Characterization of a Low-Temperature Plasma (LTP) Ambient Ionization Source Using Temporally Resolved Monochromatic Imaging Spectrometry.

The low-temperature plasma (LTP) probe is a common plasma-based source used for ambient desorption-ionization mass spectrometry (MS). While the LTP probe has been characterized in detail with MS, relatively few studies have used optical spectroscopy. In this paper, two-dimensional (2D) imaging at selected wavelengths is used to visualize important species in the LTP plasma jet. First, 2D steady-state images of the LTP plume for N2+ (391.2 nm), He I (706.5 nm), and N2 (337.1 nm) emissions were recorded under selected plasma conditions. Second, time-resolved 2D emission maps of radiative species in the LTP plasma jet were recorded through the use of a 200 ns detection gate and varying gate delays with respect to the LTP trigger pulse. Emission from He I, N2+, and N2 in the plasma jet region was found to show a transient behavior (often referred to as plasma bullets) lasting only a few microseconds. The N2+ and He I maps were highly correlated in spatial and temporal structure. Further, emission from N2 showed two maxima in time, one before and one after the maximum emission for N2+ and He I, due to an initial electronic excitation wave and ion-electron recombination, respectively. Third, the interaction of the LTP probe with a sample substrate and an electrically grounded metallic needle was studied. Emission from a fluorophore on the sample substrate showed an initial photon-induced excitation from plasma-generated photons followed by electronic excitation by other plasma species. The presence of a grounded needle near the plasma jet significantly extended the plasma jet lifetime and also generated a long-lived corona discharge on the needle. The effect of LTP operating parameters on emission spectra was correlated with mass-spectral results including reagent-ion signals. Lastly, five movies provide a side-by-side comparison of the temporal behavior of emitting species and insights into the interactions of the emission clouds with a sample surface as well as an external needle. Temporally and spatially resolved imaging provided insights into important processes in the LTP plasma jet, which will help improve analyte ion sampling in LTP-MS.

Characterization and Optimization of a Spectral Window for Direct Gaseous Uranium Hexafluoride Enrichment Assay Using Laser-Induced Breakdown Spectroscopy.

Through a systematic scanning of 235U and 238U emission lines between 280 nm and 745 nm, the optimal emission line for direct gaseous uranium hexafluoride (UF6) enrichment assay using laser-induced breakdown spectroscopy (LIBS) was found. Screening for spectral features that are potentially useful for U isotopic analysis was gauged from the magnitude of the 235U-238U isotopic shift and the signal-to-background ratio of the emission line through a parameter termed ΔSBR 235U-238U. The ΔSBR spectrum shows peaks at wavelength positions where there are strong lines with significant 235U-238U shifts. The screening identified 13 spectral-window candidates, which were down selected based on their overall accuracy in predicting the 235U enrichment of three UF6 samples of natural (0.720 atom% 235U) and low-enriched (4.675 atom% and 9.157 atom% 235U) grades. The U(I) 646.498 nm emission line, with a determined 235U-238U isotopic shift of -17.7 pm, was found to be the optimal spectral window for direct UF6 enrichment assay. The root mean square error for enrichment assays on the three natural and low-enriched UF6 samples, with each sample measured in six replicates, was 0.31% in absolute 235U content. Each measurement comprised LIBS signals accumulated from 3000 laser shots. The analytical bias and precision were better than 0.5% and 0.3%, respectively, in absolute [235U/(235U + 238U)] ratios. Specific for the two low-enriched UF6 samples, the relative standard deviations from six replicated measurements were around 2%.

Factors Contributing to Early Intervention Evaluation.

OBJECTIVE: Early Intervention (EI) programs promote early childhood development but remain underutilized. Few studies have examined correlations with completion of EI referrals using a standardized referral system. Our study examined a minority, underserved population for characteristics that affect this critical step. METHODS: Subjects were referred from an inner-city pediatric primary care clinic for EI evaluation from 3/1/15-5/31/18. Subjects were <3 years of age at the time of referral, received pediatric care at the clinic, and were referred for EI. The dependent variable was completion of EI evaluation, verified by the medical record. Independent variables included demographic, maternal (eg, depression), child (eg, chronic illness), and referral characteristics. A multivariable logistic regression model was used to determine the predictors for completing an evaluation. RESULTS: Of 181 children referred to EI, 61.9% completed an EI evaluation; the average age was 18.9 (SD 7.4) months at first referral. For every additional month of age at the initial referral, a child was 5.0% less likely to complete an evaluation (adjusted odds ratio [aOR], 0.95; 95% confidence interval [CI], 0.90-0.99; P = .02). Two factors more than doubled the odds of completing an EI evaluation: having a chronic medical illness at the time of referral (aOR = 2.41, CI 1.21-4.79; P = .01), and being a child from a non-English speaking family (aOR = 2.22, CI 1.09-4.50; P = .03). CONCLUSIONS: The child's age and medical history, and language spoken at home affected the odds of successfully completing an EI evaluation. These findings can help clinicians target families at risk of failing to complete EI programs.

Perceptions of Audio-Visual Impact Events in Younger and Older Adults.

Previous studies have examined whether audio-visual integration changes in older age, with some studies reporting age-related differences and others reporting no differences. Most studies have either used very basic and ambiguous stimuli (e.g., flash/beep) or highly contextualized, causally related stimuli (e.g., speech). However, few have used tasks that fall somewhere between the extremes of this continuum, such as those that include contextualized, causally related stimuli that are not speech-based; for example, audio-visual impact events. The present study used a paradigm requiring duration estimates and temporal order judgements (TOJ) of audio-visual impact events. Specifically, the Schutz-Lipscomb illusion, in which the perceived duration of a percussive tone is influenced by the length of the visual striking gesture, was examined in younger and older adults. Twenty-one younger and 21 older adult participants were presented with a visual point-light representation of a percussive impact event (i.e., a marimbist striking their instrument with a long or short gesture) combined with a percussive auditory tone. Participants completed a tone duration judgement task and a TOJ task. Five audio-visual temporal offsets (-400 to +400 ms) and five spatial offsets (from -90 to +90°) were randomly introduced. Results demonstrated that the strength of the illusion did not differ between older and younger adults and was not influenced by spatial or temporal offsets. Older adults showed an 'auditory first bias' when making TOJs. The current findings expand what is known about age-related differences in audio-visual integration by considering them in the context of impact-related events.

Ethnic differences in acute promyelocytic leukaemia between New Zealand Polynesian and European patients.

Ethnic differences in haematologic malignancies remain poorly elucidated, hence research in this area is important. This was a retrospective study into potential ethnic disparity in the presentation and outcomes of acute promyelocytic leukaemia (APL) between New Zealand (NZ) Polynesian and European patients. Data were analysed for patients treated at Auckland City Hospital (ACH; n = 55) and recorded in the New Zealand Cancer Registry (NZCR; n = 173), both for the period 2000-2017. We found that Polynesian patients treated at ACH presented at a younger age than European (P = 0.005), showed higher blast counts (P = 0.033), and a marginally higher prothrombin ratio (P = 0.02). Treatment with all-trans retinoic acid (ATRA) was started faster in Polynesian patients than European (P = 0.021), suggesting Polynesians were sicker at presentation but were managed accordingly. There were no differences in bleeding events, transfusion requirements and early deaths during the first month of treatment. Long-term survival was also similar. Data extracted from the NZCR confirmed NZ Polynesian patients with APL were younger than European (P < 0.001), but long-term survival was similar (P = 0.920). In summary, this study indicates a discrepancy in the presentation and severity of APL between NZ Polynesian and European patients but treatment initiation was rapid with no difference in outcomes. The distinctive features of APL in NZ Polynesians raise the possibility of a predisposing genetic factor or a different risk factor profile, elucidation of which is important for all patients with APL.

Unravelling androgens in sport: Altrenogest shows strong activation of the androgen receptor in a mammalian cell bioassay.

Altrenogest is a commonly used progestogen for the suppression of oestrus and associated distracting behaviours that interfere with training and performance of female racehorses. The steroid is derived from 19-nor testosterone and is structurally similar to the anabolic androgenic steroid, trenbolone. In this study, the relative androgen potency of altrenogest was determined by a kidney (HEK293) cell androgen bioassay. The HEK293 bioassay shows that in its pure form, altrenogest has a high relative potency compared with testosterone but is not as strong as ß-trenbolone. Our results also show that altrenogest is able to activate the androgen receptor at the concentrations relevant to the administration regime of racehorses and retains its activity ex vivo. Thus, we show unequivocally that altrenogest, a progestogen used widely in female racehorses, acts as a strong androgen in a mammalian cell bioassay.

A three-way comparison of glycated haemoglobin: are results from the three platforms interchangeable?

AIMS: To determine whether glycated haemoglobin (HbA1c) results from three commonly used platforms can be interpreted cumulatively and used interchangeably in individuals with common haemoglobinopathies. A secondary goal was to assess the relationship between HbA1c concentrations, and haemoglobin and mean corpuscular volume in this population. METHODS: One hundred and forty-five samples, mostly with haemoglobinopathies, were tested by each of: Roche Gen.3 Cobas c513, Capillarys 2 Flex-Piercing and Bio-Rad D-100 platforms. Statistical comparisons and limits of performance based on biological variation, international recommendations, and local diagnostic cut-offs were drawn upon to determine comparability of results. RESULTS: Inter-platform measurements were not significantly different for the large majority of results. The four HbA1c results that showed maximum discrepancy between triplicates had the following abnormalities: heterozygous haemoglobin S/ beta thalassemia, heterozygous haemoglobin S/ alpha thalassemia, beta thalassemia trait and alpha thalassemia trait. Six triplicates of results in the thalassemia groups (7.5% of thalassemia samples) had levels that misclassified patients' glycaemic status. There was no correlation between HbA1c concentration and mean corpuscular volume, and a weak negative correlation between HbA1c concentration and haemoglobin concentration. CONCLUSION: HbA1c concentrations measured by Cobas c513, Capillarys 2 Flex-Piercing and the Bio-Rad D-100 were found to be comparable in the large majority of samples. While discordance was due to assay imprecision in some cases, in others no biological or analytical explanation could be found.

Calcium fluoride as a dominating matrix for quantitative analysis by laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS): A feasibility study.

Calcium fluoride formed by the reaction between ammonium bifluoride and calcium chloride was investigated as a dominating matrix for quantitative analysis by laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). Transformation from a solid sample to the calcium fluoride-based matrix permitted quantitative analysis based on calibration standards made from elemental standards. A low abundance stable calcium isotope, i.e. 44Ca+, was monitored as the internal standard for quantitative analysis by LA-ICP-MS. Correlation coefficient factors for multiple elements were obtained with values over 0.999. The results for multiple elements in a certified reference material of soil (NIST SRM 2710a) agreed with the certified values in the range of expanded uncertainty, indicating the present method was valid for quantitation of elements in solid samples.

Doping control analysis of total arsenic in equine plasma.

Arsenic can be easily found in our surrounding environment. Because of its ubiquitous nature, horse urine and blood invariably contain low levels of arsenic. Nevertheless, inorganic arsenic, despite its general use as a tonic for horses, is an effective doping agent having a deleterious effect because of its ability to induce gastroenteritis. The misuse of arsenic in horseracing has been controlled by an international urinary threshold of total arsenic at 0.3 µg/mL. However, an equivalent threshold for total arsenic in plasma is yet to be established. In this study, an inductively coupled plasma-mass spectrometry method has been developed for quantifying total arsenic in equine plasma. Statistical analysis determined that the data from a population study of 1,552 post-race and out-of-competition plasma samples fits a Gaussian mixture model with two Gaussian components. A rounded-up provisional threshold for plasma total arsenic at 2.5 ng/mL was subsequently established. Results from administration trials with a sodium arsanilate-containing supplement showed that both urinary and plasma arsenic was significantly elevated after administration. The maximum urinary detection time was around 22 h based on the international threshold. However, the maximum plasma detection time would be longer than 73 h if the provisional threshold of 2.5 ng/mL was adopted. In view of the high discrepancy between the urine and plasma detection times, a revised plasma threshold of 15 ng/mL is proposed to afford a comparable detection time in both matrices. The risk of a normal sample exceeding the proposed plasma total arsenic threshold is practically zero.

Treatment outcomes of patients with acute promyelocytic leukaemia between 2000 and 2017, a retrospective, single centre experience.

All-trans retinoic acid (ATRA) and arsenic trioxide (ATO) are effective induction therapy for acute promyelocytic leukaemia (APL). However, early thrombo-haemorrhagic complications and mortality remain high. We aimed to investigate how the timing of ATRA initiation and the inclusion of ATO influence patient outcomes. Clinical records were retrospectively reviewed for all patients treated for APL in a single, tertiary centre during 2000-2017. Among 70 patients with APL, 36 (51.4%) presented with thrombo-haemorrhagic complications, and four (5.8%) died within 30 days. The median time to ATRA initiation was 11.2 (range 0-104) h from the time of admission. Patients requiring more transfusions started on ATRA sooner (P = 0.04). Patients with adverse early events did not start ATRA later (P = 0.99). Nevertheless, patients that required additional tests for diagnosis (PML immunofluorescence or molecular) started on ATRA later (28.5 versus 5.3 h; P < 0.0001), and had more thrombo-haemorrhagic complications (P = 0.04). Long-term survival was actually better in patients who started ATRA later (P = 0.03), which is likely explained by higher proportion of low risk patients in this group. Patients treated with ATO (n = 23) maintained higher fibrinogen levels and required less transfusions during induction (P < 0.05), with no disease-related deaths in this group over a median follow-up time of 37.8 months (interquartile range 44.9 months). In summary, fast ATRA initiation reduces early but not late adverse events in APL patients, and the inclusion of ATO helps further improve both early and late outcomes in APL.

A high-throughput and broad-spectrum screening method for analysing over 120 drugs in horse urine using liquid chromatography-high-resolution mass spectrometry.

A high-throughput method has been developed for the doping control analysis of 124 drug targets, processing up to 154 horse urine samples in as short as 4.5 h, from the time the samples arrive at the laboratory to the reporting deadline of 30 min before the first race, including sample receipt and registration, preparation and instrument analysis and data vetting time. Sample preparation involves a brief enzyme hydrolysis step (30 min) to detect both free and glucuronide-conjugated drug targets. This is followed by extraction using solid-supported liquid extraction (SLE) and analysis using liquid chromatography-high-resolution mass spectrometry (LC-HRMS). The entire set-up comprised of four sets of Biotage Extrahera automation systems for conducting SLE and five to six sets of Orbitrap for instrumental screening using LC-HRMS. Suspicious samples flagged were subject to confirmatory analyses using liquid chromatography-triple quadrupole mass spectrometry. The method comprises 124 drug targets from a spectrum of 41 drug classes covering acidic, basic and neutral drugs. More than 85% of the targets had limits of detection at or below 5 ng/mL in horse urine, with the lowest at 0.02 ng/mL. The method was validated for qualitative identification, including specificity, sensitivity, extraction recovery and precision. Method applicability was demonstrated by the successful detection of different drugs, namely (a) butorphanol, (b) dexamethasone, (c) diclofenac, (d) flunixin and (e) phenylbutazone, in post-race or out-of-competition urine samples collected from racehorses. This method was developed for pre-race urine testing in Hong Kong; however, it is also suitable for testing post-race or out-of-competition urine samples, especially when a quick total analysis time is desired.

Myeloblasts in normal bone marrows expressing leukaemia-associated immunophenotypes.

Measurable residual disease (MRD) status of patients undergoing treatment for acute myeloid leukaemia (AML) is important for prognosis and guides treatment. Multicolour flow cytometry (MCF) is a sensitive MRD method. The current approach relies on identification of blasts expressing leukaemia-associated immunophenotypes (LAIP) or by blasts expressing aberrant differentiation/maturation profiles compared to that seen in normal haematopoietic precursor cells at follow-up, i.e., different from normal (DFN). However, expression of LAIP on normal myeloblasts affects the specificity of the result, and the understanding of what is normal is important. Limited published data are currently available. We report findings from 14 normal adult bone marrows. MCF was performed on the residual normal marrow specimens from 14 adults. Expression of CD15, CD11b, CD7, CD4, and CD56 on CD34+ myeloblasts was assessed. Analysis of samples was performed using 4-colour flow cytometry which was the methodology used when this work was done, and is still being used in many clinical flow laboratories worldwide. LAIP is defined by lineage infidelity or asynchronous expression of differentiation markers. The cases of normal myeloblasts with LAIP involving the markers used and above the cut-off levels for MRD detection (0.01%) varies between 43% and 100%, limiting the specificity of the results for MRD. Even if the threshold is raised to 0.1%, there will still be false positive cases using aberrant CD15 or CD7. Our work provided useful information for AML MRD determination in our laboratory. A collaborative database of LAIP on normal myeloblasts using standardised analysis should be useful to determine the optimal diagnostic cut-off for AML MRD using LAIP.

Early treatment of acute promyelocytic leukaemia is accurately guided by the PML protein localisation pattern: real-life experience from a tertiary New Zealand centre.

Current guidelines recommend that a rapid test be used to assist diagnosis of acute promyelocytic leukaemia (APL), but the choice of an assay is discretionary. PML immunofluorescence (PML IF) identifies the microparticulate pattern of the PML protein localisation, highly specific for APL. The aim of this study was to evaluate clinical utility of PML IF in a real-life setting based on a retrospective records review for all patients who had PML IF performed in our centre between 2000 and 2017. Final analysis included 151 patients, 70 of whom had APL. PML IF was reported on average 3 days faster than cytogenetics. Compared with genetic results, PML IF showed sensitivity of 96% and specificity of 100%. PML IF accurately predicted APL in four APL cases with cryptic karyotype/FISH and excluded APL in 98% cases tested based on the suspicious immunophenotype alone, 21/28 of whom had mutated NPM1. Results of PML IF influenced decision to start ATRA in 25 (36%) APL patients and led to its termination in six non-APL patients. In conclusion, PML IF is a fast and reliable test that facilitates accurate treatment decisions when APL is suspected. This performance of PML IF remains hard to match in a real-life setting.

Highly Sensitive Determination of Arsenic and Antimony Based on an Interrupted Gas Flow Atmospheric Pressure Glow Discharge Excitation Source.

A novel interrupted gas flow (IF) technique has been proposed for highly sensitive determination of ultratrace levels of arsenic and antimony in water samples by atmospheric pressure glow discharge (APGD) excitation source coupled with HCl-KBH4 hydride generation (HG). It is demonstrated that the gas flow interruption technique provides a dramatic and reproducible enhancement of emission signals of 1-2 orders of magnitude for As and Sb over conventional continuous gas flow (CF) in APGD. The enhanced analyte emission sensitivities in IF-APGD were investigated from the viewpoint of changes in plasma excitation temperature and analyte density. With eight As lines as the thermometric probe, no measurable change in excitation temperature was found, suggesting that the enhancement is caused by an increase in analyte number density in the plasma immediately following the gas flow interruption. Furthermore, the enhancement factor was found to increase with the time interval in between the gas interruption, supporting an analyte adsorption (or trap)-release mechanism hypothesis. Under optimized conditions, the detection limits (DLs) of IF-APGD mode for As and Sb were calculated to be 0.02 and 0.003 µg L-1, which are, respectively, about 27- and 120-fold improved compared to CF-APGD mode. The linearity of calibration for both As and Sb reached R2 > 0.999 in the 0.1-5 µg L-1 range. The accuracy of the proposed method was validated by the determination of certified reference materials (CRMs), and the results agreed well with the certified values.

Evaluation of an immunochromatographic strip test for alpha-thalassaemia screening.

INTRODUCTION: Hb H inclusion test (HbH-i) commonly used for α-thalassaemia screening is not standardised and is labour-intensive. This study evaluated a strip test based on immunochromatographic detection of Hb Bart's (ICT) for use as a routine screening test for α-thalassaemia screening in the clinical laboratory setting. METHODS: The performance characteristics of the ICT was determined by comparing the results of ICT and HbH-i on 67 patients, and the α-globin genotype on 47 of these patients who also had the molecular analysis. Specimen stability was tested on 16 specimens with the ICT repeated after 7 days of storage. The age of babies from which the ICT result becomes valid was determined on 49 samples with patient age ranged from 4 weeks to 12 months. RESULTS: The ICT had higher overall sensitivity of 76% compared to 24% for HbH-i in detecting carriers of α-thalassaemia mutations, and this is seen in all α-thalassaemia genotypes. The test could be carried out on specimens stored at 4°C for 7 days and gave valid results with no false positive from the age of 6 months onwards. It required no special technical expertise or equipment and gave the result in less than 5 minutes. CONCLUSION: The ICT is simple to perform, with higher sensitivity than HbH-i, and gives the result in a short time and at a lower cost. This can be used by clinical laboratories to replace HbH-i for α-thalassaemia detection.

International normalised ratio monitoring in the community populations of the Auckland and Northland regions of New Zealand: time in therapeutic range and frequency of testing.

BACKGROUND: Warfarin remains a commonly used anticoagulant for the treatment and prevention of thrombosis. To balance the risks and benefits of therapy, monitoring of the international normalised ratio (INR) is necessary. Patients derive most benefit from warfarin when they spend ≥65% of time in the therapeutic range (INR 2-3). We performed an analysis of INR monitoring for the Auckland and Northland regions of New Zealand in order to estimate anticoagulation control and appropriateness of testing at the population level. METHODS: INR test results and patient demographics (age and sex) were extracted from the laboratory information system of Labtests and Northland Pathology Laboratories for the period of 1 January 2016 to 27 July 2016. RESULTS: We included 126 184 INR results from 10 922 patients. The median age of patients represented was 74 years and 57% were male. The overall mean time in therapeutic range was 63%, with a mean interval between INR tests of 14 days. CONCLUSION: Our results indicate that anticoagulant control in our communities could be improved, and that inappropriately frequent INR testing should be redressed. Appropriate interventions could lead to net clinical benefits and reduce resource misallocation.

Solid matrix transformation and tracer addition using molten ammonium bifluoride salt as a sample preparation method for laser ablation inductively coupled plasma mass spectrometry.

Solid sampling and analysis methods, such as laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS), are challenged by matrix effects and calibration difficulties. Matrix-matched standards for external calibration are seldom available and it is difficult to distribute spikes evenly into a solid matrix as internal standards. While isotopic ratios of the same element can be measured to high precision, matrix-dependent effects in the sampling and analysis process frustrate accurate quantification and elemental ratio determinations. Here we introduce a potentially general solid matrix transformation approach entailing chemical reactions in molten ammonium bifluoride (ABF) salt that enables the introduction of spikes as tracers or internal standards. Proof of principle experiments show that the decomposition of uranium ore in sealed PFA fluoropolymer vials at 230 °C yields, after cooling, new solids suitable for direct solid sampling by LA. When spikes are included in the molten salt reaction, subsequent LA-ICP-MS sampling at several spots indicate that the spikes are evenly distributed, and that U-235 tracer dramatically improves reproducibility in U-238 analysis. Precisions improved from 17% relative standard deviation for U-238 signals to 0.1% for the ratio of sample U-238 to spiked U-235, a factor of over two orders of magnitude. These results introduce the concept of solid matrix transformation (SMT) using ABF, and provide proof of principle for a new method of incorporating internal standards into a solid for LA-ICP-MS. This new approach, SMT-LA-ICP-MS, provides opportunities to improve calibration and quantification in solids based analysis. Looking forward, tracer addition to transformed solids opens up LA-based methods to analytical methodologies such as standard addition, isotope dilution, preparation of matrix-matched solid standards, external calibration, and monitoring instrument drift against external calibration standards.