Current insights on social media as a tool for the dissemination of research and education in surgery: a narrative review.

The purpose of our narrative review is to summarize the utilization of social media (SoMe) platforms for research communication within the field of surgery. We searched the PubMed database for articles in the last decade that discuss the utilization of SoMe in surgery and then categorized the diverse purposes of SoMe. SoMe proved to be a powerful tool for disseminating articles. Employing strategic methods like visual abstracts enhances article citation rates, the impact factor, h-index, and Altmetric score (an emerging alternative metric that comprehensively and instantly quantifies the social impact of scientific papers). SoMe also proved valuable for surgical education, with online videos shared widely for surgical training. However, it is essential to acknowledge the associated risk of inconsistency in quality. Moreover, SoMe facilitates discussion on specific topics through hashtags or closed groups and is instrumental in recruiting surgeons, with over half of general surgery residency programs in the US efficiently leveraging these platforms to attract the attention of potential candidates. Thus, there is a wealth of evidence supporting the effective use of SoMe for surgeons. In the contemporary era where SoMe is widely utilized, surgeons should be well-versed in this evidence.

Influences of amino-terminal modifications on amyloid fibril formation of human serum amyloid A.

Human serum amyloid A (SAA) is a precursor protein involved in AA amyloidosis. The N-terminal region of the SAA molecule is crucial for amyloid fibril formation, and therefore modifications in this region are considered to influence the pathogenesis of AA amyloidosis. In the present study, using the N-terminal peptide corresponding to the putative first helix region of the SAA molecule, we investigated the influences of N-terminal modifications on amyloid fibril formation. Spectroscopic analyses revealed that carbamoylation of the N-terminal amino group delayed the onset of amyloid fibril formation. From transmission electron microscopic observations, the N-terminal carbamoylated aggregate showed remarkably different morphologies from the unmodified control. In contrast, acetylation of the N-terminal amino group or truncation of N-terminal amino acid(s) considerably diminished amyloidogenic properties. Furthermore, we also tested the cell toxicity of each peptide aggregate on cultured cells by two cytotoxic assays. Irrespective of carbamoylation or acetylation, MTT assay revealed that SAA peptides reduced the reductive activity of MTT on cells, whereas no apparent increase in LDH release was observed during an LDH assay. In contrast, N-terminal truncation did not affect either MTT reduction or LDH release. These results suggest that N-terminal modification of SAA molecules can act as a switch to regulate susceptibility to AA amyloidosis.

Rapid Clinical Improvement of Multicentric Castleman Disease (MCD) with Renal Involvement Following Treatment with Tocilizumab: AA Amyloidosis as a Possible Renal Involvement of MCD.

Castleman disease (CD) is a lymphoproliferative disorder that manifests as hypergammaglobulinemia and severe inflammation with multiorgan involvement. However, renal involvement has been infrequently described in CD. We present a case of a 63-year-old Japanese male patient with multicentric CD (MCD) in whom kidney involvement, including impaired renal function and massive proteinuria, is present. He had a 2-year history of inflammatory arthritis and was referred to our clinic with newly developed proteinuria, renal dysfunction, and elevated levels of acute-phase proteins. Abdominal computed tomography scan revealed hepatosplenomegaly, including mesenteric and inguinal lymph node enlargements. The patient underwent inguinal lymph node resection. Excisional biopsy of the inguinal lymph node showed multiple lymphoid follicles and expansion of interfollicular areas by marked plasmacytosis consistent with mixed type CD. The patient was diagnosed with human herpes virus 8-negative MCD according to the international diagnostic criteria for CD. Diagnostic renal biopsy was not performed following the medical viewpoint. Tocilizumab (TCZ) treatment was highly effective in reducing proteinuria and stabilizing renal function, as well as improving other clinical symptoms. The patient responded to TCZ treatment, and the renal involvement was rapidly improved. Our preliminary immunohistochemical analysis indicated AA amyloid deposits in urinary epithelial cells suggesting a possible renal involvement of AA amyloidosis. TCZ could potentially be one of the therapeutic options in patients with MCD with renal involvement.

Effects of oral cystine and glutamine on exercise-induced changes in gastrointestinal permeability and damage markers in young men.

PURPOSE: Although acute prolonged strenuous exercise has been shown to increase markers of gastrointestinal permeability and damage, little is known regarding the efficacy of nutritional supplement interventions on the attenuation of exercise-induced gastrointestinal syndrome. This study addressed the effects of oral amino acid supplementation on markers of gastrointestinal permeability and damage in response to exercise. METHODS: Sixteen active men aged 22.7 ± 2.6 years (mean ± standard deviation) completed placebo or cystine and glutamine supplementation trials in random order. Participants received either a placebo or cystine and glutamine supplements, three times a day for 5 days, separated by a 2-week washout period. On day 6, participants took their designated supplements 30 min before running at a speed corresponding to 75% of maximal oxygen uptake for 1 h, followed by a 4-h rest period. Blood samples were collected pre-exercise, immediately post-exercise, 30 min post-exercise, and 1, 2 and 4 h post-exercise on day 6. The plasma lactulose to mannitol ratio (L:M) and plasma intestinal fatty acid-binding protein (I-FABP) were used as markers of gastrointestinal permeability and damage, respectively. RESULTS: Plasma L:M (linear mixed model, coefficient ± standard error: - 0.011 ± 0.004, P = 0.0090) and changes (i.e., from pre-exercise) in plasma I-FABP (linear mixed model, - 195.3 ± 65.7 coefficient ± standard error (pg/mL), P = 0.0035) were lower in the cystine and glutamine supplementation trial than in the placebo trial. CONCLUSION: Oral cystine and glutamine supplementation attenuated the markers of gastrointestinal permeability and damage after 1 h of strenuous running in young men. TRIAL REGISTRATION NUMBER: UMIN000026008. DATE OF REGISTRATION: 13 December 2018.

Study on the Mechanism of False Low Measurement of IgG-Binding (Affinity) IgM Type M Protein by Turbidimetric Immunoassay.

BACKGROUND: The purpose of this study was to investigate the immunological and physical characteristics of IgM-λ type M-protein from patients who were measured low in the turbidimetric immunoassay (TIA) IgM assay without error codes for high concentration to determine the cause of the false low levels and to clarify the mechanism of their occurrence. METHODS: Materials were IgM patient samples and 8 serum samples from other IgM M-protein patients as controls. Patient samples were assayed by the TIA method, in which five manufacturers and six models (two reagent manufacturers) share the principle, and the BN ProSpec method (nephelometric method), which has a different principle. Dilution linearity tests, IgG addition experiments, isoelectric point electrophoresis, and hydrophobic chromatography were performed on patients and subjects. In addition, the binding capacity of γ-globulin by BIACORE was also examined. RESULTS: The reaction curve of the patient IgM curved downward when the concentration of IgM exceeded 20 g/L, and no error code was obtained. In the measurement by the TIA method of five manufacturers and six models, patient IgM was measured at a false low level with no error code obtained in undiluted dilution by any of the instruments and reagents, but could be measured without any problem by the nephelometric method. In addition, in the patient IgG addition experiment, only patient IgM showed a false low level under high IgG concentration. Furthermore, the binding capacity of patient IgM to γ-globulin (IgG) by BIACORE was significantly higher than that of the control IgM-type M protein. CONCLUSIONS: Patient IgM has an affinity (binding capacity) for IgG and forms an IgM-IgG complex under conditions of high IgG concentration. It was speculated that this complex inhibited the reaction with the anti-IgM antibody and the absorbance of the second reaction did not increase, suggesting a false low.

Glycosylated Bence Jones Protein with Poor Thermal Reactivity in Heat Coagulation Tests.

BACKGROUND: We experienced a patient with multiple myeloma whose urine contained a considerable amount of Bence Jones protein (BJP), which demonstrated poor thermal reactivity in heat coagulation test. The mechanism for this phenomenon was assessed. METHODS: Immunoelectrophoretic analyses reveal that a band corresponding to BJP in the urine had 2,600 Dalton by reduction after glycosidase treatment, but not after sialidase treatment. In addition, the glycosidase-treated urine tested positive in heat coagulation test. CONCLUSIONS: Glycosylation of the immunoglobulin light chain, which has rarely been seen, is the cause of the unexpected behavior of this patent's BJP in heat coagulation tests.

Impact of infectious disease consultation on patients with Staphylococcus aureus bacteremia at a Japanese tertiary hospital: A retrospective observational study.

Several studies across various countries have shown the benefit of infectious disease consultation in patients with Staphylococcus aureus bacteremia (SAB). However, the effect of such consultation services in patients with SAB in Japan remains unknown. Accordingly, we aimed to examine the effectiveness of infectious disease consultation in SAB patients at an accredited hospital in Japan. We hypothesized that infectious disease consultation in SAB patients is associated with lower in-hospital mortality. We identified patients with SAB between January 2011 and January 2014. SAB was defined as the presence of at least one set of positive blood culture samples. The outcomes of patients who did and did not receive bedside infectious disease consultation were compared. The primary outcome was in-hospital mortality. We identified 183 patients with SAB. Eighty-seven patients (48%) received infectious disease consultation services, while 96 (52%) did not. There were no significant differences in in-hospital mortality between the infectious disease consultation and control groups (15.0% vs. 23.0%, p = 0.20). Logistic regression analysis showed that bedside infectious disease consultation (odds ratio, 0.23; 95% confidence interval, 0.08-0.69; p = 0.01) was independently associated with lower in-hospital mortality. In conclusion, bedside infectious disease consultation may help reduce the in-hospital mortality in patients with SAB in Japan.

Intracardiac metastasis from unknown uterine cervical cancer with severe thrombocytopenia.

INTRODUCTION: Cardiac metastasis is relatively common in malignant neoplasms, such as lung cancers, breast cancers, melanomas, lymphomas, and leukemias. In contrast, cardiac metastasis of uterine cervical cancer, solitary metastasis to the heart, and tumors inducing severe thrombocytopenia are rare. CASE REPORT: The present patient was a 52-year-old female who was diagnosed with a solitary cardiac tumor prior to uterine cervical cancer and presented with severe thrombocytopenia. Our case had two remarkable aspects: 1) successful treatment under the condition of severe thrombocytopenia in association with the presence of a cardiac tumor, and survival without recurrence of the carcinoma one year after surgery; and 2) a solitary cardiac metastatic tumor larger than the primary uterine cervix carcinoma. COMMENT: we report an extremely rare case of solitary cardiac metastasis of uterine cervical cancer, which wassuccessfully treated. One year after cardiac surgery, the patient is alive without recurrence of the carcinoma.

Azithromycin plus ß-lactam versus levofloxacin plus ß-lactam for severe community-acquired pneumonia: A retrospective nationwide database analysis.

Previous studies showed potential benefits of macrolide combined with ß-lactam for severe community-acquired pneumonia (CAP). However, it remains inconclusive whether macrolide plus ß-lactam is superior to respiratory fluoroquinolone plus ß-lactam for patients with severe CAP. Using a nationwide inpatient database in Japan, we performed propensity score matching and inverse probability of treatment weighting (IPTW) to compare 28-day mortality and in-hospital mortality between azithromycin plus ß-lactam and levofloxacin plus ß-lactam for severe CAP patients admitted to hospital between July 2010 and March 2015. We identified 1,999 patients with severe pneumonia who received azithromycin plus ß-lactam (n = 840) or levofloxacin plus ß-lactam (n = 1,159) within 2 days after admission. Five-hundred sixty propensity score-matched pairs showed no significant differences between azithromycin plus ß-lactam and levofloxacin plus ß-lactam in 28-day mortality and in-hospital mortality (19.3% vs. 20.7%, p = 0.601 and 24.8% vs. 26.8%, p = 0.495, respectively). IPTW analysis also showed no significant differences between azithromycin plus ß-lactam and levofloxacin plus ß-lactam in 28-day mortality (risk difference, -3.5% [95% confidence interval, -8.8% to 1.7%] and in-hospital mortality (risk difference, -3.6%; 95% confidence interval, -9.4% to 2.1%). In conclusion, there were no significant differences in 28-day mortality and in-hospital mortality between azithromycin plus ß-lactam and levofloxacin plus ß-lactam for severe CAP patients.

The Ratio of Oxidized Lipoprotein(a) to Native Lipoprotein(a) and the Endothelial Function in Patients with Type 2 Diabetes Mellitus.

The ratio of oxidized lipoprotein(a) to native lipoprotein(a) (oxLp(a)/Lp(a)) may be a reasonable index for assessing endothelial dysfunction in type 2 diabetes mellitus (T2DM). The present study investigated whether the oxLp(a)/Lp(a) level is correlated with the endothelial function using the Endo-PATTM, a newly developed device, in patients with T2DM. A total of 63 patients with T2DM (mean age: 59 years old) were enrolled in the study. The patients' serum Lp(a) and oxLp(a) levels were measured using an enzyme-linked immunosorbent assay. The reactive hyperemia index (RHI) level was measured using an Endo-PATTM 2000. A correlation analysis between the measured variables was conducted. Among the patients, the mean hemoglobin A1c was 7.8%. The median level of oxLp(a)/Lp(a) was 0.28 (interquartile range: 0.07-0.54), and the mean RHI was 1.8 (standard deviation: 0.4). In a multiple linear regression analysis, the oxLp(a)/Lp(a) level was an independent, significant, and inverse variable for the RHI level (ß = -0.26, p < 0.05), along with male gender. A high oxLp(a)/Lp(a) level may reflect endothelial dysfunction, as assessed by the Endo-PATTM, in patients with T2DM. Further studies are warranted to confirm the observed findings.

Acceleration of amyloid fibril formation by carboxyl-terminal truncation of human serum amyloid A.

Human serum amyloid A (SAA) is a precursor protein of AA amyloidosis. Although the full-length SAA is 104 amino acids long, the C-terminal-truncated SAA lacking mainly residues 77-104 is predominantly deposited in AA amyloidosis. Nevertheless, the amyloid fibril formation of such truncated forms of human SAA has never been investigated. In the present study, we examined the effect of C-terminal truncation on amyloid fibril formation of human SAA induced by heparan sulfate (HS). Circular dichroism (CD) measurements demonstrated that the C-terminal truncation induces a reduced α-helical structure of the SAA molecule. HS-induced increases in thioflavin T fluorescence for SAA (1-76) peptide and less significant increases for full-length SAA were observed. CD spectral changes of SAA (1-76) peptide but not full-length SAA were observed when incubated with HS, although the spectrum was not typical for a ß-structure. Fourier transform infrared experiments clearly revealed that SAA (1-76) peptide forms a ß-sheet structure. Transmission electron microscopy revealed that short fibrillar aggregates of SAA (1-76) peptides, which became longer with increasing peptide concentrations, were observed under conditions in which full-length SAA scarcely formed fibrillar aggregates. These results suggested that the C-terminal truncation of human SAA accelerates amyloid fibril formation.

Preserved Vasoconstriction and Relaxation of Saphenous Vein Grafts Obtained by a No-Touch Technique for Coronary Artery Bypass Grafting.

BACKGROUND: To obtain a saphenous vein graft (SVG) for coronary artery bypass grafting (CABG), the benefit of using a no-touch (NT) technique in vascular function has not been fully investigated. Methods and Results: The pathological and physiological functions of human SVGs with a NT technique to preserve the perivascular adipose tissue (PVAT) and ones obtained by using a conventional (CON) technique removing PVAT, were examined. Immunohistochemistry of the section of SVGs showed that the phosphorylation of endothelial nitric oxide synthase in the endothelium of the NT group was more responsive to vascular endothelial growth factor. A myograph of SVGs showed greater contraction with phenylephrine in the NT group. However, the strong contraction was eliminated in SVGs taken by electrocautery. In the 10 patients whose SVGs were taken without electrocautery, endothelial-dependent relaxation with bradykinin was apparently increased in the CON group more than in the NT group. Smooth muscle relaxation with nitroprusside was higher in the CON group at the lower concentrations; however, the relaxation became greater in the NT group at the high concentrations. Therefore, the effect of neutralizing PVAT-released factors in the both groups was further examined. After medium of NT and CON were exchanged in half, relaxation of SVGs was immediately restored in the NT group. CONCLUSIONS: The results suggest that the NT technique preserves the functions of vasoconstriction and relaxation. Also, the presence of PVAT-released vasoconstrictive factors was suspected.

False-positive elevation of 1,3-beta-D-glucan caused by continuous administration of penicillin G.

The 1,3-beta-D-Glucan (BDG) assay is widely used for the diagnosis of fungal infections, especially in patients with hematologic malignancies. Some antimicrobials have been reported to cause false-positive results for BDG, but there has been no report on the effect of penicillin G (PCG) on BDG levels. We experienced a patient who developed false-positive BDG elevation during the administration of PCG for osteomyelitis due to Streptococcus pneumoniae infection. The serum BDG level increased up to 81.0 pg/ml during the continuous administration of PCG at 24 million units per day. However, chest and paranasal CT scan showed no evidence of fungal infection. The BDG level decreased to 38.0 pg/ml at 14 hours after the discontinuation of PCG. The amount of BDG in one vial of PCG inferred from these serum BDG levels is very similar to the actual BDG concentration in a vial of PCG. Therefore, during the administration of PCG, elevated BDG levels should be interpreted with caution, as they may be false-positive results.

A Case of Waldenstrom Macroglobulinemia with Temporary Appearance of 7S IgM Half Molecule.

BACKGROUND: We encountered a rare case of Waldenstrom macroglobulinemia with temporary appearance of 7S IgM half molecule and with monoclonal proteins binding to agarose gel. METHODS: The patient's serum and urine were analyzed using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting. The N-terminal amino acid sequences of the IgM with abnormal mass (68 kDa) were determined and compared with those of known immunoglobulin. RESULTS: The 68 kDa IgM consisted of a defective µ chain (36 kDa) and an intact κ chain. N-terminal amino acid sequence analysis demonstrated that the defective µ chain had the variable region of IgM. The agarose gel-binding ability of the IgM-κ M-protein was lost after reduction or alkaline treatment of serum. CONCLUSIONS: The 7S half molecule IgM in the present case may miss a large part of the constant region of the µ chain.

Unforced Revision in Processing Relative Clause Association Ambiguity in Japanese: Evidence Against Revision as Last Resort.

The current study tackles a long standing question of whether comprehenders perform structural revision when it is not forced by grammar or not. Using an eye-tracking reading paradigm, we addressed this issue by making use of global structural ambiguity in Japanese. Our results show that comprehenders initially associate a relative clause with the first potential head noun and that they revise this analysis when the second noun is lexico-semantically possible as the relative clause head, but do not when it is impossible. The results are incompatible with the Revision as Last Resort hypothesis. Instead, they support the parsing with unforced revision that is immediately sensitive to lexical properties. We argue that our results cannot be accounted for by serial modular processing models but that they can be explained by ranked-parallel interactive processing models. Furthermore, we propose that head-finality is a key factor involved in the availability of unforced revision.

Deletion of phospholipase A2 group IVc induces apoptosis in rat mammary tumour cells by the nuclear factor-κB/lipocalin 2 pathway.

Although some forms of phospholipase A2, the initiator of the arachidonic acid cascade, contribute to carcinogenesis in many organs, the contribution of phospholipase A2 group IVc (Pla2g4c) remains to be clarified and the function of the enzyme in cancer development is unknown. The Hirosaki hairless rat (HHR), a mutant rat strain with autosomal recessive inheritance, derived spontaneously from the Sprague-Dawley rat (SDR). The HHRs showed a lower incidence and much smaller volume of mammary tumours induced by 7,12-dimethylbenz[a]anthracene, and a markedly increased number of TUNEL (terminal deoxynucleotidyltransferase-mediated dUTP nick-end labelling)-positive apoptotic cells was detected. Array comparative genomic hybridization and PCR analyses revealed the deletion of 50-kb genomic DNA on 1q21, including Pla2g4c, in HHRs. The Pla2g4c gene was expressed in the ductal carcinoma cells and myoepithelial cells in SDRs, but not in HHRs. The direct involvement of Pla2g4c in the prevention of cell death was demonstrated through the inhibition of its expression in rat mammary tumour RMT-1 cells using siRNA. This treatment also induced expression of lipocalin 2 (Lcn2) and other NF-κB (nuclear factor κB)-related genes. siRNA-induced apoptosis was inhibited by Lcn2 repression or NF-κB inhibitors. This is the first report on Pla2g4c gene-deficient rats and their low susceptibility to mammary carcinogenesis by enhancing NF-κB/Lcn2-induced apoptosis.

Establishment of a recessive mutant small-eye rat with lens involution and retinal detachment associated with partial deletion and rearrangement of the Cryba1 gene.

From our stock of SDRs (Sprague-Dawley rats), we established a mutant strain having small opaque eyes and named it HiSER (Hirosaki small-eye rat). The HiSER phenotype is progressive and autosomal recessive. In HiSER eyes, disruption and involution of the lens, thickening of the inner nuclear layer, detachment and aggregation of the retina, rudimentary muscle in the ciliary body and cell infiltration in the vitreous humour were observed. Genetic linkage analysis using crossing with Brown Norway rat suggested that the causative gene(s) is located on chromosome 10. Microarray analysis showed that the expression level of the Cryba1 gene encoding ßA3/A1-crystallin on chromosome 10 was markedly decreased in HiSER eyes. Genomic PCR revealed deletion of a 3.6-kb DNA region encompassing exons 4-6 of the gene in HiSERs. In HiSER eyes, a chimaeric transcript of the gene containing exons 1-3 and an approximately 250-bp sequence originating from the 3'-UTR of the Nufip2 gene, located downstream of the breakpoint in the opposite direction, was present. Whereas the chimaeric transcript was expressed in HiSER eyes, neither normal nor chimaeric ßA3/A1-crystallin proteins were detected by Western blot analysis. Real-time RT (reverse transcription)-PCR analysis revealed that expression level of the Nufip2 gene in the HiSER eye was 40% of that in the SDR eye. These results suggest that the disappearance of the ßA3/A1-crystallin protein and, in addition, down-regulation of the Nufip2 gene as a consequence of gene rearrangement causes the HiSER phenotype.

[Effort for Internationalization of Japanese Society of Laboratory Medicine].

The International Committee of the Japanese Society of Laboratory Medicine (JSLM) has established an encouragement award for young scientists to present papers at international conferences, such as the World Congresses of the World Association of Societies of Pathology and Laboratory Medicine (WASPaLM) and the Meetings of the Asian Society for Clinical Pathology and Laboratory Medicine (ASCPaLM). JSLM has promoted cooperation with international organizations for clinical pathology and laboratory medi- cine, including WASPaLM and ASCPaLM. The 32nd World Congress of Biomedical Laboratory Science, IFBLS2016, will be held in Kobe, Japan from August 31st to September 4th, 2016. The 29th World Con- gress of WASPaLM will be held in Kyoto, Japan from November 14th to 19th, 2017. Continuous efforts will be required for JSLM to promote education, research, and international quality standards though cooperation with international organizations for clinical pathology and laboratory medicine. [Review].

[Acute Kidney Injury in a Patient with Diarrhea and Vomiting Undergoing Chemotherapy for Colorectal Cancer].

A case of acute kidney injury (AKI) strongly suspected to be drug-induced (oxaliplatin and non-steroidal anti-inflammatory drug) is discussed regarding the mechanism of a reduced glomerular filtration rate responsible for the development of AKI. Urinary biochemical tests are useful for the differential diagnosis of pre- renal (functional) AKI and intrinsic (structural) AKI(so-called acute tubular necrosis). In this case, although a comprehensive differential diagnosis using these parameters supported intrinsic AKI, only one pa- rameter, fractional excretion of urea (FEurea), indicated the existence of prerenal AKI. As a result of treatment with the appropriate management of body fluid in addition to avoiding nephrotoxic medications, AKI rapidly improved. FEurea revealed the underlying mechanism of AKI. [Review].

[The Accurate Quantification of Monoclonal Immunoglobulin by A Capillary Electrophoresis System].

The amount of monoclonal immunoglobulin (M protein) distinguishes multiple myeloma (M) from mono- clonal gammopathy of undetermined significance (MGUS) and indicates the effectiveness of treatment for MM. It should be calculated by serum total protein (g/dL) and M peak ratio (%) on the densitometry of se- rum electrophoresis. However, the ordinary method possibly overestimates the amount of M protein, be- cause this method utilizes the area from the baseline of the M peak (baseline method). For the more accu- rate measurement of M protein, in this study, we evaluated a capillary electrophoresis system that enables to extract the proper area of M peak by manual operation (peak method). Three serum samples with positive M protein were mixed with M protein negative serum at various ratio, and the measured values of M protein were compared with the theoretical values for both baseline and peak methods. All the results showed that the peak method gave the values close to the theoretical values compared with the baseline method. Espe- cially, the less M protein positive serum was mixed, the further the values by the baseline method parted from the theoretical one. In conclusion, the peak method using a capillary electrophoresis system should be introduced for the accurate quantification of M protein. [Original].