Clinica chimica acta; international journal of clinical chemistry
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Neonates represent a group with unusual sample characteristics and tend to have high hematocrits (Hct). The critically ill patient is also far from ideal with respect to sample type, being prone to either hemodilution or hemoconcentration. Prior to the selection of a point-of-care testing (POCT) analyser for blood gases and electrolytes, we therefore undertook a careful evaluation of some of the performance characteristics of selected instruments. ⋯ It also showed an important bias for pO(2) at levels that are clinically significant. The possibility of operator-related effects on test results has to be eliminated. In terms of ease of use and client satisfaction, the system was well received.
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Point-of-care testing (POCT) for the management of patients with diabetes has become a standard of care. Originally, diabetic monitoring was accomplished by manual urine dipsticks. The development of hand-held, battery-operated capillary glucose monitors radically improved the ability of physicians and nurses to monitor diabetic patients during their hospital stay. ⋯ Glucose values can now be performed in a fraction of the time of the first-generation meters, the need to wipe the glucose strips has been eliminated, and only certified operators can use the instrument. Networking technology allows for centralized quality control management, and the ability to network with other point-of-care technologies using intranet and in the near future internet applications. Collectively, these developments have radically improved the efficiency and quality of bedside capillary glucose testing, and have significantly enhanced the ability to manage this important technology.
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The present study was designed to investigate the role of NF-kappaB in influencing the outcome of sepsis modulated by previous heat shock treatment. Sepsis was induced in rats by cecum ligation and puncture (CLP) method, which manifests two distinct clinical phases: an initial hyperdynamic phase (9 h after CLP, early sepsis) followed by a hypodynamic phase (18 h after CLP, late sepsis). Rats of heated group were treated by whole body hyperthermia 24 h prior to the CLP operation. ⋯ Previously treated by heat shock, late-sepsis rats emerged with high preservation of p65 expression and NF-kappaB activity, while Hsp72 was over-expressed. In conclusion, down-regulation of NF-kappaB activity during late sepsis could be attenuated by pretreatment of heat shock through the preservation of p65 expression. The results may provide a mechanistic explanation for the improved outcome to polymicrobial sepsis of rats that are preconditioned with heat shock, as well as a novel highlight for therapeutic intervention of severe infection.
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The potential clinical utility of single sample CK-MB isoforms measurement for early risk stratification of Emergency Department (ED) patients with possible myocardial ischemia was evaluated among 405 patients presenting to two urban EDs. Clinical and serologic data were prospectively collected and the occurrence of adverse events (AEs) and myocardial infarction (MI) during the 14-day outcome period was recorded and utilized to calculate and compare relative risks (RR) and predictive values of isoforms and CK-MB alone. Among the 405 patients, 67 accrued 105 AEs. ⋯ Isoforms' superior sensitivity allowed identification of many high risk patients missed by CK-MB alone. Further, for the prediction of MI, isoforms had superior diagnostic sensitivity and equivalent specificity. This investigation supports the emergency department use of early, single sample CK-MB isoform testing.