Clinical Chemistry Podcast

Acute abdominal pain is one of the most common presenting symptoms in emergency department patients and its differential diagnosis can be extensive and challenging. Rapid and accurate diagnosis of urgent causes of abdominal pain is essential for the early initiation of effective therapy and efficient patient flow. To see how the clinical laboratory can help in this process, a recent study that appeared in the February 2019 issue of Clinical Chemistry examined inflammatory biomarkers in the emergency diagnosis of urgent abdominal pain.

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.

High-density lipoproteins, or HDLs, are macromolecular assemblies that play a key role in lipid transport, but also exert effects in endothelial function, thrombosis, and inflammation. A recent focus by several groups on HDL function rather than HDL cholesterol revealed that efflux capacity was inversely associated with coronary artery disease. Traditionally, cholesterol efflux is measured using a cell-based assay where cultured microphages are treated with radioactively-labeled cholesterol and subsequently exposed to a cholesterol acceptor. A recent study that appeared in the February 2019 issue of Clinical Chemistry took a completely different approach and assessed the lipoprotein proteome by using liquid chromatography and tandem mass spectrometry to measure 21 lipoprotein associated proteins.

Machine learning involves the study of algorithms and mathematical models so that computer systems can progressively improve their performance on solving a specific task. A recent application of machine learning through the interpretation of urine steroid profiles appears in the November 2018 issue of Clinical Chemistry.

A recent study appears in the September 2018 issue of Clinical Chemistry, an assessment of digital PCR as a primary reference measurement procedure to support advances in precision medicine.

In almost all high-income countries, the U.S. included, women live longer than men. As we enter a new era in which biomedical data are increasingly ubiquitous, current and future research may help us understand the fundamental issues that drive differences in longevity and other health outcomes between men and women. Our ability to measure the entire spectrum of information about the human biological, environmental, and behavioral condition will become both routine and relatively inexpensive from genes to genomics. From clinical data to the electronic health record in insurance claims. From digital information about behavior and social interaction to geospatial referencing. The January 2019 issue of Clinical Chemistry is devoted to topics of men's health and in that issue, an article examined differences in health outcomes between men and women and underlying biological, behavioral, and societal factors.

The unintended pregnancy rate in the United States is approximately 45% despite of variety of contraceptive options available to women. Today, male condoms and withdrawal are the only reversible contraceptive methods available to men with typical failure rates between 10% and 20%. But what about a male contraceptive pill? Studies indicate that more than half of men would be interested in using a reversible method if it was available. And many women would be willing to rely on their partner to use such a contraceptive. Unplanned pregnancy rates could improve if both partners use a contraceptive method or if men had more options to control their own fertility. The January 2019 issue of Clinical Chemistry is devoted to topics of men's health. And in that issue, an article examined developments in male contraceptives with an update on both novel hormonal and non-hormonal methods.

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."

Preeclampsia is a serious disorder of pregnancy that occurs by 24 weeks of gestation or later and can occur in up to 5% of all pregnancies. Maternal weight, advancing maternal age, nulliparity, a previous pregnancy with preeclampsia, and insulin-dependent diabetes are just some of the predisposing factors for developing preeclampsia. Over the past few years, development in screening, prevention, and treatment for preeclampsia have occurred and genetic studies are just now providing new insights into the etiology of this disorder. A Q&A feature in the December 2018 issue of Clinical Chemistry asked three experts with different roles in this field to discuss recent advances and ongoing challenges in preeclampsia research and implementation.

The December 2018 issue of Clinical Chemistry published a Perspective article titled "CRISPR Methods for Nucleic Acid Detection Herald the Future of Molecular Diagnostics," which discusses the findings of Chen and colleagues who earlier this year were the first to create a diagnostic tool out of a CRISPR-Cas system and demonstrate its clinical utility.

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.

Influenza viruses affect millions of people each year, leading to several hundred thousand hospitalizations and thousands of deaths annually in the U.S. Early antiviral therapy reduces the duration of illness, complications and mortality associated with the flu, yet antivirals are often underutilized. However, patients with a positive influenza diagnostic test results are more likely to receive appropriate antiviral therapy and less likely to be prescribed unnecessary antibiotics. Access to reliable influenza testing is critical to facilitate both optimal patient outcomes and antimicrobial stewardship.

Recently, the first point-of-care molecular diagnostic test was cleared by the U.S. Food and Drug Administration for detection of the flu. At the same time, concerns about the performance of commonly used rapid antigen tests have surfaced. The landscape of influenza diagnostics is rapidly evolving and clinical laboratories are certain to face pressure regarding new testing modalities.

A Q&A feature in the November 2018 issue of Clinical Chemistry asked five experts with different roles in this field to discuss recent advances and ongoing challenges in influenza diagnostics.