid (UA) interferents that are components of physiological media. Polymer coatings can be used to shield biosensors from these interferences and prolong their functional lifetime. This work explored several approaches to protect redox polymer-based glucose biosensors against such interferences by designing six targeted multi-layer sensor architectures. Biological interferents, like cells and proteins, and UA and AA interferents were found to have individual effects on the current density and operational stability of glucose biosensors, requiring individual protection and treatment. Protection against biofouling can be achieved using a poly(2-methacryloyloxyethyl phosphorylcholine-co-glycidyl methacrylate) (MPC) zwitterionic polymer coating. An enzyme-scavenging approach was compared to electrostatic repulsion by negatively charged polymers for protection against AA and UA interferences. A multi-layer novel polymer design (PD) system consisting of a cross-linkable negatively charged polyvinylimidazole-polysulfostyrene co-polymer inner layer and a cross-linkable MPC zwitterionic polymer outer layer showed the best protection against AA, UA, and biological interferences. The sensor protected using the novel PD shield displayed the lowest mean absolute relative difference between the glucose reading without the interferent and the reading value with the interferent present and also displayed the lowest variability in sensor readings in complex media. For sensor measurements in artificial plasma, the novel PD extends the linear range (R² = 0.99) of the sensor from 0-10 mM for the control to 0-20 mM, shows a smaller decrease in sensitivity, and retains high current densities. The application of PD multi-target coating improves sensor performance in complex media and shows promise for use in sensors operating in real conditions.

The Use of Sacrificial Graphite-like Coating to Improve Fusion Efficiency of Copper in Selective Laser Melting

Thin and ultrathin carbon films reduce the laser energy required for copper powder fusion in selective laser melting (SLM). The low absorption of infrared (IR) radiation and its excellent thermal conductivity leads to an intricate combination of processing parameters to obtain high-quality printed parts in SLM. Two carbon-based sacrificial thin films were deposited onto copper to facilitate light absorption into the copper substrates. Graphite-like (3.5 µm) and ultra-thin (25 nm) amorphous carbon films were deposited by aerosol spraying and direct current magnetron sputtering, respectively. The melting was analyzed for several IR (1.06 µm) laser powers in order to observe the coating influence on the energy absorption. Scanning electron microscopy showed the topography and cross-section of the thermally affected area, electron backscatter diffraction provided the surface chemical composition of the films, and glow-discharge optical emission spectroscopy (GDOES) allowed the tracking of the in-deep chemical composition of the 3D printed parts using carbon film-covered copper. Ultra-thin films of a few tens of nanometers could reduce fusion energy by about 40%, enhanced by interferences phenomena. Despite the lower energy required, the melting maintained good quality and high wettability when using top carbon coatings. A copper part was SLM printed and associated with 25 nm of carbon deposition between two copper layers. The chemical composition analysis demonstrated that the carbon was intrinsically removed during the fusion process, preserving the high purity of the copper part.

Characterization of the Ability of Low-Cost GNSS Receiver to Detect Spoofing Using Clock Bias

The aim of this paper was to propose a method to characterize the ability of a GNSS user to detect a spoofing attack from the behavior of the clock bias. Spoofing interference is not a new issue, especially in military GNSS, although it is a new challenge for civil GNSS, since it is currently implemented and used in many everyday applications. For this reason, it is still a topical issue, especially for receivers that only have access to high-level data (PVT,CN0). To address this important issue, after conducting a study of the receiver clock polarization calculation process, this led to the development of a very basic Matlab model that emulates a spoofing attack at the computational level. Using this model, we were able to observe that the clock bias is affected by the attack. However, the amplitude of this disturbance depends on two factors: the distance between the spoofer and the target and the synchronization between the clock that generates the spoofing signal and the reference clock of the constellation. To validate this observation, more or less synchronized spoofing attacks were carried out on a fixed commercial GNSS receiver with the use of GNSS signal simulators and also with a moving target. We propose then a method to characterize the capacity of detecting a spoofing attack with the clock bias behavior. We present the application of this method for two commercial receivers of the same manufacturer from different generations.

False positive result of human chorionic gonadotropin caused by human anti-mouse antibodies

Immunochemical reactions are fast, can be automated, and generally do not require pretreatment of biological material. Based on these advantages, they are widely used. On the other hand, they are susceptible to analytical interference that can lead to inaccurate results. These factors include the presence of anti-mouse antibodies, causing false positive (or sometimes false negative) results. Although the anti-mouse antibodies over many decades have been repeatedly identified to be the causative source but due to the rarity of such encounters they remain insufficiently considered. Here we show a case, a 45 year-old female who was mis-diagnosed with pregnancy due to falsely elevated human chorionic gonadotropin (hCG) due to anti-mouse antibodies. This led to the patient undergoing two ultrasound examinations and laparoscopy before the hCG was repeated on alternative assays which showed negative results, preventing the patient from methotrexate treatment. Here we describe the details of the case, outline the assay principal, supporting the finding from literature and outlining a process on how to identify such interferences in timely manner.

Point of care blood glucose devices in the hospital setting

Dysglycemia is common among hospitalized patients. Accurate point-of-care (POC) glucose monitoring is necessary for the safe administration of insulin. Unfortunately, POC glucose meters are not all created equal. Interfering factors such as abnormal hematocrit, abnormal oxygen tension, and oxidizing/reducing substances can lead to inaccurate glucose measurements and result in inappropriate insulin dosing. The introduction of autocorrecting glucose meters has changed the POC testing landscape. Autocorrecting glucose meters provide more accurate measurements and have been associated with improved glycemic control in hospitalized patients. Continuous glucose monitoring has also created interest in using these platforms in at-risk inpatient populations. Future glucose monitoring technologies such as artificial intelligence/machine learning, wearable smart devices, and closed-loop insulin management systems are poised to transform glycemic management. The goal of this review is to provide an overview of glucose monitoring technology, summarize the clinical impact of glucose monitoring accuracy, and highlight emerging and future POC glucose monitoring technologies.

A Macro-TSH: A Clinical Diagnostic Dilemma

Isolated increase in thyrotropin stimulating hormone (TSH) in a clinically euthyroid patient may be caused by the formation of a macromolecule between TSH and autoantibodies causing discordant thyroid function test results. Despite the effort to eliminate interferences in immunoassays, these assays are still vulnerable to different interferences. Immunoassay interferences may cause erroneous results and lead to misdiagnosis which may subject a patient to unnecessary investigations and treatment. Immunoassays are affected by multiple substances; these may be endogenous or exogenous such as heterophile antibodies, autoantibodies, macromolecules, and human anti-mouse antibodies. This case reports a 47-year-old African woman who presented with a persistent elevated TSH with thyroid hormones within normal reference limits. She was found to have a macro-TSH which was associated with IgA paraprotein.

The effect of burosumab on intact and C-terminal FGF23 measurements

OBJECTIVE

To investigate the effect of CRYSVITA® (burosumab-twza) on FGF23 measurements in an intact and a C-terminal immunoassay.

METHODS

An intact serum FGF23 (MedFrontier) and a C-terminal plasma FGF23 assay (Immutopics) were used. Serum/plasma pools were spiked to span the burosumab therapeutic range (1.4-11.3 μg/ml) and FGF23 recovery was assessed. Patient serum and plasma samples obtained pre and post-burosumab treatment were evaluated on both assays and compared with corresponding phosphorus measurements RESULTS: Spiking burosumab (1.4-11.3 μg/ml) into sample pools resulted in a dose-dependent negative analytical interference on intact FGF23 measurements and no significant interference for C-terminal FGF23 measurements. However, more than a 500-fold median increase (post- vs. pre-burosumab administration) in in vivo FGF23 concentrations were observed by both assays.

CONCLUSIONS

Therapeutic concentrations of burosumab result in a negative analytical interference of the intact, but not the C-terminal FGF23 immunoassay. Despite this in vitro analytical interference in the intact assay, relatively large elevations of both intact FGF23 and C-terminal FGF23 measurements were observed in vivo following burosumab administration. Following burosumab administration, FGF23 measurements must be interpreted within the clinical context of the patient and other relevant biomarker results.

SUMMARY

This article describes a negative analytical interference by burosumab in an intact FGF23 immunoassay. The recovery of C-terminal FGF23 is not significantly affected by the presence of burosumab. In vivo, both assays demonstrate extreme FGF23 elevations in the presence of the drug. Furthermore, the measurement of FGF23 blocked by burosumab is not clinically useful regarding hypophosphataemia.

A Reliable and Precise Protocol for Urea Quantification in Photo/Electrocatalysis

To comply with the trend toward green and sustainable development of the fine chemical industry, multitudinous promising technologies (e.g., photocatalysis and electrocatalysis) are beginning to dabble in the green synthesis of fine chemicals, particularly urea synthesis. Whilst numerous advances are made in mechanistic understanding, the low yield reported so far also imposes more stringent requirements on the reliability and anti-interference of the detection method. Herein, the applicability of frequently used methods for urea quantification is methodically compared. In terms of the experimental results, a precise and methodical protocol for urea quantification or evaluation in photo/electrocatalysis is explored and established, with emphasis on screening quantitative methods under specific conditions and indispensable isotopic tracing experiments. The budding urea photo/electrosynthesis urgently demands a rigorous protocol, including the rapid isotopic identification and evaluation criteria, capable of promoting healthy development in the future.

Dubiously increased FT4 and FT3 levels in clinically euthyroid patients: clinical finding or analytical pitfall?

OBJECTIVES

We systematically investigated normally or subclinically increased thyroid stimulating hormone (TSH) values associated with unexpectedly increased thyroxine (FT4) and free triiodothyronine (FT3) in findings of patients without any thyroid disease. Moreover, we looked for alternatives to overcome such states with an improved diagnostic procedure and to investigate the pathogenetic background of the respective patients.

METHODS

Samples with TSH concentrations within the range of 0.4-10 mU/L combined with increased concentrations of FT4 (n=120; Cobas, Roche) were collected over a period of around six years. Cobas FT4 results were compared with measurements from Liaison (DiaSorin) and Architect (Abbott) FT4 assays. For further validation all samples were measured for total thyroxine (TT4) (Cobas, Roche). Finally, FT3 and TT3 as complementary parameters were measured in samples with leftover material. To overcome potential analytical disturbances from stimulating heterophilic antibodies, we used heterophilic blocking tubes (HBTs).

RESULTS

From the 120 samples with increased FT4 concentrations by Cobas, 51/120 were also increased by Liaison, and 26/120 by Architect. However, the measurement of TT4 indicated only n=10/120 increased values. The number of increased FT3 (n=71) measurements was higher in Architect>Cobas>Liaison (28>27>9). TT3 levels of 70/71 samples were within the reference interval. HBTs were inappropriate to reduce unspecific immunoreactivity in our samples. No clear pathogenetic background could be elucidated in the anamnesis of individual patients.

CONCLUSIONS

To overcome dubious constellations of TSH, FT4, and FT3, it is helpful to measure TT4 and TT3 for control or to use an immunoassay with an alternative assay design for the respective parameters.

Device interaction between cardiac contractility modulation (CCM) and subcutaneous defibrillator (S-ICD)

Combined implantation of cardiac contractility modulation (CCM) with subcutaneous implantable cardioverter-defibrillator (S-ICD) appears a suitable option to reduce the amount of intracardiac leads and complications for patients. Here we report on a patient with ischemic cardiomyopathy carrying an S-ICD in which a CCM device was implanted. During crosstalk testing post-CCM implantation, the S-ICD misannotated QRS complexes and T waves. The problem was solved through reprogramming the CCM, while preserving S-ICD functionality and improving heart failure symptoms. In conclusion, S-ICD combined with CCM seems to be a good and safe option for patients when device interference is being ruled out.

Evaluation of a new point-of-care testing for creatinine and urea measurement

Point of care testing makes it possible to obtain results in an extremely short time. Recently, radiometer has expanded the panel of tests available on its ABL90 FLEX PLUS blood gas analyzer (ABL90) by adding urea and creatinine. The aim of this study was to verify the performance of these new parameters. This included assessment of imprecision, linearity, accuracy by comparison with central laboratory standard assays and interferences. In addition, clinical utility in a dialysis center was evaluated. Within-lab coefficients of variation were close to 2%. The mean and limits of agreement (mean ± 1.96 SD) of the difference between ABL90 and Roche enzymatic assays on cobas 8000 were 0.5 (from -1.4 to 2.3) mmol/L and -0.9 (from -19.5 to 17.8) µmol/L for urea and creatinine, respectively. The ABL90 enzymatic urea and creatinine assays met the acceptance criteria based on biological variation for imprecision and showed good agreement with central laboratory. The two assays were unaffected by hematocrit variation between 20 and 70%, hemolysis and icterus interferences. It should be noted that the relationship between lab methods and ABL90 was conserved even for high pre-dialysis values allowing easy access to dialysis adequacy parameters (Kt/V) and muscle mass evaluation (creatinine index). Rapid measurement of creatinine and urea using whole blood specimens on ABL90 appears as a fast and convenient method. Analytical performances were in accordance with our expectations without any significant interferences by hemolysis or icterus.

Delayed diagnosis and treatment of extreme hypertriglyceridemia due to rejection of a lipemic sample

Introduction

Most laboratories routinely determine haemolysis, icterus and lipemia indices to identify lipemic samples and reject potentially affected results. Hypertriglyceridemia is the most common cause of lipemia and severe hypertriglyceridemia (≥ 11.3 mmol/L) is a major risk factor of acute pancreatitis.

Laboratory analysis

A 56-year-old woman attended the outpatient clinic for a follow-up visit 1 month after a kidney transplantation. Her immunosuppressive therapy consisted of corticosteroids, cyclosporine, and mycophenolic acid. The routine clinical chemistry sample was rejected due to extreme lipemia. The comment "extreme lipemic sample" was added on the report, but the requesting physician could not be reached. The Cobas 8000 gave a technical error (absorption > 3.3) for the HIL-indices (L-index: 38.6 mmol/L) which persisted after high-speed centrifugation. The patient was given a new appointment 2 days later. The new sample was also grossly lipemic and gave the same technical error (L-index: 35.9 mmol/L).

What happened

The second sample was manually diluted 20-fold after centrifugation to obtain a result for triglycerides within the measuring range (0.10-50.0 mmol/L). Triglycerides were 169.1 mmol/L, corresponding to very severe hypertriglyceridemia. This result was communicated to the nephrologist and the patient immediately recalled to the hospital. She received therapeutic plasma exchange the next day and did not develop acute pancreatitis.

Main lesson

This case illustrates the delicate balance between avoiding the release of unreliable results due to lipemia and the risk of delayed diagnosis when results are rejected. Providing an estimate of the degree of hypertriglyceridemia might be preferable to rejecting the result.

Acute Phase Response and Non-Reproducible Elevated Concentrations with a High-Sensitivity Cardiac Troponin I Assay

High-sensitivity cardiac troponin (hs-cTn) testing has enabled physicians to make earlier diagnostic and prognostic decisions in the hospital setting than previous cardiac troponin assays. Analytical improvements have permitted one to measure cardiac troponin precisely in the nanogram per litre (ng/L) range with hs-cTn assays which has resulted in fast 0/1-h and 0/2-h algorithms for ruling-in and ruling-out myocardial infarction. Although analytical interferences that affect the reporting of hs-cTn are uncommon, not all hs-cTn assays are designed the same nor have undergone the same clinical and analytical validations. Here, after investigating an initial case of discrepant hs-cTnI results, we report that patients with an acute phase response (e.g., patients with inflammatory or infectious illnesses) can yield high and non-reproducible results with the Ortho Clinical Diagnostics hs-cTnI assay. Compared to Abbott Diagnostics hs-cTnI, Ortho Clinical Diagnostics hs-cTnI assay misclassifies biochemical injury in approximately 10% of the population being assessed for myocardial injury with imprecise results in approximately half of this population (i.e., 5%). In conclusion, caution is warranted in interpreting Ortho Clinical Diagnostics hs-cTnI alone in patients being evaluated for myocardial injury, especially in patients whose primary presentation is related to an acute phase response and not an acute coronary syndrome symptom.

Discrimination of Ignitable Liquid Residues in Burned Petroleum-Derived Substrates by Using HS-MS eNose and Chemometrics

Interpretation of data from fire debris is considered as one of the most challenging steps in fire investigation. Forensic analysts are tasked to identify the presence or absence of ignitable liquid residues (ILRs) which may indicate whether a fire was started deliberately. So far, data analysis is subjected to human interpretation following the American Society for Testing and Materials' guidelines (ASTM E1618) based on gas chromatography-mass spectrometry data. However, different factors such as interfering pyrolysis compounds may hinder the interpretation of data. Some substrates release compounds that are in the range of common ignitable liquids, which interferes with accurate determination of ILRs. The aim of the current research is to investigate whether headspace-mass spectroscopy electronic nose (HS-MS eNose) combined with pattern recognition can be used to classify different ILRs from fire debris samples that contain a complex matrix (petroleum-based substrates or synthetic fibers carpet) that can strongly interfere with their identification. Six different substrates-four petroleum-derived substrates (vinyl, linoleum, polyester, and polyamide carpet), as well as two different materials for comparison purposes (cotton and cork) were used to investigate background interferences. Gasoline, diesel, ethanol, and charcoal starter with kerosene were used as ignitable liquids. In addition, fire debris samples were taken after different elapsed times. A total of 360 fire debris samples were analyzed. The obtained total ion mass spectrum was combined with unsupervised exploratory techniques such as hierarchical cluster analysis (HCA) as well as supervised linear discriminant analysis (LDA). The results from HCA show a strong tendency to group the samples according to the ILs and substrate used, and LDA allowed for a full identification and discrimination of every ILR regardless of the substrate.

Pre-analytical mysteries: A case of severe hypervitaminosis D and mild hypercalcaemia

We describe a case of severe hypervitaminosis D and mild hypercalcaemia in a 68-year-old woman who presented with fatigue and weight loss. Her 25-hydroxy vitamin D (25OHD) was > 400 nmol/L (50-150) and corrected serum calcium was 2.83 mmol/L (2.1-2.6). Her intact parathyroid hormone (PTH) was 4.9 pmol/L (2.0-9.5). Further investigation revealed an IgM kappa paraprotein, and a bone marrow aspirate confirmed a diagnosis of lymphoplasmacytic lymphoma/Waldenstrom’s macroglobulinemia (LPL/WM). As the vitamin D level was discordant with the patient’s other results and presentation, the presence of an assay interferent was suspected. A 1-in-2 dilution of the sample returned a 25OHD result of 84 nmol/L in keeping with the presence of an interferent. Testing for rheumatoid factor was negative. The sample was treated with an antibody blocking reagent (Scantibodies) and results were not consistent with heterophile antibody interference. The sample was then analysed using liquid chromatography tandem mass spectrometry (LC-MS/MS), which returned a 25OHD result of 82 nmol/L. Testing on an alternative immunoassay platform produced a 25OHD result of 75 nmol/L. Reapeted testing on the original platform following reduction of the monoclonal paraprotein with chemotherapy, returned a result of 64 nmol/L. The patient’s mild hypercalcaemia persisted following resolution of the monoclonal paraprotein, in keeping with a diagnosis of primary hyperparathyroidism. This case highlights the potential for paraproteins to cause assay interference, and the importance of considering interference when results are incongruous with the clinical presentation.

Uncertainty Analysis of Fluorescence-Based Oil-In-Water Monitors for Oil and Gas Produced Water

Offshore oil and gas facilities are currently measuring the oil-in-water (OiW) concentration in the produced water manually before discharging it into the ocean, which in most cases fulfills the government regulations. However, as stricter regulations and environmental concerns are increasing over time, the importance of measuring OiW in real-time intensifies. The significant amount of uncertainties associated with manual samplings, that is currently not taken into consideration, could potentially affect the acceptance of OiW monitors and lower the reputation of all online OiW measurement techniques. This work presents the performance of four fluorescence-based monitors on an in-house testing facility. Previous studies of a fluorescence-based monitor have raised concerns about the measurement of OiW concentration being flow-dependent. The proposed results show that the measurements from the fluorescence-based monitors are not or insignificantly flow-dependent. However, other parameters, such as gas bubbles and droplet sizes, do affect the measurement. Testing the monitors’ calibration method revealed that the weighted least square is preferred to achieve high reproducibility. Due to the high sensitivity to different compositions of atomic structures, other than aromatic hydrocarbons, the fluorescence-based monitor might not be feasible for measuring OiW concentrations in dynamic separation facilities with consistent changes. Nevertheless, they are still of interest for measuring the separation efficiency of a deoiling hydrocyclone to enhance its deoiling performance, as the separation efficiency is not dependent on OiW trueness but rather the OiW concentration before and after the hydrocyclone.

Relevance of 3D virtual planning in predicting bony interferences between distal and proximal fragments after sagittal split osteotomy

After sagittal split osteotomy, the mandibular distal and proximal fragments do not always align themselves passively to one another, resulting in bony interferences and subsequent anomalous settlement of the condyles. Predicting these interferences could be an important ancillary procedure for avoiding intra- and postoperative surgical complications, rendering orthognathic surgery more effective and safer. This study evaluated the relevance of virtual surgical planning in assessing the displacement of the proximal segments after virtual distal segment repositioning, for predicting bony interferences between the segments and thus avoiding related intra- and postoperative surgical complications. The presence of interferences between the distal and proximal segments was compared between virtually predicted (computer-assisted simulation surgery, Dolphin software) and real cases in 100 consecutive patients diagnosed with dentofacial deformities who underwent orthognathic surgery with mandibular repositioning (using a short lingual osteotomy (SLO)). The results indicated that clockwise rotation of the mandible was the mandibular movement most prone to segment interference. Furthermore, virtual planning was sensitive (100%) but had low specificity (51.6%) in predicting proximal and distal segment interferences. This low specificity was due to the software-based automated design of the mandibular osteotomy, where the length of the distal segment was longer than the real SLO, and the mandibular ramus sagittal split was located just behind Spix's spine. Thus, more precise simulated osteotomies are needed to further validate the accuracy of virtual planning for this purpose.

Haemolysis and lipemia interfere with resistin and myeloperoxidase BioVendor ELISA assays

Introduction

The aim of our study was to investigate the influence of haemolysis and lipemia on resistin (RES) and myeloperoxidase (MPO) measurement by BioVendor enzyme-linked immunosorbent assays (ELISA).

Materials and methods

Blood was taken from healthy volunteers into lithium heparin tubes. Plasma samples were spiked with Lipofundin® emulsion (B. Braun Melsungen AG, Germany) for lipemia interference testing. Haemolysed samples were obtained by drawing aliquots of heparinized blood through a 26 gauge needle. Index of haemolysis (H), lipemia (L) and triglyceride concentration were measured on Abbott Architect c8000. Haemoglobin concentration was measured on Sysmex XN-1000. Concentrations of RES and MPO in all samples were determined with RES and MPO ELISA kits (BioVendor, Czech Republic). All measurements were performed in triplicate. Biases from the native samples were calculated for both analytes and compared with an arbitrary value (e.g. ± 10%).

Results

Triglyceride concentration in the investigated samples ranged from 0.57 to 38.23 mmol/L, which corresponds to L index from - 0.01 to 13.77. Haemoglobin concentration in all samples ranged from 0 to 8 g/L which correspond to H index from 0.05 to 8.77. Both MPO and RES showed significant biases at 1 g/L haemoglobin (58.7% and 66.7%, respectively). Also, both MPO and RES showed significant biases at 4.66 mmol/L triglycerides (33.8% and - 12.2%, respectively).

Conclusions

Resistin BioVendor assays are affected by haemolysis and lipemia already at low degree of interferent. Haemolysis was found to interfere at 1 g/L haemoglobin for both assays, while lipemia interferes at 4.66 mmol/L of triglycerides.

Machine learning algorithms for the detection of spurious white blood cell differentials due to erythrocyte lysis resistance

AIMS

Red blood cell (RBC) lysis resistance interferes with white blood cell (WBC) count and differential; still, its detection relies on the identification of an abnormal scattergram, and this is not clearly adverted by specific flags in the Beckman-Coulter DXH-800. The aims were to analyse precisely the effect of RBC lysis resistance interference in WBC counts, differentials and cell population data (CPD) and then to design, develop and implement a novel diagnostic machine learning (ML) model to optimise the detection of samples presenting this phenomenon.

METHODS

WBC counts, differentials and CPD from 232 patients (anaemia or liver disease) were compared with 100 healthy controls (HC) using analysis of variance. The data were analysed after a corrective action, and the analyser differentials were also compared with the digital leucocyte differentials. The ML support vector machine (SVM) algorithm was trained with 70% of the samples (n=233) and the 30% remaining (n=99) were employed exclusively during the validation phase.

RESULTS

We identified that impedance WBC was not affected by the RBC lysis resistance interference while the DXH-800 differentials overestimated lymphoid subpopulations (17.6%), sometimes even yielding spurious lymphocytosis, and the latter were corrected when sample dilution was performed. The ML-SVM algorithm allowed the classification of the pathological groups when compared with HC with validation accuracies corresponding to 97.98%, 100% and 88.78% for the global, anaemia and liver disease groups, respectively.

CONCLUSIONS

The proposed algorithm has an impressive discriminatory potential and its application would be a valuable support system to detect spurious results due to RBC lysis resistance.

In Vitro Sugar Interference Testing With Amperometric Glucose Oxidase Sensors

BACKGROUND

Electrochemical enzymatic glucose sensors are intended to measure blood or interstitial fluid glucose concentrations. One class of these glucose sensors are continuous glucose monitors (CGMs), indicated for tracking and trending of glucose concentrations in interstitial fluid and as an adjunct to blood glucose testing. Currently approved CGMs employ a glucose oxidase (GOx) electrochemical detection scheme. Potential interfering agents can impact the accuracy of results obtained by glucose sensors, including CGMs.

METHODS

Seven sugars, seven sugar alcohols, and three artificial sweeteners were in vitro screened for interference with amperometric glucose oxidase (GOx) sensors at concentrations greater than physiologic concentrations. Galactose was investigated further at physiologically relevant concentrations using a custom amperometric system. Furthermore, glucose and galactose calibration experiments were conducted to facilitate multiple enzyme kinetic analysis approaches (Michaelis-Menten and Hill equation) to understand the potential source and mechanism of interference from galactose.

RESULTS

Under in vitro testing, except for galactose, xylose and mannose, all screened compounds exhibited interference bias, expressed in mean absolute relative difference (MARD), of ⩽ 20% even at concentrations significantly higher than normal physiologic concentrations. Galactose exhibited, CGM-dependent, MARD of 47-72% and was subjected to further testing. The highest recorded mean relative difference (MRD) was 6.9 ± 1.3% when testing physiologically relevant galactose concentrations (0.1-10 mg/dL). Enzyme kinetic analysis provided calculations of maximum reaction rates ( imax ), apparent Michaelis constants ( Kmapp ), and Hill equation h parameters for glucose and galactose substrates for the enzymes in the CGMs.

CONCLUSION

Under the conditions of in vitro screening, 14 of the 17 compounds did not exhibit measuarable interference. Galactose exhibited the highest interference during screening, but did not substantially interfere with CGMs under the conditions of in vitro testing at physiologically relevant concentrations. Enzyme kinetic analysis conducted with galactose supported the notion that (1) the reactivity of GOx enzyme toward nonglucose sugars and (2) the presence of enzymatic impurities (such as galactose oxidase) are two potential sources for sugar interference with GOx glucose sensors, and thus, should be considered during device development.

Low Power Operation of Temperature-Modulated Metal Oxide Semiconductor Gas Sensors

Mobile applications based on gas sensing present new opportunities for low-cost air quality monitoring, safety, and healthcare. Metal oxide semiconductor (MOX) gas sensors represent the most prominent technology for integration into portable devices, such as smartphones and wearables. Traditionally, MOX sensors have been continuously powered to increase the stability of the sensing layer. However, continuous power is not feasible in many battery-operated applications due to power consumption limitations or the intended intermittent device operation. This work benchmarks two low-power, duty-cycling, and on-demand modes against the continuous power one. The duty-cycling mode periodically turns the sensors on and off and represents a trade-off between power consumption and stability. On-demand operation achieves the lowest power consumption by powering the sensors only while taking a measurement. Twelve thermally modulated SB-500-12 (FIS Inc. Jacksonville, FL, USA) sensors were exposed to low concentrations of carbon monoxide (0-9 ppm) with environmental conditions, such as ambient humidity (15-75% relative humidity) and temperature (21-27 °C), varying within the indicated ranges. Partial Least Squares (PLS) models were built using calibration data, and the prediction error in external validation samples was evaluated during the two weeks following calibration. We found that on-demand operation produced a deformation of the sensor conductance patterns, which led to an increase in the prediction error by almost a factor of 5 as compared to continuous operation (2.2 versus 0.45 ppm). Applying a 10% duty-cycling operation of 10-min periods reduced this prediction error to a factor of 2 (0.9 versus 0.45 ppm). The proposed duty-cycling powering scheme saved up to 90% energy as compared to the continuous operating mode. This low-power mode may be advantageous for applications that do not require continuous and periodic measurements, and which can tolerate slightly higher prediction errors.

Retrospective Approach to Evaluate Interferences in Immunoassay

BACKGROUND

Despite the increase in sensitivity and specificity of immunoassay technique over years, analytical interference remains to be major area of concern. The interfering substances are endogenous substances that are natural, polyreactive antibodies as heterophilic or auto antibodies, or human anti-animal antibodies together with other unsuspected binding proteins that are unique to the individual. Interfering substances can interfere with the reaction between analyte and reagent antibodies in immunoassay resulting in false positive or negative values. This ultimately results in misinterpretation of patients reports and finally to wrong course of treatment.

OBJECTIVE

In our study, we used a retrospective approach to find out the extent of interferences and type of interferences in some cases during our routine practice.

METHOD

The immunoassay reports which were clinically not correlating were retrospectively evaluated after discussion with the clinician. Over a period of six month a total of 42 samples were evaluated for interference for different immunoassay parameters such as Beta HCG, Estradiol, CA 125, AFP, prolactin, Hepatitis B Surface antigen (HbSAg) and troponin I. The samples were treated with commercially available antibody blocking agents and were reanalyzed. Commercially available diluents were used in some cases to evaluate high dose hook effect. Different platform, methodology and reagents were used for re -analysis.

RESULTS

Out of 42 samples, 19 were found to be affected by interferences The data obtained for interferences was as follows beta HCG - 6 samples (2 positive and 4 negative interference); estradiol - 3 samples (2 positive and 1 negative interference); CA-125-3 samples (2 positive and 1 negative interference), Alfa Feto Protein - 2 samples (2 positive interference); prolactin - 1 sample (positive interference); Hepatitis B Surface antigen - 1 samples (negative interference); troponin I - 2 samples (positive interference).

CONCLUSION

Despite the use of state of the art laboratory equipments, chances of interference in immunoassay analysis resulting from endogenous substances could not be ruled out. In conclusion, thorough evaluation of all immunoassay reports should be carried out in cases of suspected interference.

A Novel Monopulse Technique for Adaptive Phased Array Radar

The monopulse angle measuring technique is widely adopted in radar systems due to its simplicity and speed in accurately acquiring a target’s angle. However, in a spatial adaptive array, beam distortion, due to adaptive beamforming, can result in serious deterioration of monopulse performance. In this paper, a novel constrained monopulse angle measuring algorithm is proposed for spatial adaptive arrays. This algorithm maintains the ability to suppress the unwanted signals without suffering from beam distortion. Compared with conventional adaptive monopulse methods, the proposed algorithm adopts a new form of constraint in forming the difference beam with the merit that it is more robust in most practical situations. At the same time, it also exhibits the simplicity of one-dimension monopulse, helping to make this algorithm even more appealing to use in adaptive planar arrays. The theoretical mean and variance of the proposed monopulse estimator is derived for theoretical analysis. Mathematical simulations are formulated to demonstrate the effectiveness and advantages of the proposed algorithm. Both theoretical analysis and simulation results show that the proposed algorithm can outperform the conventional adaptive monopulse methods in the presence of severe interference near the mainlobe.

Fano Interference in the Optical Absorption of an Individual Gold-Silver Nanodimer

Fano resonances are central features in the responses of many systems including atoms, molecules, and nanomaterials. They arise as a consequence of interferences between two channels, most frequently associated with two system modes. In plasmonic materials, Fano interferences between optical modes have been shown, experimentally and theoretically, to induce narrow features in their scattering spectra. By investigating individual silver-gold heterodimers, we first experimentally demonstrate that Fano interference is also a key effect in the optical absorption of plasmonic nano-objects, in agreement with theoretical predictions. Conversely to previously investigated systems, the two interacting modes at the origin of absorptive Fano effect are mostly localized on either one or the other dimer component. Experimental results were obtained by selectively monitoring the optical absorption of one dimer component using a two-color nonlinear time-resolved technique. This also opens the way to full optical far-field noncontact investigations of charge or energy exchanges between nano-objects with a spatial resolution much smaller than the optical wavelength.

Diagnostic difficulties of factor XI deficiencies: interferences' assay or real deficit?

Madam P, 77 years old, consulted in the hemostasis department after a coagulation anomaly was discovered during her preoperative test for a total hip prosthesis. After confirmation of a persistent and increased aPTT, additional tests were performed and showed the presence of antiphospholipid antibodies. Factor VIII level could be corrected after the plasma dilution to 1/40(th). But successive dilutions were not enough to obtain a correct factor IX (FIX) and factor XI (FXI) level. FIX level was obtained by chromogenic method in order to avoid the interferences caused by the antibodies. Finally, despite the change of reagents and dilutions up to 1/160(th), the FXI level couldn't be determined. Despite these results and those of the thrombin generation assay, the surgery was successfully done without specific treatment thanks to the absence of hemorrhagic history. This observation highlights the diagnostic and monitoring difficulties for uncommon clotting factor deficit. The development of interference free test could increase the support for these patients.

Catalytic Oxidation of Hydroquinone in Aqueous Solution over Bimetallic PdCo Catalyst Supported on Carbon: Effect of Interferents and Electrochemical Measurement

Palladium-cobalt alloy nanoparticles were synthesized and dispersed on carbon black support, aiming to have a less expensive catalyst. Catalytic behaviors of PdCo/C catalyst for the oxidation of hydroquinone (HQ) with H2O2 in aqueous solution were evaluated using high-performance liquid chromatography (HPLC). The results revealed that PdCo/C catalyst had better catalytic activity than an equal amount of commercial Pd/C and Co/C catalysts because of the d-band hybridization between Pd and Co. The effects of pH value, solvent, and various interferents including inorganic and organic compounds on the efficiency of HQ oxidation were further investigated. Furthermore, on the basis of mixed potential theory, comprehensive electrochemical measurements such as the open-circuit potential-time (OCP-t) technique and Tafel plot were efficient to assess the catalytic activity of the catalyst, and the results obtained were consistent with those of HPLC measurements. The efficient HQ oxidation was closely associated with the catalytic activity of PdCo nanoparticles because they accelerated the electron-transfer process and facilitated the generation of OH radicals.

[Pseudohypobicarbonatemia in a patient with a kappa IgA monoclonal gammapathy]

Paraprotein interferences assays are known but rather unusual in clinical chemistry.we here report a paraprotein interference with a bicarbonate assay in a IgA kappa-type myeloma patient. Serum bicarbonate level was assessed by the enzymatic method of a multiparametric chemistry analyzer (Advia 1800, Siemens) as well as a specific electrode assay on a blood gas analyzer (GEM 4000, IL). Paraprotein interference with the enzymatic assay was evidenced by an abnomally low bicarbonate level measured by the enzymatic method in contrast with usual levels obtained by using the gas analyzer and with the clinical status of the patient. Therefore, gammapathy has to be taken into consideration when interpreting biological data.

The Danger of Using Total Error Models to Compare Glucose Meter Performance

Glucose meter performance specifications provide limits for 95% of results, which is the same as total error. A popular total error model is that total error equals (average) bias plus 2 times imprecision. This model has been used to specify combinations of average bias and imprecision that satisfy total error goals. But this model is incomplete and its conclusions are suspect. It is shown that when interferences occur in glucose meters as exemplified by hematocrit interference, the total error model proposed by Boyd and Bruns cannot distinguish between meters that differ in performance. The CLSI standard EP21-A, does not have this problem because it directly estimates total error bypassing the need for a model. An example illustrates these points.

Understanding the Thickness-Dependent Performance of Organic Bulk Heterojunction Solar Cells: The Influence of Mobility, Lifetime, and Space Charge

We investigate the reasons for the dependence of photovoltaic performance on the absorber thickness of organic solar cells using experiments and drift-diffusion simulations. The main trend in photocurrent and fill factor versus thickness is determined by mobility and lifetime of the charge carriers. In addition, space charge becomes more and more important the thicker the device is because it creates field free regions with low collection efficiency. The two main sources of space-charge effects are doping and asymmetric mobilities. We show that for our experimental results on Si-PCPDTBT:PC71BM (poly[(4,40-bis(2-ethylhexyl)dithieno[3,2-b:20,30-d]silole)-2,6-diyl-alt-(4,7-bis(2-thienyl)-2,1,3-benzothiadiazole)-5,50-diyl]:[6,6]-phenyl C71-butyric acid methyl ester) solar cells, the influence of doping is most likely the dominant influence on the space charge and has an important effect on the thickness dependence of performance.

Current concepts of thyroid function and laboratory evaluation

The role of triodothyronine (T(3) in regulating thyroid function is paramount in that at cellular level it interacts with receptors in the nucleus and thereby modulates gene expression. The multiple steps in the processing of lodide by the thyroid gland is under the influence of the thyroid stimulating hormone (TSH). In terms of laboratory evaluation of thyroid function the primary test is TSH. To discriminate between hypothalamic and pitutary dysfunction, the thyroid releasing hormone (TRH) stimulation test is useful. Currently used 2-site Immunometric procedures that employ mouse monoclonal antibodies can be subject to Interference by heterophlle antibodies in patient's serum. Drugs and other extraneous substances can influence the results obtained in some thyroid function tests. Thyroid dysfunction could also be due to autoimmune disease. The limitations of the usefulness of thyroid function tests in non-thyroidal illness should be kept in perspective. In conclusion, the proper interpretation of results of thyroid function tests depends on the sound understanding of concepts of thyroid function and variables affecting laboratory testing.

Analysis of Accelerants in Fire Debris - Data Interpretation

Analysis of accelerants in fire debris involves the isolation of residual volatiles from the matrix and the analysis of these volatiles, usually by gas chromatography (GC). The resulting chromatograms are interpreted by comparing to a library of accelerant chromatograms obtained under similar conditions. This review first mentions ASTM's system in classifying fire accelerants into light petroleum distillates, gasoline, medium petroleum distillates, kerosene, heavy petroleum distillates, and unclassified compounds. Chromatograms with well-resolved n-alkane homolog patterns are most recognizable. Chromatograms that are inadequately resolved can be improved by columns having higher efficiency or selectivity, while those with too much interference can be improved by physical removal or reduction of these interfering compounds or selective detection. Using a mass spectrometer (MS) as the detector in GC/MS applications allows the display of common ions shared by compounds with similar structural features, thus greatly facilitating pattern recognition practices. Computer algorithms are now available for automated recognition of patterns possessed by various categories of accelerants. The state-of-the-art in forensic laboratories' analysis of accelerants in fire debris is presented as an appendix to this review. Data generated in annual proficiency tests over an 8-year period (1987-1995) revealed increased use of GC/MS instrumentation and some persisting problems, which include false positives and difficulties associated with component discrimination in the sample preparation process and recognition of partially evaporated distillates.

Errors in Spectrophotometry and Calibration Procedures to Avoid Them

Based on simple principles, spectrophotometry nevertheless demands a lot of precautions to avoid errors. The following properties of spectrophotometers will be discussed together with methods to test them: Spectral properties-wavelength accuracy, bandwidth, stray light; photometric linearity; interactions between sample and instrument-multiple reflections, polarization, divergence, sample wedge, sample tilt, optical path length (refractive index), interferences. Calibration of master instruments is feasible only by complicated procedures. With such a master instrument standards may be calibrated which greatly simplify performance checks of instruments used for practical work. For testing high quality spectrophotometers the use of emission lines and nearly neutral absorbing solid filters as standards seems to be superior, for some kinds of routine instruments the use of absorption bands and liquid filters may be necessary.