Biomedical subjects

M Ruddel

Publications and source records attributed to M Ruddel.

15 recordsLinked to original sources

PubMed1992

The effect of alcohol withdrawal on serum concentrations of Lp(a), apolipoproteins A-1 and B, and lipids.

Moderate alcohol consumption is associated with a decreased risk of coronary artery disease. The mechanism of the putative protective effect of alcohol intake, however, remains elusive. Recent studies suggest that a ratio of apolipoprotein A-I/apolipoprotein B and Lp(a) are better indicators of the risk of atherosclerosis than total cholesterol and high density lipoprotein cholesterol. To assess the effect of alcohol on these analytes, we determined the concentration of Lp(a), apolipoprotein A-I, apolipoprotein B, total cholesterol, and high-density lipoprotein cholesterol, and calculated low-density lipoprotein cholesterol in serum of 12 patients meeting DSM-III-R criteria for alcohol dependence at the time of admission for treatment of alcohol withdrawal (before). The analyses were repeated after 4 weeks of supervised abstinence on a locked research unit (after). With abstinence, there was a significant increase in the concentration of Lp(a), the atherogenic index and the ratio of low-density to high-density lipoprotein cholesterol but a significant decrease in total cholesterol, high-density lipoprotein cholesterol, apolipoprotein A-I, and the apolipoprotein A-I/B ratio. Apolipoprotein B and low-density lipoprotein cholesterol showed no significant changes before and after alcohol abstinence. Thus, decreased Lp(a) and increased high-density lipoprotein cholesterol and apolipoprotein A-I may be factors mediating the putative protective effect of alcohol in coronary artery disease.

Adult↗

PubMed1990

Direct and indirect techniques for free thyroxin compared in patients with nonthyroidal illness. III. Analysis of interference variables by stepwise regression.

We applied stepwise regression for multivariate analysis of data for free thyroxin (FT4) in serum and for other laboratory tests of thyroid function in patients with nonthyroidal illness. Using the maximum R2 improvement and backward elimination methods to test five variables [prealbumin, albumin, T4-binding globulin (TBG), free fatty acids (FFA), and FFA/albumin molar ratio], we found that the variables with the greatest predictive power clustered according to the methodology of FT4 measurement. Thus, we best predicted the FT4 results obtained by 16 techniques as follows: FT4 measured by one-step (analog) RIAs, with albumin; FT4 determined by two-step (sequential) RIAs, with FFA or FFA/albumin molar ratio; FT4 estimated by a binding-rate-based RIA or conceptually related FT4 indices [based on triiodothyronine (T3) uptake], with TBG; FT4 measured by equilibrium dialysis, with TBG and FFA/albumin molar ratio; and T4/TBG ratios, with either none or prealbumin and albumin. We could very highly (P less than 0.001) predict total T4 and T3 by considering TBG, and total T3 also by considering prealbumin and albumin, whereas reverse T3 was predictable with prealbumin only (negative relationship). We found comparatively weak associations between thyrotropin (TSH) and albumin or TBG. In clinical practice, abnormalities in key variables should call attention to possible effects of these variables on FT4 and other thyroid-test results and thus to the need for appropriate correction or alternative testing.

Carrier Proteins↗

PubMed1990

Changes in laboratory results for cancer patients treated with interleukin-2.

The systemic administration of interleukin-2 (IL-2) can lead to significant antitumor responses in some patients with metastatic cancer in whom standard therapy has failed. A limitation of this immunotherapy is the toxicity associated with IL-2 infusion. To assess toxicity, we determined aspartate aminotransferase (AST; EC 2.6.1.1), alanine aminotransferase (ALT; EC 2.6.1.2), gamma-glutamyltransferase (GGT; EC 2.3.2.2), lactate dehydrogenase (LD; EC 1.1.1.27), alkaline phosphatase (ALP; EC 3.1.3.1), creatine kinase (CK; EC 2.7.3.2), total bilirubin (TBI), direct bilirubin (DBI), creatinine, urea nitrogen, and C-reactive protein in serum from 21 patients before and during five consecutive days of IL-2 treatment. Ten patients were followed for an additional five days after the end of IL-2 therapy. The IL-2 infusion caused liver toxicity and prerenal azotemia, as evidenced by significant increases (P less than 0.05) of all analytes except CK by day 1. There was a progressive increase in the results (except CK) for these tests until IL-2 treatment was stopped. Seven tests related to liver function (AST, ALT, GGT, LD, ALP, DBI, and TBI) showed increases, but the test results indicated significant improvement and moved toward the baseline value five days after the end of IL-2 therapy. Concentrations of creatinine and urea nitrogen in serum were normal three days after the cessation of IL-2 therapy.

C-Reactive Protein↗

PubMed1989

Direct and indirect techniques for free thyroxin compared in patients with nonthyroidal illness. I. Effect of free fatty acids.

We examined the effect of endogenous free fatty acids (FFA) on the measurement of free thyroxin (FT4) by five different methodologies represented in 16 different assays in a large number of patients with nonthyroidal illness (NTI). Some, but not all, one-step (analog) FT4 RIAs negatively correlated with FFA concentration. All two-step FT4 RIAs, equilibrium dialysis FT4, and the dialyzable (free) fraction of T4 positively correlated. In contrast, a binding-rate-based FT4 RIA, FT4 indices based on T3 macroaggregated albumin uptake, and T4/TBG ratios did not correlate. We also analyzed the FT4-FFA relationship with a second, more sensitive approach by correlating test results with FFA/albumin molar ratio as an estimate of the "excess" (nonalbumin bound) FFA. We found that all FT4 RIAs, equilibrium dialysis FT4, FT4 indices based on T3 uptake, the dialyzable fraction of labeled T4 in equilibrium dialysis, the fraction of labeled T4 bound to solid phase antibody in the binding-rate-based RIA, and T3 uptake correlated with the FFA/albumin molar ratio. This FFA dependency was comparable among all the various techniques and was relatively small. Thus, increases or decreases in FT4 results due to varying FFA (and albumin) concentrations are highly likely with most currently available methods (only the T4/TBG ratio did not reveal FFA-dependency), but the magnitude of changes varies with the "excess" FFA.

Dialysis↗

PubMed1989

Direct and indirect techniques for free thyroxin compared in patients with nonthyroidal illness. II. Effect of prealbumin, albumin, and thyroxin-binding globulin.

We studied the correlation of thyroxin (T4)-binding proteins with the apparent free T4 (FT4) in 101 patients with nonthyroidal illness (NTI). Most patients (95%) were seriously ill at the time of blood collection. Concentrations of T4-binding prealbumin (transthyretin), albumin, and T4-binding globulin (TBG) often were low in the sera of these patients. Albumin was the most frequently subnormal, TBG the least. FT4 in serum was determined by five methods represented in 16 different assays. With few exceptions, analog (one-step) FT4 RIAs--both the binding-rate-based RIA and the related FT4 indices (calculated from triiodothyronine-macroaggregated albumin uptake and total T4)--and T4/TBG ratios correlated positively and usually highly significantly (P less than 0.01) with concentrations of prealbumin, albumin, and TBG. Equilibrium dialysis values for FT4 did not correlate with prealbumin concentrations but showed a weakly (P less than 0.03) positive association with albumin and a highly significant (P less than 0.002) positive correlation with TBG. Of the three two-step FT4 RIAs tested, the only statistically significant but weakly (P less than 0.02) positive correlation with T4-binding proteins was between Spiria FT4 and TBG. Thus, in these NTI patients, FT4 estimates vary with methodology and, to a lesser extent, with the particular assay used. The results from two-step FT4 RIAs are least associated with binding protein concentrations.

Humans↗

PubMed1988

Nutritional status of patients with acquired immunodeficiency syndrome.

Nutritional status may be an important factor in the prognosis of morbidity and mortality. We assessed the nutritional status of individuals seropositive for human immunodeficiency virus (HIV) (as confirmed by Western blot) and of patients with AIDS, by determining the concentration in serum of total protein, albumin, prealbumin (transthyretin), and retinol-binding protein. HIV-seropositive individuals showed no significant difference from normal volunteers in values for prealbumin, albumin, and retinol-binding protein. Patients with AIDS showed significantly smaller prealbumin and albumin concentrations than did normal and HIV-positive individuals. There was no significant difference in the concentration of retinol-binding protein among the three groups. The concentration of total serum protein was significantly greater in HIV-positive individuals and in patients with AIDS than in normal individuals. Thus, the nutritional status of patients with AIDS may be a factor for morbidity and mortality.

Acquired Immunodeficiency Syndrome↗

PubMed1988

Analytical bias for cholesterol and the percent of the population deemed at risk for coronary heart disease.

The effect of methodological bias on the population at risk is dependent on the location of the reference value in the distribution of the population. We fitted the cumulative distribution for cholesterol to a rational function and calculated the apparent reference values for four biased methods: Technicon SMAC (2.6%), DuPont aca (4.0 to 4.8%), Kodak DT-60 (-2.0 to -5.5%), and BMD Reflotron (-7.4 to -7.8%). With the true and apparent reference values for cholesterol and the rational function, we determined the percentage increase or decrease in the population deemed at risk for coronary heart disease. The population at risk increased by as much as 48% for methods with positive bias, and decreased by as much as 54% for methods with negative bias. If we restrict the percentage of the population incorrectly diagnosed to 3% and use reference values (cut points) recommended by the National Cholesterol Education Program, the maximum allowable methodological bias would be 1.6% for positive bias and -1.55% for negative bias. Therefore, an absolute methodological bias of 3% (as recommended by the Laboratory Standardization Panel) may be too liberal.

Adult↗

PubMed1988

A model for the effect of bias for cholesterol on the population at risk.

The location of the Reference Value for an analyte within the population distribution affects the magnitude of error due to methodological bias. Using the gaussian distribution, we evaluated the effects of systematic and proportional biases of the method (positive and negative), mean value, and standard deviation on the magnitude of error. We chose four Reference Values for cholesterol as a model. For a population with a mean of 2.0 and SD of 0.36 g of cholesterol per liter, a 3% positive proportional bias causes sixfold more error at the 50th percentile than at the 97.5th. In general, the error for a given bias (proportional or systematic) is greater for a Reference Value within the body than at the tails of the distribution. Further, the magnitude of the error varies as a function of the mean and standard deviation of the population.

Cholesterol↗

PubMed1988

Enzyme abnormalities of patients with acquired immunodeficiency syndrome.

We determined the enzyme activities of glucose-6-phosphate isomerase, alanine aminotransferase, aspartate aminotransferase, and lactate dehydrogenase in serum from 23 normal controls, 27 anti-HIV seropositive individuals confirmed by Western blot, and 53 patients with acquired immunodeficiency syndrome (AIDS). There is a significant difference for all four enzyme activities among controls, HIV seropositive individuals, and patients with AIDS, the enzyme activities showing a progressive increase as the disease progresses. Evidently these enzyme measurements may be adjunctive biochemical markers for progression of AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1988

An enzymatic method for 5-fluorocytosine.

We developed an enzymatic method for determination of 5-fluorocytosine in serum, using creatine iminohydrolase (EC 3.5.4.21), the Cobas-Bio analyzer, and an extant ammonia method. Analytical recovery (y) of drug added to serum (x) was good, with y = 0.97x-0.7, Sy.x = 3.6, r = 0.997 (n = 65) over the range 6.25 to 150 mg/L. Comparison with an HPLC method (x) showed good agreement: y = 0.98x + 1.34, Sy.x = 3.7 (n = 37), as analyzed with the Deming debiased regression. Precision was good, CVs being less than 3% for within-run and less than 6% for between-run controls. Ammonia, amphotericin B, glucose, urea, and hemolysis do not interfere, but bilirubin shows analyte-dependent interference and lipemia interferes when triglycerides exceed 5 g/L. This assay is accurate, inexpensive, and easy to perform. It can be easily adapted for routine or emergency use.

Aminohydrolases↗

PubMed1987

On the albumin-dependence of measurements of free thyroxin. II. Patients with non-thyroidal illness.

We studied the relation between thyroxin-binding proteins and free thyroxin (FT4) measurements by five radioimmunoassays (RIA) and an FT4 index (FT4I) in patients with non-thyroidal illness (NTI). The one-step FT4 RIAs and the FT4I frequently failed to identify the true FT4 status (as determined by equilibrium dialysis) of NTI patients. In these patients, falsely low FT4 results with one-step RIAs and FT4I were associated with decreasing total T3 and T4 concentrations, which, furthermore, paralleled decreasing serum albumin concentrations. All NTI patients with "low T3, low T4 syndrome" had subnormal albumin concentration. The two-step RIAs and equilibrium dialysis showed normal FT4 concentrations in most patients with NTI. However, sera from a subset of NTI patients with "low T3 syndrome" gave above-normal FT4 results with these methods. From their predictably poor performance in the presence of a subnormal albumin concentration, we conclude that the one-step FT4 RIAs and FT4I are inappropriate for testing the thyrometabolic status of NTI patients.

Diagnostic Errors↗

PubMed1987

A model for assessing interference.

Most studies of analytical interference indicate the magnitude but not the type of interference. We developed a model for interference that assesses the magnitude of the following types of interference: independent of analyte concentration, dependent on analyte concentration, and a combination of the two. The experimental design for the model is an orthogonally arranged matrix with progressively increasing concentrations of analyte and interfering agent. Multiple regression with these independent variables (concentration of analyte, concentration of interfering agent, and the product of the two) is used to determine the magnitude, direction, and significance of each type of interference. Applying the model to study interference by hemoglobin with determinations of creatinine, direct bilirubin, and total bilirubin showed that hemoglobin interferes with determination of creatinine independent of the analyte concentration, interferes with total bilirubin dependent on the analyte concentration, and interferes with direct bilirubin by a combination of these two.

Bilirubin↗

PubMed1986

Comparison of automated and manual methods for urinalysis.

The authors compared results for accuracy and precision obtained by a semiautomated prototype International Remote Imaging Systems, Inc. (IRIS) urinalysis workstation (IUW) with those from quantitative manual urinalysis (QMU). Three technologists skilled in urinalysis each performed 172 urinalyses with both the IUW and QMU methods. The results show that the IUW method is likely to yield comparable counts for particulate analytes compared with the QMU, except for casts. The QMU reported significantly (P less than 0.001) more casts than the IUW method. This difference is related to at least a ninefold greater volume of untreated urine examined by the QMU method than the IUW method. The IUW method may provide a more accurate result than the QMU method at very low and high concentrations of particulate analytes. The result from 24 blind duplicate urines also analyzed by each of the three technologists with both methods showed comparable precision for particulate analytes between the two methods except for red blood cells; the QMU method had significantly (P less than 0.001) better precision for this analyte.

Automation↗

PubMed1986

On the albumin dependence of measurements of free thyroxin. I. Technical performance of seven methods.

We evaluated three one-step (analog) and two two-step radioimmunoassay for free thyroxin (FT4), and a FT4 index calculated from the total T4 (TT4) and thyroxin-binding globulin (TBG) ratio for technical performance, for correlation with the reference FT4 method (equilibrium dialysis), and for dependence on TBG and albumin concentrations. The one-step methods (Amerlex, Coat-A-Count, and GammaCoat) showed greater precision than the two-step procedures (GammaCoat and Spiria). Results by the latter two techniques, however, correlated better with those by equilibrium dialysis than did those by the analog methods or by TT4/TBG. Only the GammaCoat two-step method had a slight but statistically significant (inverse) correlation with TBG concentration. All three analog methods and TT4/TBG showed a marked dependence on albumin concentration, whereas the Spiria technique showed only a slight dependence. Only equilibrium dialysis was independent of both the TBG and albumin concentration. Thus, despite their good precision, the analog (one-step) FT4 methods and the TT4/TBG approach cannot be expected to produce valid results when the concentration of albumin in serum is abnormally low or high.

Dialysis↗

PubMed1976

Sonic fragility of the head-tail bond of bacteriophage P22.

The binding of tail parts to the head of phage P22 is normally irreversible, but after adsorption to host cells sonication releases many of the tail parts intact. This release is dependent on the power of sonication, but is independent of the length of sonication from 2 to 32 s. This phenomenon has been used to show that the upper limit of the number of P22 particles that can bind to a cell is no lower than 700.

Adsorption↗