Retrospective analysis of serum protein electrophoresis screening for monoclonal gammopathy in 533 989 cases / 中华检验医学杂志

Objective:To compare the distribution differences of serum protein electrophoresis (SPE) among different gender and age individuals, and to explore the clinical application of SPE screening monoclonal gammopathy.Methods:A retrospective analysis was conducted based on the SPE results obtained from 533 989 cases enrolled from January 2018 to December 2019 at Zhongshan Hospital Affiliated to Fudan University. Among these patients, 435 479 inpatients were from departments of hematology, nephrology, spinal surgery, endocrinology, and rheumatology and immunology; and 98 510 were apparently healthy individuals. The distributions of albumin, α1 globulin, α2 globulin, β1 globulin, β2 globulin and γ globulin in different gender and age groups (≤20, 21-30, 31-40, 41-50, 51-60, 61-70, 71-80, 81-90, ≥91 years old) were compared. A total of 10 014 cases were selected by immunofixation electrophoresis (IFE). The positive detection rates of different SPE bands and IFE bands were analyzed. The sensitivity and specificity of SPE methods were determined according to IFE results as the gold standard.Results:No significant difference was examined in the proportion of SPE bands between different genders ( P>0.05). There were statistically significant differences in the proportion of albumin bands between apparently healthy individuals and hospitalized patients at different ages (apparently healthy individuals: F=5.12, P<0.05, inpatients: F=4.18, P<0.05), and all of them decreased with the increase of age. The proportion of γ globulin bands increased with age (apparently healthy individuals: F=1.34, P<0.05; inpatients: F=1.24, P<0.05). The sensitivity of SPE was 69% (2 098/3 051), and the specificity was 97% (6 721/6 963). Compared with IFE method, the positive detection rate of monoclonal gammopathy was significantly different (χ2=5 049.94, P<0.05). The positive rate of monoclonal gammopathy in γ globulin region (21.11%, 2 114/10 014) was higher than that in β globulin region (3.28%, 328/10 014) (χ2=90.74, P<0.05) and β-γ globulin region (1.63%, 163/10 014) (χ2=44.34, P<0.05). IgG and IgM bands are common in γ globulin region. Among them, IgG-κ type accounted for 94.1% (995/1 058), IgG-λ type accounted for 94.8% (690/728), IgM-κ type accounted for 89.2% (222/249), IgM-λ accounted for 83.8% (62/74). IgA bands are common in β region, of which IgA-κ accounted for 49.8% (103/207) and IgA-λ accounted for 51.6% (149/289). The positive rate of monoclonal gammopathy of IgG-κ type was the highest (10.57%, 1 058/10 014), and the positive rate of monoclonal gammopathy of IgM-λ type was the lowest (0.74%, 74/10 014). Conclusions:With increasing age, the proportion of albumin band in SPE decreased and the proportion of γ globulin band increased. IgG and IgM type monoclonal gammopathy is mostly found in the gamma region, with a higher detection rate in IgG type. IgA type monoclonal gammopathy is mostly found in the β region, with a lower detection rate.

Characteristics and distribution of monoclonal gammopathy in clinical patients: a single-center study / 中华检验医学杂志

Objective:To investigate the characteristics and distribution of monoclonal gammopathy in clinical patients.Methods:A total of 936 171 patients (508 449 males and 427 722 females) who received capillary zone electrophoresis in Zhongshan Hospital Affiliated to Fudan University from January 2012 to December 2021 were selected, from which 14 945 patients with abnormal bands were screened as the study subjects, including 10 173 males and 4 772 females and the age 21-102 (65±13) years old. According to the age, patients were divided into 8 groups: 21-30 years old (168 cases), 31-40 years old (405 cases), 41-50 years old (1 326 cases), 51-60 years old (3 068 cases), 61-70 years old (4 985 cases), 71-80 years old (3 288 cases), 81-90 years old (1 519 cases), and≥91 years old (186 cases). The diagnostic results of the 14 945 patients with abnormal bands were collected and were divided into tumor group (5 196 cases) and non-tumor disease group (9 749 cases) according to the presence of tumor. The distribution of abnormal bands in different gender, age, and disease groups were retrospectively analyzed. Among the 14 945 patients, 4 988 cases underwent immunofixation electrophoresis, excluding 336 negative cases and 412 cases of double clonal bands reaction, and 4 240 patients with monoclonal immunoglobulin (M protein) reaction were selected as the study subjects, including 2 794 males and 1 446 females aged 21-102 (67±12) years old. They were divided into 8 groups according to the age: 21-30 years old (18 cases), 31-40 years old (91 cases), 41-50 years old (364 cases), 51-60 years old (862 cases), 61-70 years old (1 455 cases), 71-80 years old (904 cases), 81-90 years old (486 cases), and≥91 years old (60 cases). The diagnostic results and immunoglobin subtypes (IgA-κ, IgA-λ, IgG-κ, IgG-λ, IgM-κ, IgM-λ, κ, λ) of patients were collected, and the distribution of monoclonal gammopathy in different gender, age and disease groups were retrospectively analyzed.Results:Among 936 171 patients, 14 945 cases showed abnormal bands in electropherograms with a detection rate of 1.60%; the detection rates of abnormal bands in males and females were 2.00% (10 173/508 449) and 1.12% (4 772/427 722), respectively, with a statistically significant difference ( P<0.01). There was a significant difference in the detection rate of abnormal bands among different age groups ( P<0.01); among them, the highest detection rate of abnormal band in group of ≥91 years old was 5.98%, and the ratio of male to female was 1.67∶1. Among the 14 945 cases of abnormal bands, patients aged 51-60, 61-70 and 71-80 accounted for 20.53% (3 068 cases), 33.36% (4 985 cases) and 22.00% (3 288 cases), respectively, and the differences among the age groups were statistically significant (χ 2=115.82, P<0.01). In the tumor group, the top 3 tumors with abnormal bands were plasmacytoma with 1 123 cases, lymphoma with 289 cases, and leukemia with 49 cases. The detection rate of abnormal bands in electropherograms of plasmacytoma was 89.92% (1 123/1 249), which was higher than that in lymphoma and leukemia [6.73% (289/4 296) and 6.40% (49/766), respectively, P<0.01]. Among 4 240 patients with positive M protein, the proportion of 51-60, 61-70 and 71-80 years old patients were 20.33% (862/4 240), 34.32% (1 455/4 240) and 21.32% (904/4 240), respectively, and the differences among age groups were statistically significant ( P<0.01). The results of M protein types showed that the proportion of IgG-κ type was the highest in both genders, with 32.28% (902/2 794) in males and 34.30% (496/1 446) in females. In the 21-30, 31-40, and 41-50 age groups, the proportion of IgG-λ was the highest, which were 38.89% (7/18), 36.26% (33/91) and 34.07% (124/364) in these groups respectively. However, the proportions of IgG-κ were the highest in either of the 51-60, 61-70, 71-80, 81-90 and ≥91 years old groups, which were 33.87% (292/862), 34.16% (497/1 455), 31.53% (285/904), 34.57% (168/486), 28.33% (17/60), respectively, and the differences among all age groups and gender groups had statistical significance ( P<0.01). Among patients with positive M protein in the tumor group, plasmacytoma accounted for 14.22% (603/4 240), followed by lymphoma 6.30% (267/4 240); among non-tumor diseases, M proteinemia accounted for the highest proportion (7.24%, 307/4 240), followed by pulmonary infection (5.47%, 232/4 240). Conclusions:The detection rate of abnormal bands in capillary zone electrophoresis may increase with age, and is higher in males than in females in the same age group; different malignant tumor diseases can also show abnormal bands in capillary zone electrophoresis, but they are still mainly hematological tumors. Among the positive results of M protein, 61-70 years old group accounts for the highest proportion; the most common type of monoclonal gammopathy is IgG type; in the age group of 21-50 years, the proportion of IgG-λ type is the highest; in the group of >50 years old, the proportion of IgG-κ type is the highest; in the diagnosis of positive monoclonal gammopathy, the top 3 diseases are all hematological diseases, including plasmacytoma, monoclonal gammopathies and lymphoma.

Caracterización del patrón proteico y perfil antigénico de larvas L 3 de anisákidos de importancia médica aisladas de peces comerciales de la costa peruana / Characterization of the protein pattern and antigen profile of L 3 larvae of medical importance in anisakids isolated from commercial fish of the peruvian coast

RESUMEN Introducción. La anisakidosis es una zoonosis causada por la ingestión accidental de larvas (L3) de anisákidos. Objetivo. Caracterizar el patrón proteico y perfil antigénico de la L3 de Anisakis simplex s.l. (tipo I), A. physeteris s.l. (tipo II) y Contracaecum osculatum s.l. aisladas de peces comerciales. Métodos. Se realizó una corrida electroforética en SDS-PAGE de los antígenos somáticos. Se inmunizó conejos experimentalmente y se evaluó por EITB. Resultados. El patrón proteico de Anisakis tipo I mostró 12 bandas, 18 Anisakis tipo II y C. osculatum 13, con las bandas 10 y 35 kDa específicas para Anisakis tipo II, 28 y 77 para C. osculatum no presentes en Anisakis tipo I. Conclusión. Se determinó bandas inmunogénicas específicas para Anisakis tipo I con las proteínas de peso molecular 11, 14, 25 y 40 kDa, para el tipo II de 9, 10, 12, 35 y 41 kDa, y C. osculatum 13, 15, 17, 30 y 47 kDa.

ABSTRACT Introduction. Anisakidosis is a zoonosis caused by accidental ingestion of anisakid larvae (L3). Objective. To characterize the protein pattern and antigenic profile of the L3 of Anisakis simplex s.l. (type I), A. physeteris s.l. (type II) and Contracaecum osculatum s.l. commercial3 fish isolated. Methods. An SDS-PAGE electrophoretic run of the somatic antigens was performed. Rabbits were immunized experimentally and evaluated by EITB. Results. The protein pattern of Anisakis type I showed 12 bands, 18 Anisakis type II and C. osculatum 13, with bands 10 and 35 kDa specific for Anisakis type II, 28 and 77 for C. osculatum, not present in Anisakis type I. Conclusion. Specific immunogenic bands were determined for Anisakis type I with the molecular weight proteins 11, 14, 25 and 40 kDa, for type II of 9, 10, 12, 35 and 41 kDa and C. osculatum 13, 15, 17, 30 and 47 kDa.

Respuesta anticlases mayores de anticuerpos humanos séricos en antisueros hiperinmunes obtenidos en carneros / Characterization of hyperimmune anti-human serum produced in sheep

Introducción: La inmunoelectroforesis es una técnica de precipitación que permite la caracterización de muestras biológicas complejas. En el Departamento de Inmunología del Instituto de Ciencias Básicas y Preclínicas Victoria de Girón se cuenta con un antisuero hiperinmune obtenido por inmunizaciones de carneros contra proteínas totales séricas humanas y con otro antisuero anti IgA de calostro humano. Objetivo: Identificar IgG, IgM e IgA en suero humano y determinar respuesta anti IgM humana en el antisuero anti IgA de calostro humano obtenido en carnero. Material y Métodos: Se realizó un estudio observacional, descriptivo y transversal desde noviembre de 2017 hasta junio de 2018. Se desarrolló una inmunoelectroforesis de suero humano normal empleando el antisuero hiperinmune. Resultados: Se identificaron IgG, IgM e IgA además de albúmina y otras fracciones proteicas y se determinó respuesta anti IgM humana en el antisuero anti IgA de calostro humano obtenido en carnero. Conclusiones: Este trabajo permitió identificar y determinar la respuesta anticlases mayores de inmunoglobulinas en la muestra de estudio(AU)

Introduction: Immunoelectrophoresis is a precipitation technique that allows the characterization of complex biological samples. The Immunology Department of the Institute of Basic and Pre-Clinical Sciences Victoria de Girón has a hyperimmune antiserum obtained by immunization of sheep against human serum total proteins and it also has an anti-human IgA antiserum obtained from human colostrum. Objective: The aim of this study was to identify IgG, IgM and IgA in human serum and to determine response to anti-human IgM in human colostral IgA with antiserum obtained in sheep. Material and Methods: An observational descriptive cross-sectional study was conducted from November 2017 to June 2018. Immunoelectrophoresis of normal human serum was performed using hyperimmune antiserum. Results: These procedures allowed to identify IgG, IgM and IgA in addition to albumin and other protein fractions and to determine response to anti-human IgM in human colostral IgA with antiserum obtained in sheep. Conclusions: This work allowed us to identify and determine significant anti-class responses of immunoglobulins in the sample studied(AU)

POEMS syndrome coexisting with Castleman disease and negative results of hematological examination: report of one case and review of literature / 白血病·淋巴瘤

Objective To strengthen the recognition of atypical POEMS syndrome in order to improve diagnosis rate of rare cases of POEMS syndrome. Methods The diagnosis and treatment of a rare case of POEMS syndrome coexisting with Castleman disease but without M protein in serum, urine and bone marrow who was admitted to Xuanwu Hospital, Capital Medical University in November 2017 were retrospectively analyzed with review of the literature. Results The elder male was suspected with a diagnosis of POMES syndrome, but absence of monoclonal plasma cell disease that made it difficult to diagnose. Systemic PET-CT found an active metabolic lesion in left iliac bone. Although the lymph node biopsy had been performed for a diagnosis of Castleman disease, a bone biopsy was also done for a definite diagnosis. Pathological result indicated a plasmacytoma which confirmed a diagnosis of POEMS syndrome without M protein in serum, urine and bone marrow. Literature review suggested that the application of immunofixation electrophoresis was helpful to improve the diagnostic rate of POEMS syndrome. For patients with a suspected diagnosis of POEMS syndrome, bone biopsy, flow cytometry and systemic PET-CT may assist in the search for monoclonal plasma cell. Periphery neuropathy, bone lesion and treatment response were helpful in distinguishing Castleman disease coexisting with POEMS syndrome from Castleman disease without POEMS syndrome. Conclusions When a mandatory major criterion of POEMS syndrome is not sufficient, it should be actively sought, especially for patient with a suspected diagnosis of POEMS syndrome. For patients with multiple lesions, multi-site biopsies are necessary to assist in diagnosis.

The application of modified capillary immunotyping technique for cryoglobulin identification / 中华检验医学杂志

Objective To establish and evaluate the application of modified capillary immunotyping for cryoglobulin qualification .Methods Referred to literature and benchwork experience , a modified capillary immunotyping technique was set up for cryoglobulin identification . Seventy-eight cryoglobulin positive specimens were collected by a standard method in Peking Union Medical College Hospital from November 2016 to July 2017.Thirty-nine samples were identified the type of the cryoglobulin simultaneously by modified capillary immunotyping ( CI ) and immunofixation electrophoresis ( IFE ) .Results Using the modified capillary immunotyping method , the types of cryoglobulin in seventy-eight specimens were identified.The number of cases decreased in the order of Ⅲ, Ⅱ and Ⅰ type of cryoglobulin .The clinical characteristics coincidence with previous reports .The modified CI method had a dramatic advantage in the speed, clarity, and accuracy of results compared with IFE .The ratio of reportable cases between these two methods was 1:0.87.Conclusion The modified capillary immunotyping was an accurate and easy method for cryoglobulin qualification , and feasible for clinical application .

A Case of Central Nervous System Myelomatosis with Complex Chromosome Aberrations / 대한진단검사의학회지

Involvement of the central nervous system is very uncommon in multiple myeloma, observed in approximately 1% of the multiple myeloma patients. We report a case of central nervous system myelomatosis with complex chromosome aberrations in a 62-yr-old female patient, who had previously been diagnosed as multiple myeloma. Fluorescent in situ hybridization revealed 13q deletion, p53 gene deletion and IGH/FGFR3 rearrangement and chromosomal study showed complex chromosome aberrations. After four cycles of chemotherapy, the patient was admitted to the hematology department with severe headache. Plasma cells were found in the cerebrospinal fluid (CSF), and CSF immunoelectrophoresis revealed abnormal precipitin arcs against anti-IgG and anti-lambda antisera. She was given systemic chemotherapy and eight courses of intrathecal chemotherapy, which cleared plasma cells in the CSF. Two months later, she was given autologous stem cell transplantation. Three months after stem cell transplantation, central nervous system myelomatosis progressed to plasma cell leukemia and two months later,the patient expired.

The seroimmunological analysis of 117 multiple myeloma cases in xinjiang / 中国基层医药

Objective To analyze the immunological feature of the multiple myeloma. Methods The serum of 117 cases were detected by serum protein electrophoresis and immunofixation electrophoresis;and analyzed quantitatively immune globulin(IgG、IgA、IgM) ,total protein and albumin. Results Monoclone protein peak was found in 67 patients out of 117 patients tested(57.3%) ,it located mainly at γ border. Immunoglobulin G was found in 62 patients out of 117 patients tested(53.0%). Immunoglobulin A was 19 cases(16.3%) ,Immunoglobulin M was 12 cases(10. 1%) ,DL was 2 cases(1.7%) ,free light chain was 22 cases(18.8%). Homotypic immunoglobulin level increased notably and non-correspond constituent was low in immunoglobulin test. The protein quantified displayed that total protein increased and albumin decreased in different level. Conclusion The seroimmunological index played a crucial role in diagnois,clinical stage and prognosis of MM.

The clinical and laboratorial characteristics of eleven nonsecretory myeloma / 白血病·淋巴瘤

Objective To get more understanding on the symptom,and laboratory characteristics of nonsecretory myeloma(NSM).Methods 11 patients with NSM were examined by immunoglobulins IgG,IgA,IgM,IgD,IgE and their light chains,electrophoresis(PE),immunofixation electrophoresis(IFE)and serum free light chain(FLC).Results All 11 patients had more serious bone pains.all had osteolytic bone lesions.All patients were negative in PE,IFE,urine FLC tests.2 newly diagnosed patients had increased serum FLC,abnormal k/λ ratio.1 patient had normal serum FLC and normal k/λ ratio.All 11 patients had more than 30%bone marrow plasma cells.Their overall survivals were same with the typical multiple myeloma(MM).Conclusion Most NSM have more serious bone pains,and osteolytic bone lesions.PE,IFE,urine FLC tests are negative.Newly diagnosed or refractory patients have increased serum FLC,abnormal k/λ ratio,plateau phase patients have normal or reduced serum FLC.Most NSM have more than 30%bone marrow plasma cells.The therapy and prognosis of NSM are same with typical MM.

Detection of bence jones proteins of nonconcentrated urine by immunofixation electrophoresis / 中华检验医学杂志

Objective To evaluate immunofixation electrophoresis (IFE) and to compare it with conventional manual heat test method for detection of Bence Jones (BJ) protein in nonconcentrated urine. Methods We performed IFE and heat test for urinary protein analysis in 116 urine samples and evaluated a new immunofixation electrophoresis system by urinary protein analysis in 20 patients with multiple myeloma. Results 20 patients with multiple myeloma were detected to have BJ proteins (8 ? and 12?) in urine by IFE, whereas no urine BJ proteins by heat test. Conclusion The heat test for BJ proteins should be replaced by IFE because of its insensitivity and unspecificity. The IFE method is higherly sensitive and specific for screening and identification of BJ proteins in urine.

Nonsecretory Multiple Myeloma with Multiple Spine Fracture

A case of nonsecretory multiple myeloma in a 66 year-old-woman is reported. At first, she complained severe neck pain and radiologic finding showed C2 pathologic fracture. She complained severe low back pain 4 month later and L1 compression fracture was found. The lumbar MRI showed a 1.4cm-sized round enhancing lesion in the body of T12. Bone marrow aspiration biopsy at L1 spine showed a few polymorphous and small nests of mononuclear cell. L1 lamina bone biopsy showed many abnormal plasma cells. Pathologic diagnosis was multiple myeloma. However, plasma electrophoresis and protein immunoelectrophoresis of serum and urine of patient were normal. So, it is a nonecretory multiple myeloma case and the incidence of nonsecretory multiple myeloma is known to about 1% of all multiple myeloma.

Tumor-associated proteins in rat submandibular gland induced by DMBA and irradiation / 대한구강악안면방사선학회지

This study was performed in order to identify changes of the plasma membrane proteins in rat submandibular gland tumors induced by 7,12-dimethylbenz[a]anthracene [DMBA] and X-irradiation. Two kinds of tumor associated membrane proteins (protein A and B) were isolated with 3 M KCl extraction from rat submandibular gland tumors induced by DMBA and X-irradiation. To identify their antigenicities, immunoelectrophoresis and double immunodiffusion was carried out with various proteins extracted from liver, heart, skin and pancreas of adult rats and from embryonic liver, heart and skin. The rabbit antisera against the protein A did not cross-react with any of the proteins extracted from the above mentioned tissues, suggesting that protein A might be tumor specific antigen. However, the rabbit antisera against protein B was precipitated with proteins extracted from the liver of adult and embryonic rats. Polyacrylamide gel electrophoresis of these two proteins (A and B) showed that protein A was a dimer with molecular weights of 69,000 and 35,000 dalton, whereas protein B was a monomer with molecular weight of 50,000 dalton.

Isolation, purification and partial characterisation of prealbumin from cerebrospinal fluid.

Prealbumin from human cerebrospinal fluid was purified using a combination of ammonium sulphate precipitation, phenol precipitation, Polyacrylamide disc gel electrophoresis and gel filtration on Sephadex G-100. The homogeneity of the purified protein was established by Polyacrylamide gel electrophoresis and Immunoelectrophoresis. On the basis of its molecular weight (55,000), amino acid composition, electrophoretic mobility and immunological cross-reactivity, the prealbumin from cerebrospinal fluid showed complete identity with serum prealbumin. The cerebrospinal fluid prealbumin levels in various neurological disorders may have a diagnostic significance.

ESTIMATION OF POSTMORTEM INTERVAL BASED ON COMPLEMENT 3(C3) CLEAVAGE AND RECTAL TEMPERATURE / 中国法医学杂志

The C3 cleavages of human blood kept at different temperatures in vitro were studied. In 14 autopsy cases, the postmortem intervals(PMI) were estimated based on the C3 cleavage rates and the rectal temperatures. The 95% confidence of predicting PMI was?11 hours. The phenotyping of C3 could be achieved while the C3 cleavage rate was measured. It is suggested that it is useful for the personal identification of unknown corpses.

STUDIES ON EARLY DIAGNOSIS OF HEPATOCELLULAR CANCER WITH MICRO-HETEROGENEITY OF ALPHA-FETOPROTEIN / 第二军医大学学报

Microheterogeneity of alpha-fetoprotein (AFP) in the sera of 78 patients with hepatocellular cancer (HCC) and 40 patients with benign liver diseases (BLD) was studied by lectin affino-immunoelectrophoresis autoradiography. Serum AFP concentre tions varied 124-56000ng/ml in patients with HCC and 31-980 ng/ml in patient with BLD.By means of either LCA or Con-A, AFP was divided into two variants, which were coded AFP-R-L (AFP retarded by LCA) and AFP-N-L (AFP not retarded by LCA), AFP-R-C (AFP retarded by Con-A) and AFP-N-C (AFP not retarded by Con-A), respectivily. AFP-N-L percentage lower than 75% was observed in 87.2% of patients with HCC and none with BLD, AFP-R-C percentage lower than 100% in 89.7% of cases with HCC and 17.5% of patients with BLD. According to the diagnostic standard of AFP level greater than 400ng/ml for primary liver cancer, the positive rate of patients with HCC was 78.2%, and that of patients with BLD was 20.0%. Determination of microheterogeneity of AFP ran raise the positive rate of patients with HCC to 97.4% and reduce that of patients with BLD to O (by mean of LCA). Therefore, determining the concentrations of AFP variants can increase the clinic value of AFP as a marker of primary liver cancer.

Pesquisa de polissacarídeos de neisseria meningitidis do grupo C no líquido cefalorraquidiano por imunoeletroforese cruzada em acetato de celulose / Detection of polysaccharides of Neisseria meningitides serogroup C in spinal fluid by counter-immunoelectrophoresis in cellulose acetate

Os resultados de exames bacteriológicos de 846 amostras de líquido cefalorraquidiano provenientes de casos suspeitos de meningite bacteriana foram comparados com os fornecidos pela reação de imunoeletroforese cruzada em acetato de celulose. Nos casos em que foi isolada Neisseria meningitidis do grupo C houve uma concordância de 83,06%. Nos caos de meningites bacterianas não meningocócicas, a concordância foi de 99%, indicando ser a reação bastante específica (AU).