tailieunhanh - Pathology and Laboratory Medicine - part 4

Những hình thức troponins tim (còn nguyên vẹn cũng như sửa đổi) hiển thị một đặc tính "phồng lên xẹp xuống" mô hình sau khi khởi phát triệu chứng, sản xuất một cách liên tục thay đổi hồ sơ troponin. Khả năng phân biệt giữa các hình thức khác nhau của troponins lưu hành sẽ cung cấp thông tin chính xác hơn về mức độ nghiêm trọng của thiệt hại | Disease-Induced Protein Modifications 129 prior to release into the blood. These forms of cardiac troponins intact as well as modified display a characteristic rising and falling pattern after the onset of symptoms producing a continuum of changing troponin profiles. The ability to distinguish between different forms of circulating troponins would offer more precise information about severity of damage time of onset or even type of disease assisting in the triage of individual patients. This is not possible with the currently available diagnostic assays. In addition to the advantage of providing information about certain modification states of the analyte WB-DSA has a high analytical sensitivity. In fact it enabled us to detect serum cTnI in patients undergoing CABG surgery at levels below the LLD of a routinely used commercial assay ng mL 42 . This enhanced sensitivity most likely is due to the denaturing conditions used in WB-DSA which would result in the complete exposure of linear epitopes thereby increasing the probability of detection by various antibodies. cTnI in serum may be hidden owing to its ternary structure and or the formation of three-dimensional complexes with other proteins. To test this method for its clinical application serum from patients presenting at the emergency department early after onset of symptoms of ACS 4 h was analyzed by WB-DSA and the results compared to routine clinical testing 66 . A subset of the patients enrolled in this study with nondiagnostic electrocardiogram for ACS and nonsignificantly elevated routine biochemical markers cTnI CK and CK-MB showed detectable amounts of cTnI when retrospectively analyzed by WB-DSA n 6 10 . These patients were diagnosed for unstable angina n 3 second-degree heart block n 1 or discharged from the ED as chest pain not yet diagnosed n 2 . Three of the six patients revisited the ED within 3 mo complaining about chest pain. ONE ANALYTE ONE DISEASE ONE ASSAY The exact release pattern of the .

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