Audio Summary August 2023

Machine Learning in Laboratory Medicine: Recommendations of the IFCC Working Group

Driving Under the Influence of Cannabis: Impact of Combining Toxicology Testing with Field Sobriety Tests

Tissue Mass Spectrometry: How Solid Is Our Future?

Audio Summary July 2023

Polygenic Risk Scores: Genomes to Risk Prediction

Rapid Rule-Out of Myocardial Infarction Using a Single High-Sensitivity Cardiac Troponin I Measurement Strategy at Presentation to the Emergency Department: The SAFETY Study

Using Biomarkers for Traumatic Brain Injury: Are There Lessons That Can Be Learned from Implementing Cardiac Troponin?

Audio Summary June 2023

The Present and Future of Lipid Testing in Cardiovascular Risk Assessment 

This free monthly podcast is offered by Clinical Chemistry. Clinical Chemistry is the leading forum for peer-reviewed, original research on innovative practices in today's clinical laboratory. In addition to being the most cited journal in the field, Clinical Chemistry has the highest Impact Factor (7.292 in 2019) among journals of clinical chemistry, clinical (or anatomic) pathology, analytical chemistry, and the subspecialties, such as transfusion medicine and clinical microbiology.

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Clinical Chemistry Podcast

In the August 2019 issue of Clinical Chemistry, a Q&amp;A feature titled “Optimal Use of Biomarker for Chronic Kidney Disease” asked five experts in laboratory medicine and nephrology to examine laboratory ordering, testing, and reporting practices, and recommend how those practices should be optimized to better serve patients with CKD. In this podcast, Dr. Greg Miller from the Department of Pathology at Virginia Commonwealth University in Richmond who moderated the Q&amp;A will summarize the expert advice from his colleagues. 

In the August 2019 issue of Clinical Chemistry, a Q&amp;A feature titled “Optimal Use of Biomarker for Chronic Kidney Disease” asked five experts in laboratory medicine and nephrology to examine laboratory ordering, testing, and reporting practices, and recommend how those practices should be optimized to better serve patients with CKD. In this podcast, Dr. Greg Miller from the Department of Pathology at Virginia Commonwealth University in Richmond who moderated the Q&amp;A will summarize the expert advice from his colleagues.

Optimal Use of Biomarkers for Chronic Kidney Disease

Cardiovascular risk is so high in type III hyperlipoproteinemia that is typically a “treat immediately on diagnosis” disorder.  In the February 2019 issue of Clinical Chemistry, a paper presented the advantages of a non-high density lipoprotein cholesterol ratio with apolipoprotein B as a diagnostic tool for type III hyperlipoproteinemia.  In the same issue, an accompanying editorial entitled “Type III Hyperlipoproteinemia: The Forgotten, Disregarded, Neglected, Overlooked, Ignored but Highly Atherogenic, and Highly Treatable Dyslipo-proteinemia” was also published.  The author of that article is Dr. Allan Sniderman, the Edwards Professor of Cardiology at McGill University in Montreal, Quebec, Canada, and he is our guest in this podcast. 

Cardiovascular risk is so high in type III hyperlipoproteinemia that is typically a “treat immediately on diagnosis” disorder.  In the February 2019 issue of Clinical Chemistry, a paper presented the advantages of a non-high density lipoprotein cholesterol ratio with apolipoprotein B as a diagnostic tool for type III hyperlipoproteinemia.  In the same issue, an accompanying editorial entitled “Type III Hyperlipoproteinemia: The Forgotten, Disregarded, Neglected, Overlooked, Ignored but Highly Atherogenic, and Highly Treatable Dyslipo-proteinemia” was also published.  The author of that article is Dr. Allan Sniderman, the Edwards Professor of Cardiology at McGill University in Montreal, Quebec, Canada, and he is our guest in this podcast.

Type III Hyperlipoproteinemia: The Forgotten, Disregarded, Neglected, Overlooked, Ignored but Highly Atherogenic, and Highly Treatable Dyslipoproteinemia

In December 2019, a cluster of atypical pneumonia patients epidemiologically linked to a wholesale market in Wuhan, China was detected. A novel betacoronavirus named as 2019-novel coronavirus (2019-nCoV) has been identified in some of these patients. Considerable attention has been given to this virus, that according to the World Health Organization as of this recording at the end of January 2020, has so far thought to have sickened over 6,000 people and is responsible for at least 132 deaths. Because of the potential for pandemic spread, there is a great need for a rapid and accurate test for the detection of the virus. We are fortunate to have with us today Dr. Leo Poon from the School of Public Health, Li Ka Shing Faculty of Medicine at the University of Hong Kong. He and his colleagues described a new molecular diagnostic assay that allows the detection and quantification of this new coronavirus.

In December 2019, a cluster of atypical pneumonia patients epidemiologically linked to a wholesale market in Wuhan, China was detected. A novel betacoronavirus named as 2019-novel coronavirus (2019-nCoV) has been identified in some of these patients. Considerable attention has been given to this virus, that according to the World Health Organization as of this recording at the end of January 2020, has so far thought to have sickened over 6,000 people and is responsible for at least 132 deaths. Because of the potential for pandemic spread, there is a great need for a rapid and accurate test for the detection of the virus. We are fortunate to have with us today Dr. Leo Poon from the School of Public Health, Li Ka Shing Faculty of Medicine at the University of Hong Kong. He and his colleagues described a new molecular diagnostic assay that allows the detection and quantification of this new coronavirus.

Molecular Diagnosis of a Novel Coronavirus (2019-nCoV) Causing an Outbreak of Pneumonia

Amniocentesis is a common procedure usually performed to collect cells from the fetus to allow testing for abnormal chromosomes.  Cells from the amniotic fluid are collected through centrifugation, cultured, and after about two weeks, analyzed by fluorescent in situ hybridization, or FISH, or with a microarray to detect abnormal chromosome copy number changes or large chromosomal structural rearrangements.  These tests have become the gold standard for detecting Down Syndrome and several other serious birth defects because they have a low false positive rate.  However, they are unable to detect the majority of birth defects.Amniocentesis is a common procedure usually performed to collect cells from the fetus to allow testing for abnormal chromosomes.  Cells from the amniotic fluid are collected through centrifugation, cultured, and after about two weeks, analyzed by fluorescent in situ hybridization, or FISH, or with a microarray to detect abnormal chromosome copy number changes or large chromosomal structural rearrangements.  These tests have become the gold standard for detecting Down Syndrome and several other serious birth defects because they have a low false positive rate.  However, they are unable to detect the majority of birth defects.  In the April 2018 issue of Clinical Chemistry, a paper demonstrated the feasibility of generating an accurate whole genome sequence of a fetus from either the cellular or cell-free DNA of an amniotic sample. 

Amniocentesis is a common procedure usually performed to collect cells from the fetus to allow testing for abnormal chromosomes.  Cells from the amniotic fluid are collected through centrifugation, cultured, and after about two weeks, analyzed by fluorescent in situ hybridization, or FISH, or with a microarray to detect abnormal chromosome copy number changes or large chromosomal structural rearrangements.  These tests have become the gold standard for detecting Down Syndrome and several other serious birth defects because they have a low false positive rate.  However, they are unable to detect the majority of birth defects.Amniocentesis is a common procedure usually performed to collect cells from the fetus to allow testing for abnormal chromosomes.  Cells from the amniotic fluid are collected through centrifugation, cultured, and after about two weeks, analyzed by fluorescent in situ hybridization, or FISH, or with a microarray to detect abnormal chromosome copy number changes or large chromosomal structural rearrangements.  These tests have become the gold standard for detecting Down Syndrome and several other serious birth defects because they have a low false positive rate.  However, they are unable to detect the majority of birth defects. In the April 2018 issue of Clinical Chemistry, a paper demonstrated the feasibility of generating an accurate whole genome sequence of a fetus from either the cellular or cell-free DNA of an amniotic sample.

Advanced Whole-Genome Sequencing and Analysis of Fetal Genomes from Amniotic Fluid

Inborn errors of metabolism are rare diseases in which a single gene defect causes a clinically significant block in a metabolic pathway resulting either in an accumulation of substrate behind the block or a lack or deficiency of the product.  Profiling metabolites in the pathway could allow for accurate and timely identification of patients who have these diseases and help physicians to devise effective treatment.   Congenital disorders of glycosylation represent one of the largest groups of such metabolic disorders.  In May 2019, Clinical Chemistry published a study on the development and validation of a plasma protein N-glycan assay using a flow injection-electrospray ionization-quadrupole time-of-flight mass spectrometry.

Inborn errors of metabolism are rare diseases in which a single gene defect causes a clinically significant block in a metabolic pathway resulting either in an accumulation of substrate behind the block or a lack or deficiency of the product.  Profiling metabolites in the pathway could allow for accurate and timely identification of patients who have these diseases and help physicians to devise effective treatment.   Congenital disorders of glycosylation represent one of the largest groups of such metabolic disorders.  In May 2019, Clinical Chemistry published a study on the development and validation of a plasma protein N-glycan assay using a flow injection-electrospray ionization-quadrupole time-of-flight mass spectrometry.

Increased Clinical Sensitivity and Specificity of Plasma Protein N-Glycan Profiling for Diagnosing Congenital Disorders of Glycosylation by Use of Flow Injection–Electrospray Ionization–Quadrupole Time-of-Flight Mass Spectrometry

Maintaining high ethical standards is a characteristic we expect in many professionals, but perhaps most in the field of medicine.  Although biomedical ethics is a relatively new field, there have been discussions of moral issues in medicine since ancient times.  The Hippocratic Oath, for instance, was written by Hippocrates at approximately 400 B.C.  It requires that a new physician swear to uphold specific ethical standards.  Over 2000 years later new physicians still swear by the Hippocratic or a similar oath. The December 2019 issue of Clinical Chemistry published a Review paper that provides a broad overview of ethics as it pertains to laboratory medicine.

Maintaining high ethical standards is a characteristic we expect in many professionals, but perhaps most in the field of medicine.  Although biomedical ethics is a relatively new field, there have been discussions of moral issues in medicine since ancient times.  The Hippocratic Oath, for instance, was written by Hippocrates at approximately 400 B.C.  It requires that a new physician swear to uphold specific ethical standards.  Over 2000 years later new physicians still swear by the Hippocratic or a similar oath. The December 2019 issue of Clinical Chemistry published a Review paper that provides a broad overview of ethics as it pertains to laboratory medicine.

Ethics for Laboratory Medicine

October 2017 Summary Lam

Sepsis is a life-threatening condition associated with significant mortality and healthcare cost.  There is increasing evidence supporting the use procalcitonin as a biomarker for diagnosis of bacterial sepsis and as a guide to discontinue antibiotic therapy.  However, concerns about the efficacy, safety, and availability of procalcitonin exist.  A Q&amp;A article in the September 2017 issue of Clinical Chemistry asked experts with different roles in this field to share their thoughts on the challenges of procalcitonin-guided diagnosis and antibiotic therapy. 

Sepsis is a life-threatening condition associated with significant mortality and healthcare cost.  There is increasing evidence supporting the use procalcitonin as a biomarker for diagnosis of bacterial sepsis and as a guide to discontinue antibiotic therapy.  However, concerns about the efficacy, safety, and availability of procalcitonin exist.  A Q&amp;A article in the September 2017 issue of Clinical Chemistry asked experts with different roles in this field to share their thoughts on the challenges of procalcitonin-guided diagnosis and antibiotic therapy.

The Role of Procalcitonin in Diagnosis of Sepsis and Antibiotic Stewardship: Opportunities and Challenges

Audio Summary June 2018

SARS-CoV-2 Serology: Much Hype, Little Data

Coronary artery disease is the most common cause of death and morbidity in developed countries, resulting in substantial healthcare costs.  The early detection of this disease and identification of patients at risk for myocardial infarction has enormous medical and economic value.  The introduction of high-sensitivity cardiac troponin assays has revolutionized early diagnosis of myocardial infarction, but what about their use for identifying patients at risk with stable coronary artery disease?Coronary artery disease is the most common cause of death and morbidity in developed countries, resulting in substantial healthcare costs.  The early detection of this disease and identification of patients at risk for myocardial infarction has enormous medical and economic value.  The introduction of high-sensitivity cardiac troponin assays has revolutionized early diagnosis of myocardial infarction, but what about their use for identifying patients at risk with stable coronary artery disease? A recent study to address that issue as well as a comparison of high-sensitivity cardiac troponin I and troponin T assays appeared in the November 2018 issue of Clinical Chemistry.

Coronary artery disease is the most common cause of death and morbidity in developed countries, resulting in substantial healthcare costs.  The early detection of this disease and identification of patients at risk for myocardial infarction has enormous medical and economic value.  The introduction of high-sensitivity cardiac troponin assays has revolutionized early diagnosis of myocardial infarction, but what about their use for identifying patients at risk with stable coronary artery disease?Coronary artery disease is the most common cause of death and morbidity in developed countries, resulting in substantial healthcare costs.  The early detection of this disease and identification of patients at risk for myocardial infarction has enormous medical and economic value.  The introduction of high-sensitivity cardiac troponin assays has revolutionized early diagnosis of myocardial infarction, but what about their use for identifying patients at risk with stable coronary artery disease? A recent study to address that issue as well as a comparison of high-sensitivity cardiac troponin I and troponin T assays appeared in the November 2018 issue of Clinical Chemistry.

Direct Comparison of Cardiac Troponin T and I using a Uniform and a Sex-specific Approach in the Detection of Functionally Relevant Coronary Artery Disease

High-density lipoprotein or HDL is one of the most important of the lipoproteins in most species and there is evidence that points towards a role of HDL in normal immune function.  A paper appearing in the May 2019 issue of Clinical Chemistry tested the hypothesis that concentrations of HLD cholesterol are associated with risk of autoimmune disease. That study from the Copenhagen General Population Study and the Copenhagen City Heart Study included over 100,000 individuals.  We are pleased to have the senior author of that paper with us today, Dr. Borge Nordestgaard. 

High-density lipoprotein or HDL is one of the most important of the lipoproteins in most species and there is evidence that points towards a role of HDL in normal immune function.  A paper appearing in the May 2019 issue of Clinical Chemistry tested the hypothesis that concentrations of HLD cholesterol are associated with risk of autoimmune disease. That study from the Copenhagen General Population Study and the Copenhagen City Heart Study included over 100,000 individuals.  We are pleased to have the senior author of that paper with us today, Dr. Borge Nordestgaard.

Low HDL Cholesterol and High Risk of Autoimmune Disease: Two Population-Based Cohort Studies Including 117341 Individuals

Chronic kidney disease (CKD) is common, particularly in those of advanced age.

Chronic kidney disease (CKD) is common, particularly in those of advanced age.

Interpreting Cardiac Biomarkers in the Setting of Chronic Kidney Disease

Molecular diagnostics is now firmly rooted in laboratory medicine and the January 2020 issue of Clinical Chemistry is devoted to this topic.  In that issue, Dr. Linnea Baudhuin reviews genome and exome sequencing as they’re used in clinical practice.

Molecular diagnostics is now firmly rooted in laboratory medicine and the January 2020 issue of Clinical Chemistry is devoted to this topic.  In that issue, Dr. Linnea Baudhuin reviews genome and exome sequencing as they’re used in clinical practice.

Predictive and Precision Medicine with Genomic Data

The January 2019 issue of Clinical Chemistry is devoted to the area of men’s health.  Aside from non-melanoma skin cancer, prostate cancer is the most common cancer among men in the United States.  It is remarkable that even though the introduction of prostate specific antigen, or PSA, into U.S. clinical practice occurred over three decades ago, researchers and clinicians are still debating its value for prostate cancer screening. In that special issue, Dr. Andrew Vickers published an Opinion article titled, “Redesigning Prostate Cancer Screening Strategies to Reduce Overdiagnosis.”

The January 2019 issue of Clinical Chemistry is devoted to the area of men’s health.  Aside from non-melanoma skin cancer, prostate cancer is the most common cancer among men in the United States.  It is remarkable that even though the introduction of prostate specific antigen, or PSA, into U.S. clinical practice occurred over three decades ago, researchers and clinicians are still debating its value for prostate cancer screening. In that special issue, Dr. Andrew Vickers published an Opinion article titled, “Redesigning Prostate Cancer Screening Strategies to Reduce Overdiagnosis.”

Redesigning Prostate Cancer Screening Strategies to Reduce Overdiagnosis

Hepatitis C virus or HCV infection affects close to 150 million people worldwide.  In the U.S., it is estimated that as many as five million people have been infected with the Hepatitis C virus, many of whom are unaware of their infection.  HCV is now the most common indication for liver transplantation, and it accounts for more deaths each year than all other reportable infectious diseases combined including HIV. Advances in testing methods and antiviral therapies with increased development of infrastructures that improve access care now make eradication of HCV infection in well-resourced countries a realistic goal.  However, challenges in implementing screening programs and continues evolution of assay methods and screening protocols raise several issues for how clinicians and laboratories respond to the changing landscape for HCV diagnosis and treatment.  The December 2017 issue of Clinical Chemistry includes a Q&amp;A article with several experts who offer their insights and opinions on this topic.

Hepatitis C virus or HCV infection affects close to 150 million people worldwide.  In the U.S., it is estimated that as many as five million people have been infected with the Hepatitis C virus, many of whom are unaware of their infection.  HCV is now the most common indication for liver transplantation, and it accounts for more deaths each year than all other reportable infectious diseases combined including HIV. Advances in testing methods and antiviral therapies with increased development of infrastructures that improve access care now make eradication of HCV infection in well-resourced countries a realistic goal.  However, challenges in implementing screening programs and continues evolution of assay methods and screening protocols raise several issues for how clinicians and laboratories respond to the changing landscape for HCV diagnosis and treatment.  The December 2017 issue of Clinical Chemistry includes a Q&amp;A article with several experts who offer their insights and opinions on this topic.

New Therapies for Treating Hepatitis C Virus: Impact on Laboratory Testing Recommendations and Clinical Management

Molecular diagnostics is the topic of the January 2020 special issue of Clinical Chemistry.  In that issue, there is a counter point report on the use of circulating tumor cells in the management of cancer patients.  To provide further insight on this topic, we’re joined in this podcast by one of the editors of this special issue, Professor Klaus Pantel, Chairman of the Institute of Tumor Biology at the University Medical Center in Hamburg-Eppendorf in Germany. 

Molecular diagnostics is the topic of the January 2020 special issue of Clinical Chemistry.  In that issue, there is a counter point report on the use of circulating tumor cells in the management of cancer patients.  To provide further insight on this topic, we’re joined in this podcast by one of the editors of this special issue, Professor Klaus Pantel, Chairman of the Institute of Tumor Biology at the University Medical Center in Hamburg-Eppendorf in Germany.

Circulating Tumor DNA for Modern Cancer Management

Polycystic ovary syndrome is a complex endocrine-mediated disorder in women with an estimated prevalence of about 10%. Women with PCOS typically present with heterogeneous clinical signs and symptoms such as excess hair growth, irregular menstrual cycles, infertility and metabolic issues. Currently, there are no universal criteria for diagnosis of this condition and as a result, women with the disorder often reports significant delays in diagnosis and poor follow-up care. A Q&amp;A feature in the March 2019 issue of Clinical Chemistry asked five experts with different roles in this field to discuss recent advances and ongoing challenges surrounding the current diagnostic criteria, available biomarkers, and the timely diagnosis and management of women with polycystic ovary syndrome.

Polycystic ovary syndrome is a complex endocrine-mediated disorder in women with an estimated prevalence of about 10%. Women with PCOS typically present with heterogeneous clinical signs and symptoms such as excess hair growth, irregular menstrual cycles, infertility and metabolic issues. Currently, there are no universal criteria for diagnosis of this condition and as a result, women with the disorder often reports significant delays in diagnosis and poor follow-up care. A Q&amp;A feature in the March 2019 issue of Clinical Chemistry asked five experts with different roles in this field to discuss recent advances and ongoing challenges surrounding the current diagnostic criteria, available biomarkers, and the timely diagnosis and management of women with polycystic ovary syndrome.

Challenges in the Assessment and Diagnosis of Polycystic Ovary Syndrome

September 2018 Summary Guo

Hospital pneumatic tube systems provide rapid transportation of patient samples to the laboratory.  However, it is known that the physical movement through a pneumatic tube system can agitate blood samples and sometimes cause cells to break open and leak intracellular components.  As a result, multiple laboratory results are susceptible to error. The May 2019 issue of Clinical Chemistry published a paper by Dr. Ann Gronowski and Dr. Christopher Farnsworth and their colleagues at the Washington University School of Medicine in St. Louis that describes parameters for evaluating a hospital pneumatic tube system. 

Hospital pneumatic tube systems provide rapid transportation of patient samples to the laboratory.  However, it is known that the physical movement through a pneumatic tube system can agitate blood samples and sometimes cause cells to break open and leak intracellular components.  As a result, multiple laboratory results are susceptible to error. The May 2019 issue of Clinical Chemistry published a paper by Dr. Ann Gronowski and Dr. Christopher Farnsworth and their colleagues at the Washington University School of Medicine in St. Louis that describes parameters for evaluating a hospital pneumatic tube system.

Parameters for Validating a Hospital Pneumatic Tube System

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