Dissertations / Theses on the topic 'Laboratoriemedicin'

I denna studie har jag undersökt hur ledarskap på distans bedrevs av ledare med chefsuppdrag inom laboratoriemedicin. Syftet med studien var att undersöka hur cheferna beskrev vad som utmärkte ledarskapet på distans, vilka egenskaper en ledare behövde för att leda en organisation på distans och hur de kommunicerade med sina medarbetare.  Jag har i denna studie intervjuat åtta ledare på olika nivåer. Sex av informanterna arbetade inom två olika landsting och två arbetade åt en privat vårdgivare. Vid genomgången av intervjumaterialet framkom nio olika teman vilka var specifika egenskaper, delegering, resor, motivation och feed-back, avstämmande kommunikation, kommunikationsformer, mötesformer, medarbetarsamtal och information. Det som utmärkte ledarskapet på distans var att en stor del av arbetstiden gick åt till arbetsresor antingen för att besöka medarbetare eller för att delta i möten. Därför var det också viktigt att de delegerade arbetsuppgifter till medarbetarna. Resultatet visade också att det var extra viktigt när man leder på distans att man som ledare hade en kommunikativ förmåga, vilket gällde både skriftligt och muntligt. Dessutom måste budskapen vara extra tydliga så att de inte misstolkades. Eftersom medarbetarna var geografiskt utspridda så var det även en svårighet att ha fysiska möten och få alla medarbetare samlade vid ett och samma tillfälle. Andra mötesformer som förekom var telefonmöten eller videkonferenser. Information till medarbetarna förmedlades antingen via fysiska möten, e-mail, intranät eller via telefonen.
In this study, I have explored how leadership at a distance was carried out by managing directors within the field of laboratory medicine. The purpose of the study was to investigate how the directors described the distinctive features of leadership at a distance, including the traits they felt were necessary for effective leadership and the manner in which they communicated with their employees. During the course of the study, I conducted interviews with eight directors employed at different organizational levels; six of the interviewees worked for two separate county councils, and the remaining two for a private healthcare provider. Upon review of the interview transcripts, nine different themes emerged as important: specific traits, delegation, travel, motivation and feedback, coordinating communication, forms of communication, types of meetings, employee performance reviews and information. One key characteristic of leadership at a distance was the fact that directors devoted a large portion of their work week to traveling—either to visit employees or to attend meetings. Delegation of tasks by directors to employees was also found to be important. The results of the study also indicated that, in order to lead effectively at a distance, directors needed to possess a good capacity for communicating, both in writing and in speech. In addition, directors' instructions needed to be exceedingly clear, lest they be misunderstood. Because employees were dispersed geographically, meetings in which all employees were simultaneously in attendance were difficult to bring about. Other types of meetings included telephone and video conferences. Employees received information both during meetings and by way of e-mail, intranet and telephone.

Enligt Socialstyrelsens föreskrifter om ledningssystem för kvalitet och patientsäkerhet i hälso- och sjukvården, SOSFS 2005:12, krävs det av vårdgivaren att denne arbetar efter mål. Att formulera mål inom hälso- och sjukvården kräver eftertanke. Målen måste vara mätbara och inkludera flera olika delar av verksamheten. Varje förbättringsprojekt är unikt och bör relateras till de resurser som avsatts. Ett stort problem vid kontinuerlig uppföljning är att välja ut parametrar som ger tillräcklig information och är lätta att skapa. Här krävs mer utvecklade datasystem och även integrering mellan befintliga datasystem  I uppsatsen diskuteras med vilka parametrar man kan utvärdera ett förbättringsprojekt inom laboratoriemedicin. Det finns för närvarande inte några standardiserade kvalitetsparametrar inom klinisk kemi. De parametrar som i denna undersökning visade sig vara mest lämpliga att använda kontinuerligt i det korta perspektivet var svarstider, personalresurser och reagenskostnader. I det längre perspektivet kan ovanstående data kombineras till indikatorer som visar kostnad per analyspoäng och analyspoäng per årsarbetare. De indikatorer som kan få användning först när datasystem utvecklas är data från avvikelsesystem och analyskommentarer som visar t.ex. att svar inte har kunnat lämnas ut.
According to the National Board of Health and Welfare, SOSFS 2005:12, it is required that the caregiver adheres to his work through following stated objectives. Formulating goals in health care requires careful consideration. Goals must be measurable and include many different aspects of the project. Each improvement project is unique and should be directly related to the resources allocated to the project. A major problem for continuous monitoring is to select parameters that provide sufficient information and are easy to produce. This requires more advanced computer systems and integration with existing computer systems. The paper discusses the parameters an improvement project in laboratory medicine can evaluate its results after. There are currently no standardized quality parameters in clinical chemistry. The parameters used in this study that proved to be the most suitable to be used continuously in the short term was the response times, staffing and reagent costs. In the long term, the above data are combined with indicators that show cost per analysis score and analysis points per full-time employees. The indicator that may be used when the computer system is developed is deviation systems and analytical comments that show for example that a response has not been disclosed.

Primary aldosteronism (PA) is a common form of secondary hypertension with an international prevalence rates between 5 and 10 %. It is characterized by a high autonomous aldosterone production that causes cardiovascular damage, renin suppression, hypertension, sodium retention, potassium excretion and hypokalemia. The screening of PA is a simple test measuring aldosterone to renin ratio (ARR) with immunoassay method. This test is currently considered as the most reliable screening tool for PA.     The main objective of the study was to evaluate an ELISA-method, for detection of aldosterone and renin in blood plasma, to be used for routine analysis in the laboratory. The second aim was to investigate the effect of refreezing samples, considering that cryoactivation of prorenin might occur.     One hundred blood samples were analysed, in regard to aldosterone and renin, by using two commercial ELISA assays (DRG ELISA from DRG Diagnostics, Germany) on a Dynex DS2 instrument. In addition, the accuracy and precision of the methods were calculated. The effect of refreezing was investigated with a series of eight samples, which were analyzed twice on the same instrument.     Both assays performed well. The resulting data showed good precision and accuracy. The correlation between the original and refreezed samples was good, r = 0.989 and r = 1.0 for aldosterone and renin respectively. Considering that the study only included eight samples, further investigation is recommended.     Evaluation showed that both immunoassays are reliable in diagnostic use and the ELISA-method is suitable to implement in the laboratory for routine analysis.

Type-2 diabetes has become a common disease. The complications associated with thedisease are often cardiovascular. Platelets are important components in hemostasis, one function is platelet adhesion. Platelet adhesion is the first step to form a platelet plug, together with subendothelial proteins. Blood lipids contribute to membrane structure of cells and has an important role in different signaling pathways. They have a key role in platelet activation and is associated with the changes in membrane lipids. C-reactive protein (CRP) is an acute phase protein and increases during inflammation. The physiological role is not fully known but increasing levels of CRP increases the risk for cardiovascular complications. The aim of this study was to analyze the correlation between platelet adhesion with blood lipids and high sensitivity CRP in type-2 diabetics. 69 patients with type-2 diabetes participated in this study. Lipids, CRP and platelet adhesion were analyzed, the values were used to perform correlation analysis. The results show statistically significant positive correlations between ApoA-1, HDL and platelet adhesion as well as significant negative correlations between LDL, ApoB/ApoA-1-ratio, LDL/HDL-ratio and platelet adhesion. ApoA-1 and platelet adhesion with collagen showed statistically significant correlations with r-values 0,299-0,436. ApoA-1/ApoB-quota showed statistically significant correlations with r-values from -0,492 to -0,268. Majority of correlations between totalcholesterol, ApoB, triglycerides, hsCRP and platelet adhesionshowed no statistically significant correlations.
Typ-2 diabetes har blivit en vanligare sjukdom. De komplikationer som kan uppstå vid diabetes, särskilt obehandlad diabetes, är ofta kardiovaskulära komplikationer. Trombocyter är viktiga komponenter i hemostasen, en av deras funktioner är trombocytadhesion. Trombocytadhesionen är första steget vid bildandet av en trombocytpropp, tillsammans med subendoteliala proteiner så kan trombocyterna fästa till kärlväggen och hemostasen påbörjas. Blodlipider bidrar till cellmembraners struktur, energiförvaring och har en viktig roll vid olika typer av signalering. De har en nyckelroll vid trombocytaktivering eftersom trombocytaktivering är associerad med förändringar som sker hos membranlipiderna. C-reaktivt protein (CRP) är ett akutfasprotein och ökar vid inflammation. Fysiologiska rollen är inte helt känd men stegring av CRP ökar risken för kardiovaskulära komplikationer. Syftet med denna studie är att analysera korrelationen mellan trombocytadhesion med blodlipider och högkänsligt CRP hos typ 2 diabetiker. Det medverkade 69 patienter med typ-2 diabetes i studien. Blodlipider, högkänsligt CRP och trombocytadhesion analyserades ochvärdena för respektive analyt användes för korrelationsanalyser.Resultaten visar statistiskt signifikanta positiva korrelationer mellan ApoA-1, HDL och trombocytadhesion samt signifikanta negativa korrelationer mellan LDL, ApoB/ApoA-1-kvot, LDL/HDL-kvot och trombocytadhesion. ApoA-1 och trombocytadhesion med kollagen som proteinyta uppvisade statistiskt signifikanta korrelationsintervall med r-värden på 0,299-0,436. ApoA-1/ApoB-kvoten visade statistiskt signifikanta korrelationsintervall med r-värdenmellan -0,492 till -0,268. Majoriteten av korrelationerna för variablerna: totalkolesterol, ApoB, triglycerider, högkänsligt CRP och trombocytadhesion visade inga statistiskt signifikanta korrelationer.

Avsaknad av en ”gyllene standard” och en låg sensitivitet hos förstahandsmarkören total B12 har varit de stora begränsningarna i diagnostiken av vitamin B12-brist anemier. Med syftet att förbättra diagnostiken av bristanemier vid Länssjukhuset Ryhov, Jönköping utvärderades användningen av aktivt B12 vid bristanemiutredningar och en metodverifiering för analysen genomfördes på ARCHITECT i2000SR. Sambandet mellan aktivt B12 och totalt B12 undersöktes med en korrelationsanalys för totalt B12-nivåer: låg (n=10, <148 pmol/L), gråzonen (n=10, 149–200 pmol/L) och normal (n=10, 201-250 pmol/L). För bestämning av träffsäkerheten hos aktivt B12 studerades 14 bristanemifall. Ett receiver operating characteristic (ROC) diagram skapades och arean under kurvan (AUC) beräknades. Variationskoefficient (CV) för mellanliggande- och inomserieprecision för aktivt B12 var 4,4 % respektive 2,4 %. Svag korrelation observerades i alla B12-nivåer, men sammantaget resulterade nivåerna i en medelstark korrelation (R=0,600). Aktivt B12 med ett gränsvärde på 40 pmol/L resulterade i en hög specificitet (75 %) och sensitivitet (80 %) med en AUC på 90 %. Analys av aktivt B12 på ARCHITECT i2000SR möjliggör en precis mättning av aktivt B12 i humant serum och därför är lämplig för rutinmässig användning. Träffsäkerheten hos aktivt B12 var hög och markören kan därmed rekommenderas för användning vid bristanemiutredningar vid Länssjukhuset Ryhov, Jönköping.
Diagnosis of vitamin B12-defiency anemia has been challenging due to lack of ”gold standard” and poor sensitivity of total B12 as a first line marker. With the aim of improving diagnostic of anemia investigations at county hospital Ryhov, Jönköping, we performed a method verification for active B12 on ARCHITECT i2000SR and evaluated the usefulness of active B12 in diagnosing anemia. Correlation analysis was performed using samples with different total B12 ranges: low (n=10, <148 pmol/L), grey zone (n=10, 149-200 pmol/L) and normal (n=10, 201-250 pmol/L). Receiver operating characteristic (ROC) curve was created and area under the curve (AUC) was calculated for determining accuracy of active B12 using 14 deficiency cases. Coefficient of variation (CV) for within-run and total imprecision, for active B12 was 2,4 % and 4,4 %, respectively. Weak correlation was found between B12-ranges, however a moderate correlation (R=0,600) was found including all groups. Active B12 with the cut-off value of 40 pmol/L resulted in high specificity (75%) and sensitivity (80%) and had an AUC of 90 %. Active B12 assay on ARCHITECT i2000SR allows a precise measurement of active B12 in human serum and therefore is adequate for routine use. Active B12 had high accuracy and can be recommended in anemia investigations in county hospital Ryhov, Jönköping.

Background: Idiopathic inflammatory myopathies (IIM) constitute a heterogeneous group of diseases with severe consequences for the life of affected patients. Dermatomyositis, polymyositis and inclusion body myositis (IBM) are the classical representatives of this group. The treatments given today often have limited effects, and are taken at the cost of side effects. Major obstacles in the search for more effective treatments are; (1) an incomplete understanding of the disease mechanisms, (2) difficulties to delineate homogeneous disease groups for clinical studies and (3) the sometimes challenging task to diagnose these diseases. Aims: We addressed a number of “loose ends” in the areas of pathogenesis, classification and diagnosis; mechanisms of muscle fiber degeneration in IIM, with a focus of programmed cell death (apoptosis) and invasion of muscle  fibers by inflammatory cells (partial invasion); protecting and mediating factors present in muscle; the association of other diseases with IIM, in particular celiac disease ; the evaluation of two classification systems and laboratory methods for increased diagnostic performance. The studies: We included 106 patients, diagnosed at the Neuromuscular unit in Linköping, Sweden, with pathological muscle findings consistent with IIM. The incidence in the county of Östergötland (during 5 years) was 7.3 per million/year (3 patients each year). Of 88 patients with confirmed IIM 4 (4.5 %) had celiac disease, 33 (38%) had an associated systemic inflammatory disease and 5 (5.7 %) had a malignancy. Ninety-nine patients were included for a comparison of two classification systems using criteria of the European Neuromuscle Centre (Amato/ENMC), and the widely used Bohan and Peter classification, both with the addition of IBM according to Griggs et al. Using the Amato/ENMC criteria the most prevalent diagnostic group after IBM (30%) was nonspecific myositis (23%), followed by polymyositis (20%) and dermatomyositis 17%). A substantial number of patients meeting Bohan and Peter (or Griggs) criteria were excluded by Amato/ENMC criteria, most (21/23) due to lack of detectable muscle weakness. Extended muscle sectioning increased the sensitivity of a muscle biopsy by 15 % and the specificity by 22%, and showed an overlap between disease groups. Muscle biopsies from patients with IIM and controls were used to investigate pathological findings considered specific for disease groups, and for the presence of programmed cell death (apoptosis) and disease protecting and mediating factors in muscle. The presence of apoptotic muscle fiber nuclei was detected in muscle with partial invasion (however not in the invaded fibers) in the presence of granzyme B and CD8+ cytotoxic T cells. The major apoptosis inhibiting protein Bcl-2 was shown to be constitutionally expressed in healthy muscle but weakened in IIM. Conclusion: We present apoptosis as a possible disease mechanism in parallel with partial invasion of fibers. Furthermore, partial invasion may not be a suitable distinguishing feature in the pathogenesis, or for classification and diagnosis of IIM. We also introduce the anti-apoptotic Bcl-2 as a possible relevant muscle fiber protecting factor. A more extensive pathological work-up improves classification and diagnosis of IIM. The proposed Amato/ENMC creates a substantial portion of patients with non-specific or unclassified myositis. Associated diseases are common in IIM, and also include celiac disease.

Duktal bröstcancer är den vanligaste formen av invasiva brösttumörer. Graderingssystemet för bröstcancer har definierats av Elston och Ellis och är baserat på tre parametrar. En av dessa är räkning av antal mitoser på preparat färgade med Hematoxylin och Eosin (HE). Som ett komplement vid bedömning av bröstcancer analyseras Ki67, en proliferationsmarkör, med hjälp av immunhistokemi (IHC).  Fosfohiston H3 (pHH3) är ett histonprotein som finns i cellkärnan. Proteinet tros vara en specifik markör för mitos eftersom den är fosforylerad enbart under M-fasen och i slutet av G2-fasen. Syftet med studien var att utvärdera pHH3 som potentiell markör för mitos vid diagnostiseringen av duktal bröstcancer. Syftet var även att jämföra metoden med räkning av antal mitoser och Ki67-positiva celler, samt att studera den interindividuella skillnaden vid bedömningen av preparaten. Materialet bestod av 20 sektorresektat med invasiv duktal bröstcancer. Preparaten färgades med IHC och bedömdes mikroskopiskt. Celler som var positiva för pHH3 och Ki67 samt antal mitoser räknades, av tre läkare. Ett medelvärde för varje patientfall och metod beräknades från läkarnas bedömningar. Metodernas variationskoefficienter och dess medelvärden beräknades. Variationskoefficienterna uppvisade medelvärden på 0,21 för Ki67 +/- 0,10 SD, 0,33 för pHH3 +/- 0,14 SD och 0,46 för mitosräkning +/- 0,34 SD. Korrelationskoefficienterna för metoderna och respektive läkare uppvisade en spridning. Korrelationerna uppvisade medelvärden på r = 0,78 för Ki67 och pHH3, r = 0,74 för Ki67 och mitos samt r = 0,83 för pHH3 och mitos. Enligt studien verkar antipHH3 vara ett bra komplement vid bedömning av duktal bröstcancer. Dock krävs tydliga kriterier för vad som ska räknas som en pHH3-positiv cell. Intervariabiliteten verkar bli mindre med anti-pHH3 än vid räkning av mitoser, som är mer tidskrävande. Minst intervariabilitet ses vid bedömning av anti-Ki67 som en proliferationsmarkör.
Ductal carcinoma of the breast is the most common form of invasive breast tumours. The grading system for breast cancer is defined by Elston and Ellis and is based on three criterions. One of these criterions is the mitotic count in pathological sections of breast carcinomas stained with Hematoxylin Eosin. A common method often applied as a complement in diagnosis of breast carcinoma is immunohistochemical staining with use of antibodies directed against Ki67, a proliferation marker. Phosphohistone H3 is a histone protein that is located in the cell nucleus. The protein is believed to be a specific marker for mitosis since it only is phosphorylated during mitosis, and to some extent at the end of the G2-phase. The purpose of this study was to evaluate pHH3 as a potential marker for mitosis when diagnosing ductal breast cancer. The purpose was also to compare the method to mitotic figuring and the count of Ki67-positive cells, and to study the inter-individual variability when assessing the histological sections. The material consisted of 20 biopsies containing invasive ductal breast cancer. The sections were stained using IHC and all sections were evaluated microscopically. Cells positive for pHH3, Ki67 and mitotic cells were quantified, by three doctors. From the doctors results an average value was determined for each case and method. To be able to compare the methods the coefficient of variation was calculated. The average value of the coefficient of variation was determined for each method and also the standard deviation (SD). The coefficient of variation showed average values of 0,21 for Ki67 +/- 0,10 SD, 0,33 for pHH3 +/- 0,14 SD and 0,46 for mitotic figuring +/- 0,34 SD. The correlation coefficients for the methods and each doctor showed dispersion. The correlations showed average values of r = 0,78 for Ki67 and pHH3, r = 0,74 for Ki67 and mitosis and r = 0,83 for pHH3 and mitosis. According to this study it seems as though anti-pHH3 could complement the other methods. However explicit criteria which defines a threshold value of which cells should be considered pHH3-positive needs to be established. The inter-individual differences seem to decrease using antipHH3 compared with mitotic counting, which is more time consuming. Although the minimum difference can be seen when assessing anti-Ki67 as a proliferation marker.

Kolesterol transporteras i blodet med hjälp av lipoproteinpartiklar. Höga nivåer av low-density lipoprotein (LDL)-kolesterol i blodet är en riskfaktor för kardiovaskulär sjukdom. Koncentrationen av LDL-kolesterol kan beräknas med hjälp av Friedewalds formel men det finns även metoder där LDL-kolesterol kan analyseras direkt. Syftet med arbetet var att verifiera metoden direkt LDL-kolesterol på analysinstrumentet Beckman Coulter AU680. Metodens inomserie- och totalimprecision analyserades. Två korrelationsstudier utfördes mellan direkt LDL-kolesterol och beräknat LDL-kolesterol, en med 43 patientprover med triglycerider < 4,5 mmol/L och en med 11 patientprover med triglycerider > 4,5 mmol/L. Friedewalds formel ska egentligen inte användas vid triglycerider > 4,5 mmol/L, men i detta fall användes formeln ändå för att utvärdera eventuella skillnader mellan metodernas resultat vid höga triglyceridkoncentrationer. Vid analys av metodens inomserieimprecision blev variationskoefficienten (CV) omkring 0,5 % vid analys av både den låga kontrollen (A1) och den höga kontrollen (A2). CV för totalimprecisionen blev 1,21 % vid analys av A1 och 1,11 % vid analys av A2. Korrelationsstudierna visade ett linjärt samband mellan metoderna men den direkta metoden gav något högre resultat vid lägre koncentrationer och något lägre resultat vid högre koncentrationer jämfört med beräknat LDL-kolesterol. Vid triglycerider > 4,5 mmol/L gav den direkta metoden betydligt högre resultat än beräknat LDL-kolesterol. Slutsatsen blev att metoden hade god precision. Överensstämmelsen mellan metodernas resultat var relativt bra för proverna med triglycerider < 4,5 mmol/L. Vid triglycerider > 4,5 mmol/L var differensen mellan metoderna stor, troligtvis på grund av falskt för låga resultat från beräknat LDL-kolesterol.
Cholesterol is transported in the blood by lipoproteins. High levels of low-density lipoprotein (LDL)-cholesterol in the blood is a risk factor for cardiovascular disease. The concentration of LDL-cholesterol can be calculated using the Friedewald formula but there are also methods that measure LDL-cholesterol directly. The aim of this study was to verify the method P-LDL-cholesterol on a Beckman Coulter AU680 analyzer. Within-run imprecision and total imprecision were analyzed. The correlation between direct LDL-cholesterol and calculated LDL-cholesterol was examined using 43 patient samples with triglyceride levels < 4,5 mmol/L and 11 patient samples with triglyceride levels > 4,5 mmol/L. The Friedewald formula is not supposed to be used on triglyceride levels > 4,5 mmol/L, but in this case the formula was used anyway to evaluate differences between the methods at high triglyceride concentrations. The coefficient of variation (CV) for the within-run imprecision was about 0,5 %, both for the low control (A1) and the high control (A2). Total imprecision had a CV of 1,21 % for A1 and 1,11 % for A2. There was a linear relationship between the methods, but the direct method gave slightly higher results at low concentrations and slightly lower results at high concentrations compared to calculated LDL-cholesterol. At triglyceride levels > 4,5 mmol/L the results from the direct method was considerably higher than calculated LDL-cholesterol. The conclusion is that the precision of the method was good. The correlation between the results from direct LDL-cholesterol and calculated LDL-cholesterol was relatively high for samples with triglyceride levels < 4,5 mmol/L. At triglyceride levels > 4,5 mmol/L there was a big difference between the methods, probably because of falsely low results from calculated LDL-cholesterol.

Warfarin är ett läkemedel som används för att förhindra att högriskpatienter såsom de med förmaksflimmer får tromboembolism. Denna verkan uppnås genom att hämma de K-vitaminberoende faktorerna VII, X och protrombin och på så sätt minska blodets förmåga att koagulera. Att hitta rätt dosering av läkemedlet för warfarinbehandlade patienter har visat sig vara svårt eftersom det kräver regelbunden provtagning och påverkas av mat- och levnadsvanor. Det vanligaste sättet att mäta protrombinkomplexhalten är med venös plasma men det är även möjligt att använda sig av kapillär plasma. Helblod kan användas för mekaniska metoder som inte använder sig av optisk detektion. Fördelen är att helblod inte kräver centrifugering. Studiens syfte var att undersöka om det fanns en signifikant skillnad (p≤0,05) mellan helblod och plasma som används i den nuvarande metoden för kapillära prover och om det finns en skillnad i stabiliteten av dessa prov. Dubbla prover togs från 30 warfarinbehandlade patienter och 5 icke warfarinbehandlade individer. Ett av proven centrifugerades och analyserades på plasma, det andra analyserades på helblod. Resultaten visade att det fanns en signifikant skillnad (p≤0,05) mellan metoderna. Bland-Altman diagrammet visade att 95 % av helblodsproverna inte var högre än 0,25 INR och lägre än 0,14 INR. Detta har en låg klinisk inverkan. 4 Proverna förvarades i rumstemperatur i upp till 24 timmar och analyserades sedan om. Ingen förändring över 10 % kunde observeras i hållbarheten. Studien visade att trots att det finns en signifikant skillnad är det möjligt att ersätta den nuvarande metoden med plasma och använda helblod istället.
Warfarin is a drug used to prevent high-risk patients such as those with atrial fibrillation from thromboembolisms. This effect is achieved by suppressing vitamin-K dependent factors VII, X and prothrombin and therefore decreasing the bloods ability to clot. Finding the right dosage of the drug for warfarin treated patients has proven difficult, as it demands regular blood draws to monitor their prothrombin complex level, which is affected by dietary and living habits. The most common way to measure prothrombin complex levels is by using venous plasma but it is also possible to use capillary plasma. Whole blood can be used for mechanical methods, which don’t use optical detection. The benefit is that whole blood doesn’t require centrifugation. The aim of this study was to investigate if there was a significant difference (p≤0,05) between using whole blood and plasma which is the existing method for capillary sample and also if there is any differences between the stability of these samples. Double samples from 30 warfarin treated patients and 5 non-treated persons were taken. One of the samples were centrifuged and analyzed on plasma and the other analyzed on whole blood. The results showed that there was a significant difference (p≤0,05) between the methods. Bland-Altman plot comparison showed that 95 % of the whole blood samples would not be higher than 0,25 INR and lower than 0,14 INR. This has low clinical impact. The samples were stored at room temperature for up to 24 hours and reanalyzed. No changes over 10 % in INR values were observed. This study showed that even though there is a significant difference, it is possible to replace the existing method which using plasma with the whole blood instead.

The pre-analytical phase is known for being the most important step in the laboratory process to reach reliable test results. If handling, transport or preparation of the sample is performed incorrectly the results can deviate from the true value. Today, sampling tubes contains various additives to stabilize concentration levels. The aim of this study was to test a new sampling tube containing fluoride/citrate for glucose, lactate and homocysteine. It was also of interest to evaluate the stability of those three analytes in lithium-heparin, sodium-fluoride/potassium oxalate and fluoride/citrate tubes. To perform the sustainability study, a method verification was done for homocysteine in plasma. The study was performed in a hospital laboratory on the routine instrument Roche Cobas 6000 analyzer. Blood was drawn from 20 patients and was analyzed at the hospital laboratory in Gävle. The blood samples were transported frozen to the laboratory in Hudiksvall and were used in the method verification. For the sustainability study, blood was drawn from 10 healthy volunteers in lithium-heparin, sodium-fluoride/potassium oxalate and fluoride/citrate tubes. The method verification was approved. The results showed that glucose was stable for up to 72 hours in Vacuette Glycaemia tube with fluoride/citrate and this tube also gave more accurate results. Lactate and homocysteine were also stable in fluoride/citrate, but needs further studies. All three analytes were more stable if the sample tubes were centrifuged as soon as possible after blood collection. Fluoride/citrate tubes were stable without centrifugation directly.

Snabb och korrekt artidentifiering är avgörande för effektiv behandling av svampinfektioner, särskilt bland immunsupprimerade patienter. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) används rutinmässigt på kliniska laboratorier för identifiering av karaktäristiska proteinmönster hos bakterier och jästsvampar genom tolkning av proteinspektra i en masspektradatabas för korrekt artidentifiering. Mögelsvamparnas hårda cellvägg och heterogena växtsätt med varierande proteinuttryck beroende på mognadsstadie, försvårar identifiering med MALDI-TOF MS. Metodens tänkbara fördelar mot traditionella metoden mikroskopering är förkortade svarstider, säkrare artidentifiering av fler arter och mindre beroende av subjektiv morfologisk bedömning. Studiens syfte var att undersöka om MALDI-TOF MS kunde anpassas och användas för identifieringen av mögelsvamp i klinisk rutindiagnostik. Fyra referensstammar (Aspergillus niger, A. fumigatus, A.terreus, A.flavus) och ett kliniskt isolat (A.terreus) undersöktes. Preparationsmetoderna (I) fullständig myrsyraextraktion, (II) direktapplicering och (III) suspension i destillerat vatten användes för analys av sporer och frontmycel hos yngre och äldre mögelkulturer. Två olika masspektradatabaser för artidentifiering jämfördes; rutindatabasen BDAL och den specialiserade mögeldatabasen Filamentous Fungi Library. Även plocktekniken av mögelmaterial inför analys med MALDI-TOF MS utvärderades. Vid vissa tillfällen förbättrades artidentifieringen efter extraktion av mögelkulturerna, medan i andra fall var direktapplicering fullt tillräcklig. Mögelmaterial med mycket sporer tenderade ge något fler artidentifieringar i BDAL oavsett kulturernas ålder.  Filamentous Fungi Library tenderade i vissa fall ge bättre resultat jämfört med BDAL för yngre kulturer. Fler studier krävs för att utvärdera och optimera MALDI-TOF MS som metod för artidentifiering av mögelsvamp.
Rapid and accurate species identification is crucial for successful treatment of fungal infections, especially among immunosuppressed patients. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) is used routinely at clinical laboratories to identify characteristic protein patterns of bacteria and yeast by the interpretation of protein spectra in a database for accurate species identification. The hard cell wall of the mold and the heterogeneous growth with varying protein expression due to maturation, complicates identification with MALDI-TOF MS. The potential benefits of this method compared to microscopy as traditional method are shortened turn-around times, safer species identification of more species that is independent on subjective morphological assessment. The purpose of the study was to investigate whether MALDI-TOF MS could be adapted and used for the identification of molds in clinical routine diagnostics. Four reference strains (Aspergillus niger, A.fumigatus, A.terreus, A.flavus) and a clinical isolate (A.terreus) were examined. The preparation methods (I) complete formic acid extraction, (II) direct application and (III) suspension in distilled water were used for analysis of spores and frontmycelium from younger and older mold cultures. Two different masspektradatabases for species identification were compared; routine database BDAL and the specialized mold database, Filamentous Fungi Library. Also the collecting technique of mold prior to analysis with MALDI-TOF MS was evaluated. Sometimes, the species identification improved after extraction of mold cultures, while in other cases direct application was sufficient. Cultures with a lot of spores tended to give slightly more species identifications in BDAL regardless of the age of cultures. Filamentous Fungi Library, in some cases, tended to improve the performance compared to BDAL for younger cultures. More studies are required to evaluate and optimize MALDI-TOF MS as a method of mold identification.

Neisseria gonorrhoeae (NG) har successivt utvecklat resistens mot många antimikrobiella medel och betraktas som ett av de tre reella hoten bland antibiotikaresistenta bakterier. Ciprofloxacin är ett bredspektrum-antibiotikum tillhörande gruppen kinoloner som, förutom att behandla urinvägsinfektioner, används mot NG och infektioner i mage och tarm. Dock har det rapporterats att ca 30 % av NG-isolat som samlats in genom gonokock-isolatövervakningsprojekt (GISP) under 2017 var resistenta mot ciprofloxacin. På molekylnivå är resistens mot ciprofloxacin starkt associerad med en enda mutation i kodon 91 i gyras-genen (gyrA). Detta projekt har undersökt om det går att använda molekylärbiologiska metoder för att detektera NG-isolat med gyrA mutationen. Analysen gjordes med två olika PCR-system, ”7500 Fast Real-Time PCR System” från Applied Biosystems (ABI) och Panther Fusion från Hologic. Proberna som användes designades för påvisning av vildtyp gyrA (ciprofloxacin-känslig) och mutant gyrA (ciprofloxacin-resistent) hos NG. I projektet analyserades 50 NG-positiva prov (analyserade med screeningtest APTIMA COMBO2 från Hologic), från 43 patienter som provtagits under januari-februari 2020 i Region Skåne. Några patienter testades flera gånger vid olika tillfällen. NG-odling hade utförts parallellt från motsvarande tagna prov från patienterna. ABI-metoden påvisade genen hos 90 % (45/50) av NG-positiva prover (APTIMA COMBO2) medan endast 24 av de 49 proven (49 %) kunde odlas med traditionell metodik för att därefter resistensbestämmas. Av de 45 prov där gyras-genen kunde detekteras med ABI-metoden, uppvisade 28 (62 %) av proven en muterad gen och därmed en potentiell resistens för ciprofloxacin. Panther Fusion-metoden påvisade genen hos 80 % (40/50) av NG-positiva prover (APTIMA COMBO2), och såsom tidigare nämnts, kunde endast 24 av de 49 proven (49 %) odlas med traditionell metodik för att därefter resistensbestämmas. Av de 40 prov där gyras-genen kunde detekteras med Panther Fusion-metoden, uppvisade 26 av proven (65 %) en muterad gen och därmed en potentiell resistens för ciprofloxacin. En jämförelse mellan resultaten från PCR-metoderna och odlingarna visar att av de 24 odlingarna som kunde resistensbestämmas fick ABI-metoden resultat för 23 och Panther Fusion för 22. PCR-metodernas resultat överensstämde perfekt med resultaten från odling med samma 8 känsliga och 15 respektive 14 resistenta NG-isolat som odling. De båda PCR-metoderna och traditionell odling uppvisade jämförbara resultat. Av de 24 prov som kunde odlas och därmed resistensbestämmas, detekterades med ABI-metoden gyras-genen i 23 av dessa prov och i 22 av proven med Panther Fusion-metoden. Resistens mot ciprofloxacin uppvisades genom odling i 16 av de 24 odlingsbara prov, och av dessa 24 odlingsbara prov uppvisade ABI-metoden en muterad gen i 15 av proven och Panther Fusion-metoden en muterad gen i 14 av proven. Traditionell odling kunde bara genomföras på 24 av proven och PCR-metoderna identifierade signifikant fler prov innehållande vildtyp eller muterad gyras-gen, 45 respektive 40 prov. Projektet visade tydligt att PCR-metoderna kan identifiera fler prov än genom traditionell odling och kan därmed upptäcka fler prov med förväntad ciprofloxacin-resistens än vad som kan bestämmas genom traditionell odling.
Neisseria gonorrhoeae (NG) has been developing a resistance towards several different antibiotics and is viewed as one of the three real threats among resistant bacteria. Ciprofloxacin is a broad-spectrum-antibiotic belonging to the group quinolone antibiotics which, in addition to being used to treat urinal infections, is used to treat NG and infections in the stomach and intestines. However, it has been reported that 30 % of NG-isolates that have been gathered through the Gonococcal Isolate Surveillance Project (GISP) throughout 2017 were resistant to ciprofloxacin. On a molecular level, resistance to ciprofloxacin is strongly associated with a single mutation in kodon 91 in the gyras-gene (gyrA). This project sought to examine if it is possible to use methods from molecular biology to detect which NG that have the gyrA-mutation. The test was done using two different PCR-systems, ”7500 Fast Real-Time PCR System” from Applied Biosystems (ABI) and Panther Fusion from Hologic. The probes used were designed to show wild type gyrA (ciprofloxacin sensitive), and mutated gyrA (ciprofloxacin resistant) in NG. In this project 50 NG-positive samples (analysed with screentest APTIMA COMBO2 from Hologic), from 43 patients that had been tested during January-February 2020 in Region Skåne, were analysed. Some patients were tested several times, within the time period. NG-cultivation had been done in parallel from corresponding samples taken from the patients. The ABI-method showed the gene in 90 % (45/50) of NG-positive samples (APTIMA COMBO2) while only 24 of the 49 samples (49 %) could be cultivated by traditional methodology, and then tested for resistance. Of the 45 samples where the gyras-gene could be detected with the ABI-method, 28 samples (62 %) exhibited a mutated gene and thus a potential resistance to ciprofloxacin. The Panther fusion-method showed the gene in 80 % (40/50) of NG-positive samples (APTIMA COMBO2), and as mentioned earlier, only 24 of the 49 samples (49 %) could be cultivated by traditional methodology to then be tested for resistance. Of the 40 samples where the gyras-gene could be detected with the Panther Fusion-method, 26 samples (65 %) exhibited a mutated gene and thus a potential resistance to ciprofloxacin. The two PCR-methods and traditional cultivation exhibited comparable results. Of the 24 samples that could be cultivated and thus tested for resistance, the ABI-method detected the gyras-gene in 23 of these samples and the Panther Fusion-method detected the gene in 22 of the samples. Cultivation exhibited resistance to ciprofloxacin in 16 of the 24 samples that could be cultivated, and of these 24 cultivatable samples the ABI method exhibited a mutated gene in 15 of the samples and the Panther Fusion-method exhibited a mutated gene in 14 of the samples. Traditional cultivation could only be done on 24 of the samples and the PCR-methods could identify significantly more samples containing either wild type or mutated gyras-gene, 45 and 40 samples, respectively. The project clearly showed that more samples can be identified with the PCR-methods than through traditional cultivation, and thereby discover more samples with expected ciprofloxacin-resistance, than can be determined through traditional cultivation.

Trigger finger is one of the most common hand conditions, with a prevalence of almost 3%. The aetiology remains unclear even though many causes have been suggested. The prevailing paradigm is that the pathogenesis of trigger finger is ascribed to primary changes in the first fibrous condensation of the tendon sheath (A1-pulley). Several studies have investigated pathology in the pulley, but few have investigated the tendon. The general aim of this thesis was to find out if there is pathology in the trigger finger tendon and to define it. We first looked at trigger finger tendon biopsies in a light microscope, and found that they were histologically different from healthy tendons. They showed signs of micro-ruptures, collagen degradation, increased amounts of ground substance, both hyper- and hypo-cellular areas, round active cell nuclei and absence of inflammatory cells, all similar to tendinosis. The histological picture was further assessed by using a scoring system for Achilles tendinosis. The trigger finger tendons scored high, suggesting a similar histopathology. Next, we performed a quantitative real-time polymerase chain reaction (qPCR) on trigger finger tendons. We assessed the mRNA expression of 10 genes, which have been described to be differently expressed in Achilles tendinosis (collagen 1 and 3, versican, decorin, biglycan, aggrecan, MMP-2, MMP-3, ADAMTS-5, and TIMP-3). The overall expression pattern agreed with previous studies on Achilles tendinosis, suggesting that the cellular function in trigger finger tendons is disturbed in a similar way as in Achilles tendinosis. Recent experimental and observational research has suggested potential side effects of statin treatment on tendons, but firm evidence was lacking. We performed an epidemiological study on two large population-based cohorts. Statin use was found to increase the risk of both trigger finger and tendinosis in the shoulder and Achilles tendons, especially among men. This suggests a similar pathology in trigger finger and tendinosis. We have also studied the time to treatment effect after a single injection of glucocorticoid in trigger finger. Our results suggest that 60-80% of patients can expect resolution of the triggering within 14 days, and half of them within seven days. This result allows correct information to be given to the patient and proper planning of follow-ups. In conclusion, the pathology in trigger finger tendons is similar to tendinosis in other tendons.

Rectal cancer is one of the three most common malignancies in Sweden with an annual incidence of about 2000 cases. Current treatment consists of surgical resection of the rectum including the loco-regional lymph nodes in the mesorectum. In advanced cases, neoadjuvant chemo-radiotherapy (CRT) prior to the operative treatment reduces local recurrences and enables surgery. The neoadjuvant treatment can also eradicate the tumour completely, i.e. complete response. This research project was designed to investigate the effects of preoperative radiotherapy/ CRT and analyze methods to predict response to CRT. Study I investigated the expression of the FXYD-3 protein with immunohistochemistry in rectal cancer, with or without preoperative radiotherapy. The results from the total cohort showed that, strong FXYD-3 expression was correlated to infiltrative tumour growth (p = 0.02). In the radiotherapy group, strong FXYD-3 expression was related to an unfavourable prognosis (p = 0.02). Tumours with strong FXYD-3 expression had less tumour necrosis (p = 0.02) after radiotherapy. FXYD-3 expression in the primary tumour was increased compared to normal mucosa (p=0.008). We concluded that FXYD-3 expression was a prognostic factor in patients receiving preoperative radiotherapy for rectal cancer. Study II investigated FXYD-3 expression in tumours that developed local recurrences following surgery and compared this with expression in tumours that did not develop local recurrences. There was no difference in the expression of FXYD-3 between the group that developed local recurrences and the group that did not develop local recurrences. There was no difference in survival between those with strong or weak FXYD-3 expression. We concluded that this study could not confirm the findings from study 1 i.e. that FXYD-3 expression has prognostic significance in rectal cancer. Study III was a register-based study on the incidence and effects of complete response to neoadjuvant treatment. Eight per cent of the patients with adequate CRT to achieve complete response also had a complete histological response of the luminal tumor in the resected bowel. Sixteen per cent of that group had remaining lymph node metastases in the operative specimen. Chemotherapy together with radiotherapy doubled the chance of complete response in the luminal tumour. Patients with remaining lymph node metastases had a lower survival rate compared to those without. We concluded that residual nodal involvement after neoadjuvant treatment was an important factor for reduced survival after complete response in the luminal tumour. Study IV followed up the results from the previous study by re-evaluating magnetic resonance imaging (MRI)- images in patients with complete tumour response. Two experienced MRI radiologists performed blinded re-staging of post CRT MR- images from patients with complete response in the luminal tumour. One group with lymph node metastases and another one without were studied and the results compared with the pathology reports. The sensitivity, specificity, and positive and negative predicted values for correct staging of positive lymph nodes was 37%, 84%, 70% and 57%. The size of the largest lymph node (4.5 mm, p=0.04) seemed to indicate presence of a tumour positive lymph node. We concluded that MRI couldn’t correctly stage patients for lymph node metastases in patients with complete response to CRT in the luminal tumour.

Aim: To study the possibility of detecting lymph node metastasis in locally advanced urinary bladder cancer (UBC) treated with radical cystectomy (RC) by using preoperative positron emission tomography/computed tomography (PET/CT) and peroperative sentinel node biopsy (SNB) technique. We also investigate the clinical significance of macrophage traits expression by cancer cells, M2-macrophage infiltration (MI) in tumor stroma and the immunohistochemical expression of biomarkers in cancer cells in relation to clinicopathologic data. Patients and Methods: We studied prospectively 122 patients with UBC, pathological stage pT1–pT4 treated with RC and pelvic lymph node dissection (PLND) during 2005–2011 at the Department of Urology, Linköping University Hospital. In the first study, we compared the results of preoperative PET/CT and conventional CT with the findings of postoperative histopathological evaluation of lymph nodes (LNs). In the second study we investigated the value of SNB technique for detecting pathological LNs during RC in patients with UBC. W also examined the significance of the primary tumor location in the bladder in predicting the site of LN metastases, and the prognostic significance of lympho-vascular invasion (LVI) and lymph node metastasis density (LNMD) on survival. In the third study, we investigate the clinical significance of macrophage infiltration (MI) in tumor stroma and macrophage-traits expression by tumor cells. In the fourth study, we investigate the cell cycle suppression proteins p53, p21, pRb, p16, p14 ARF as well as tumors proliferative protein Ki67 and DNA repair protein ERCC1 expression in cancer cells. The results were compared with clinical and pathological characteristics and outcome. Results: Prior to RC, PET/CT was used to detect LN metastasis in 54 patients. PET/CT had 41% sensitivity, 86% specificity, 58% PPV, and 76% NPV, whereas the corresponding figures for conventional CT were 41%, 89%, 64%, and 77%. SNB was performed during RC in 103 patients. A median number of 29 (range 7–68) nodes per patient were examined. SNs were detected in 83 out of 103 patients (81%). The sensitivity and specificity for detecting metastatic disease by SNB varied among LN stations, with average values of 67% -90%. LNMD or ≥8% and LVI were significantly related to shorter survival. In 103 patients, MI was high in 33% of cases, while moderate and low infiltration occurred in 42% and 25% of tumors respectively. Patients with tumors containing high and moderate compared to low MI had low rate of LN metastases (P=0.06) and improved survival (P=0.06), although not at significant level. The expression of different tumor suppression proteins was altered in 47-91% of the patients. There were no significant association between cancer specific survival (CSS) and any of the studied biomarkers. In case of altered p14ARF, ERCC1 or p21, CSS was low in case of low p53 immunostaining but increased in case of p53 accumulation, although not at a significant level, indicating a possible protective effect of p53 accumulation in these cases. Conclusion: PET/ CT provided no improvement over conventional CT in detection and localization of regional LN metastases in bladder cancer. It is possible to detect the SN but the technique is not a reliable for perioperative localization of LN metastases; however, LVI and LNMD at a cut-off level of 8% had significant prognostic values. MI in the tumor microenvironment but not CD163 expression in tumor cells seems to be synergistic with the immune response against urinary bladder cancer. Our results further indicate that altered p53 might have protective effect on survival in case of altered p14ARF, p21, or ERCC1 indicating an interaction between these biomarkers.

Bedömningen av höger kammares systoliska funktion kan med fördel göras med ekokardiografi, bl.a. med tekniker som tvådimensionell ekokardiografi, motion-mode (M-mode) och Tissue Doppler Imaging (TDI). Mätvärden som kan fås ut av dessa tekniker är Tricuspid Annular Plane Systolic Excursion (TAPSE) och s`. TAPSE beskriver annulus tricuspidalis longitudinella rörlighet. s´ beskriver den maximala systoliska hastigheten i annulus tricuspidalis. Syftet med examensarbetet var att undersöka sambandet mellan TAPSE och s´ vid högerkammarfunktionsbestämning. Studien är en retrospektiv tvärsnittsstudie och består av 99 deltagare i åldrarna 18–90 år. Både friska och hjärt-och kärlsjuka deltagare inkluderades, men inte patienter med förmaksflimmer eller individer som var yngre än 18 år. Deltagarna undersöktes med transthorakal ekokardiografi (TTE) vid Länssjukhuset Ryhov i Jönköping, vid undersökningen mättes TAPSE och s´. Det var samma biomedicinska analytiker (BMA) som utförde undersökningarna. McNemars test utfördes och ett Kappa-värde räknades ut. Resultatet visade signifikant skillnad och Kappa-värdet var lågt vilket talar för dåligt samband mellan de båda variablerna. Utfallet i studien visar att fler deltagare klassas med normal högerkammarfunktion mätt med TAPSE, medan samma individer klassas med högerkammardysfunktion mätt med s´. Orsaken till det dåliga sambandet mellan parametrarna är okänt och bör studeras vidare i kommande studier.
The assessment of right ventricular systolic function is done by echocardiography, with techniques as twodimensional echocardiography, motion-mode (M-mode) and Tissue Doppler Imaging (TDI). Measurements ​​obtained from these techniques are Tricuspid Annular Plane Systolic Excursion (TAPSE) and s`. TAPSE describes the longitudinal movement of annulus tricuspidalis. s´ describes annulus tricuspidalis maximal systolic velocity. The purpose of this essay was to explore the relationship between TAPSE and s´. The study consists of 99 participants between the ages of 18 and 90. The population was consisted of individuals with or without cardiovascular disease, but not individuals with atrial fibrillation. Participants were investigated with transthorakal echocardiography (TTE) at Länssjukhuset Ryhov in Jönköping. At the examination both TAPSE and s´ was measured. McNemar's test was performed and a Kappa value was calculated. The result showed a significant difference and the Kappa value was low which indicates a low relationship between the variables. The outcome of the study shows that several participants are classified with normal right ventricular function measured with TAPSE, but the same individuals are classified with right ventricular dysfunction measured by s'. The reason for the poor relationship between the parameters is unknown and should be studied further in future studies.

Anemi kan uppstå till följd av förlust av erytrocyter eller försämrad produktion av nya erytrocyter. För att upptäcka och följa upp patienter med anemi är det viktigt att korrekt kunna mäta hemoglobinkoncentrationen (Hb) i blodet. En vanlig metod för att mäta Hb-koncentration är fotometri i kombination med en kemisk omvandling. Liksom alla mätningar med ljus är dessa känsliga för turbiditet i provet. Lipemi är en vanlig källa till turbiditet som kan uppstå till exempel som följd av en fettrik måltid, diabetes mellitus, lever- eller njursjukdomar, alkoholism och vissa läkemedel. Olika instrumenttillverkare har olika metoder för att motverka interferensen av lipemi. Sysmex hematologi-instrument XN-10 använder en fettlösande bärarvätska i sin fotometriska kanal (HGB) och HemoCue mäter vid en andra våglängd som ska kompensera för turbiditet. Sysmex XN-10 har också en optisk kanal (HGB-O) som är till för att räkna retikulocyter genom att mäta deras nukleinsyra- samt Hb-innehåll men ger då också ett beräknat värde på Hb-koncentrationen i hela provet. Syftet med denna studie var att jämföra HGB och den HGB-O för bestämning av Hb-koncentrationen i helblod. Båda kanalerna jämfördes även med HemoCue Hb 201+ vid bestämning av Hbkoncentrationen i svårt lipemiska prover. Hb-mätning på plasma från motsvarande prover utfördes också för att undersöka om värdet motsvarade Hb-höjningen i de lipemiska proverna. Prover analyserade med både HGB och HGB-O på Sysmex XN-10 på klinisk kemi vid Skånes universitetssjukhus i Lund under november månad 2018 (n = 392) jämfördes med hjälp av Spearmans rangkorrelationskoefficient. Lipemi simulerades med fettemulsionen Intralipid i totalt 32 prover. Färdiganalyserade patientprover från föregående dag delades i ett lipemiskt prov med Intralipidtillsats och ett nollprov med tillsats av NaCl-lösning i en motsvarande volym. Differenserna mellan de lipemiska- och nollprovernas Hb-värden testades för signifikans med icke-parametrisk Wilcoxons teckenrangtest. Kruskal-Wallis samt Dunns's tester användes för att visa på signifikanta skillnader mellan de tre metoderna. Signifikansnivån sattes vid p < 0,05. Resultaten visade god korrelation mellan HGB - och HGB-O Hb-värden med ett Spearman korrelationsvärde på 0,982.  Jämförelsen av metoderna vid lipemi visade signifikant skillnad mellan nollprov och lipemiskt prov för HGB- (p < 0,001) men inte HGB-O (p = 0,11) på XN-10. HemoCue Hb 201+ visade också signifikant skillnad (p < 0,001) vid lipemi men med lägre median-värde än HGB och mindre spridning än HGB-O. HGB-O:s median-värde tydde på minst lipemipåverkan men spridningen av differenserna var stor. Spridningen av HGB-O resultaten kan bero på hemolys då endast intracellulärt Hb mäts i denna kanal. Resultaten i denna studie tyder på att HemoCue-metoden är den mest pålitliga vid Hb-mätning av lipemiska prover och därmed det lämpligaste komplementet till HGBmetoden
Anemia can arise from either loss of erythrocytes or impaired production of new erythrocytes. In order to discover and evaluate the treatment of anemic patients, correct Hb measurements are important. A common method to measure Hb concentration is photometry in combination with chemical conversion of the Hb. Like all light-dependent methods this suffers from a vulnerability to turbidity that scatters light. Lipemia is a common cause of turbidity caused by e.g. recent intake of high fat foods, diabetes mellitus, liver or kidney disease, alcoholism and some drugs. Manufacturers of Hb analyzers use different methods to counter the influence of interference from lipemia on measurements. Sysmex XN-10 analyzers use a fat dissolving sheath fluid in its photometric channel (HGB) and HemoCue measures absorbance at a second wavelength to compensate for turbidity. Sysmex XN-10 also has an optic channel (HGB-O) for counting reticulocytes by measuring their nucleic acid and Hb content. At the same time this channel measures Hb equivalents of erythrocytes and gives a calculated value of Hb content in the entire sample. The aim of this study was to compare the photometric and the optical channels for measuring Hb concentration in whole blood. Both the Sysmex XN-10 channels were compared with HemoCue Hb 201+ when measuring Hb concentrations in lipemic samples. Plasma Hb concentration was determined for the corresponding samples in order to investigate correlation between elevation in Hb concentration with and without simulated lipemia and in the plasma after centrifugation. Samples analyzed at Skånes University Hospital in Lund during the month of November 2018 (n = 392) using both HGB and HGB-O on XN-10 were compared using Spearman's signed correlations coefficient. Lipemia was simulated by using the fat emulsion Intralipid in a total of 32 samples. Samples collected and analyzed on the previous day was used for the study. Each sample was split into one part with added Intralipid to form a lipemic sample and one part with NaCl-solution of the same volume as Intralipid in the lipemic sample. The differences between lipemic and non lipemic samples was tested for significance by the non-parametric Wilcoxons signed ranks test for each of the methods. Significance between the three methods was tested by using Kruskal-Wallis and Dunn's tests. Level of significance was set to p < 0.05. The results showed good correlation between earlier test run on both HGB and HGB-O with a Spearman correlation score of 0,982.  A significant difference was found between lipemic and non lipemic samples with the photometric method (p < 0,001) but not the optical method (p = 0,11) on XN10. HemoCue Hb 201+ also showed a significant difference (p < 0,001) between lipemic and non lipemic samples but a lower median than HGB and less deviation than HGB-O. The median of HGB-O indicated that it was influenced the least by lipemia of the three methods but had the greatest deviation of the differences. The greater deviation of HGB-O values may have been caused by hemolysis since the method measures intra cellular Hb. HemoCue shows according to this study the slightest deviation of the three methods and a less heightened median value compared to HGB which confirms the methods suitability as complement to HGB when dealing with lipemic samples.

Urinblåsecancer är den sjunde vanligaste cancerformen i Sverige där blåssköljvätska utgör det huvudsakliga provmaterialet vid utredning. ThinPrep® är en vanligt förkommande metod som används inom vätskebaserad cytologi vid analys av blåssköljvätska. Fixering av provmaterialet kan försvåra diagnostiken på grund av förändrad morfologi samt artefakter.  Studiens syfte var att jämföra erhållet preparatinnehåll från blåssköljvätskor som fixerats med fixeringslösning innehållande ättiksyra med CytoLyt® solution. Studien ämnade även jämföra ThinPrep® filtren ”Non-GYN” och ”UroCyte”.  Studien inkluderade 90 patientprover av blåssköljvätska som fixerades med tillsats av ättiksyra samt CytoLyt®, varvid filtren ”Non-GYN” samt ”UroCyte” användes. Preparaten bedömdes av cytodiagnostiker samt cytopatolog utifrån kriterierna: bakgrundsmaterial, cellmängd samt färgbarhet. Resultatet visade att CytoLyt® i kombination med filtret ”Non-GYN” gav ett mer representativt preparat samt lämnade en god bakgrundsbild. Användandet av CytoLyt® resulterade i fler diagnostiska fördelar jämfört med fixering av ättiksyra, vilket även gynnar patienter.
Bladder cancer is the seventh most common form of cancer in Sweden where the main source of material for investigation are bladder washings. A common method within liquid-based cytology for analysis of bladder washings is ThinPrep®. Altered morphology as well as artifacts due to fixation can complicate funkar “the diagnostics of the sample. The aim of this study was to compare the slide content obtained from bladder washings fixed with fixative containing acetic acid with CytoLyt® solution. The study also intended to compare the ThinPrep® filters "Non-GYN" and "UroCyte". A total of 90 samples of bladder washings from patients where included. The samples where fixed with the addition of acetic acid and CytoLyt®, using the "Non-GYN" and "UroCyte" filters. A cytotechnologist and a cytopathologist assessed the preparations based on the criteria background material, cell quantity and the amount of colour change. The results showed that CytoLyt® in combination with the filter "Non-GYN" gave a more representative preparation and provided a good background image. The use of CytoLyt® resulted in more diagnostic benefits compared to fixation with acetic acid, which also benefits patients.

Elastinfibrer ger blodkärl och andra vävnader deras flexibilitet. Elastinfärgning är relevant när man misstänker melanom, temporalis artrit, venös invasion och efter blodkärlsoperationer. Syftet var att med hjälp av olika vävnadstyper optimera och implementera den automatiserad elastinfärgningen enligt Hart, för att ersätta den nuvarande manuella elastinfärgning enligt Verhoeff vid patologilaboratoriet på länssjukhuset Ryhov, Jönköping. Colon, njure, hud samt navelsträng färgades med den automatiska metoden enligt Hart för att hitta optimala inställningar. Vävnader från samma områden färgades med den manuella metoden enligt Verhoeff samt den automatiska metoden enligt Hart för att jämföra dem. Snitten bedömdes av en läkare så allt färgades som det skulle. Optimeringen av Harts metod resulterade i en inkubationstid på tolv minuter samt en optimal färgningsbehandling utan xylen. Resultaten av jämförelsen mellan den automatiska metoden enligt Hart och den manuella metoden enligt Verhoeff visar att den automatiska metoden enligt Hart ger bättre kontrast samt bakgrundsinfärgning. Slutsatsen blev att den automatiska metoden enligt Harts var bättre än den manuella metoden enligt Verhoeff, att i framtida studier studera möjligheten att byta ut läskningen mot till exempel ytterligare ett etanoldop samt att byta ut snitten av navelsträngen mot snitt av lever.
Elastic fibres ensure blood vessels and other tissues flexibility. Elastic staining of tissue is relevant when there is suspicion of melanoma, temporalis arteritis, venous invasion and after operations on blood vessels. The aim of the study was with the help of different tissue samples optimize and implement Hart´s elastic staining method as a substitute for Verhoeff’s at pathology lab at county hospital Ryhov, Jönköping. Colon, kidney, skin, and umbilical cord cross section got stained with Hart´s automated elastic staining method to evaluate the optimal staining procedure. Same region of the tissues was stained with Verhoeff´s manual elastic staining method and Hart´s method. All cross section were assessed and compared with the help of a pathologist doctor. Optimization of Hart´s method resulted in an incubation period of twelve minutes and optimal staining procedure without xylene. Result of comparison between Hart´s staining method and Verhoeff´s staining method showed that Hart´s staining method had a better contrast and background. Conclusions of the study was that Hart´s staining method was better than Verhoeff´s staining method, further studies could include research about a substitution of the blotting step with an extra ethanol bath as an example and liver tissue instead of the umbilical cord.

Klinisk kemiska analyser har hög klinisk relevans. I serum/plasma kan olika parametrar kvantifieras. Dessa parametrar kan vara proteiner, enzymer, joner, metaller, lipider och kolhydrater. Med hjälp av referensintervall kan veterinärer ställa diagnos, följa behandling och sjukdomsförlopp. Parametrar detekteras med olika analysprinciper/metoder; kolorimetri, immunturbidimetri, enzymatisk metod och potentiometri. Djursjukhuset, AniCura, i Hässleholm mottagas både hundar och katter. Cirka 120 kemianalyser analyseras varje dag. AniCura har köpt in ett nytt våtkemiiinstrument, Indiko Plus, som ska ersätta Cobas C111. Med Indiko Plus tillkommer fler provpositioner, 8 nya analyser, ökad kapaciteten och underlättad användning.  Syftet med denna studie var att jämföra instrumenten och ta fram eget referensintervall som jämfördes med referensintervall framtaget av Thermo Fisher. Verifiering av det nya instrumentet genomfördes med precisionsstudie och linjäritetsstudie. Provtagning på hundar och katter utfördes av personal på AniCura. Jämförelsen gjordes med patientprover och referensintervall togs fram med hjälp av prover från friska hundar och katter. Jämförelsen visade att 9 av 13 analyser hade statistisk signifikant skillnad. Orsaken till det beror troligen på skillnaden av reagens, instrumentens ålder och tid mellan mätningar. Ett nytt referensintervall utarbetades och skiljde sig inte mycket från Thermo Fishers intervall. Vidare validering på grund av liten population rekommenderades. Precisionen för Indiko Plus blev godkänd. Linjäriteten blev icke linjär och berodde troligen på en dålig pipett och bör göras om.
Clinical chemical analyzes has high clinical relevance. In serum/plasma, different parameters can be quantified. Parameters can be proteins, enzymes, ions, metals, lipids, and carbohydrates. With reference intervals, veterinarians can set diagnosis, follow treatment and development of the disease. Parameters are detected with different analysis principles/methods; colorimetry, immunoturbidimetry, enzymatic method and potentiometry. The animal hospital, AniCura, in Hässleholm accept dogs and cats. About 120 chemical analyzes are analyzed every day. AniCura purchased a new instrument, Indiko Plus, which will replace Cobas C111. Indiko Plus provide, more sample positions, 8 new analyzes, increased capacity, and facilitated use. The purpose of this study was to compare the instruments and produce a new reference interval which was compared to the reference interval provided by Thermo Fisher. To verify Indiko Plus, a precision and linearity study were conducted. Blood sampling of dogs and cats was performed by staff at AniCura. The comparison was made with patient samples and the reference intervals were obtained using samples from healthy animals. The comparison showed 9 of 13 analyzes had a statistically significant difference. The reason for this is probably due to the difference in reagents, the age of the instruments and the time between measurements. A new reference interval was developed and did not differ much from the Thermo Fisher interval. Further validation due to low population was recommended. The precision for Indiko Plus was approved. The linearity study shows not linear trend but was likely due to a bad pipette and should be redone.

Normalt sett skyddar komplementsystemet kroppen mot infektioner och patogener. Vid vissa typer av njursjukdomar, framför allt vid C3-glomerulopati, förekommer autoantikroppar som kallas ”nephritic factors” (NeF). Sådana antikroppar stabiliserar enzymkomplex (konvertas) i komplementsystemet, vilket leder till destruktiv komplementaktivering via den alternativa vägen. Syftet med studien var att utveckla minst en metod för att analysera C5NeF på kliniska prover.  C5NeF In-House ELISA analyserade bindning av C5NeF till C5-konvertas. Analys av C5-klyvning i löslig fas kvantifierade mängden C5a som bildats vid stabilisering av C5-konvertas. Cut-off för analyserna bestämdes genom analys av prover från 20 friska blodgivare. Tolv patientprover med möjlig förekomst av C5NeF analyserades. För att utesluta falskt positiv reaktion i C5NeF in-house ELISA analyserades även förekomst av antikroppar mot specifika enskilda komplementproteiner. Åtta patientprover var positiva i C5NeF In-House ELISA, fem patientprover uppvisade positivt resultat för C3NeF, vilket inte var oväntat utifrån tidigare publikationer som visat att det är vanligt att patienter med C5NeF också ofta är positiva för C3NeF. Tre patientprover erhöll positivt resultat i endast C5NeF In-House ELISA och två av dessa var positiva i analys av C5-klyvning i löslig fas. Studien resulterade i etablering av en metod för analys av C5NeF.
Normally the complement system protects the body from infections and pathogens. In certain types of kidney diseases, mainly C3-glomerulopathy, autoantibodies called ”Nephritic Factors” (NeF) are found. NeFs stabilize enzyme complexes (convertases) in the complement system, an event which leads to destructive complement activation via the alternative pathway. The purpose of this study was to develop at least one method to analyse C5NeF on clinical samples.  C5NeF In-House ELISA analysed binding of C5NeF to C5 convertases. Analysis of C5-cleavage in the soluble phase measured the amount of C5a formed when C5-convertase was stabilized. Cut-off for the analyses was determined through analysis of 20 blood donor samples from healthy individuals. Twelve patient samples with possible C5NeF were analysed. To exclude false positive results in C5NeF In-House ELISA analysis of antibodies against specific single complement factors was performed.  Eight patient samples were positive in C5NeF In-House ELISA, five patient samples showed positive result for C3NeF, a finding which was not unexpected as previous publications have shown that concomitant presence of C3NeF and C5NeF is common in C3-glomerulopathy. Where most patients are positive for both C3NeF and C5NeF. Three patient samples received positive result in only C5NeF In-House ELISA and two of these samples were positive in the analysis of C5-cleavage in soluble phase. In conclusion, in this study a method to examine C5NeF was developed.

Biotin är ett vitamin som finns naturligt i livsmedel och det dagliga intaget nås via födan. Höga doser biotintillskott samt höga doser biotin i läkemedel, kan leda till biotininterferens i kliniska immunokemiska analyser. Roche Diagnostics® vill införa nya reagens med högre tröskel för biotininterferens för att minska risken för biotininterferens vid analys av patientplasma. Därför var syftet med studien att metodverifiera fyra nya reagens från Roche Diagnostics® som används vid diagnostisering och behandling av hjärtsvikt, sepsis, och prostatacancer. De fyra reagensen, Elecsys® proBNP II, Elecsys® BRAHMS PCT, Elecsys® total PSA samt Elecsys® free PSA metodverifierades för att användas på Cobas® e801. Studiematerialet bestod av 20 patientprover av litiumheparinplasma per reagens (totalt 80 patientprover). Resultatet av verifieringen av Elecsys® proBNP II visade en korrelation till det befintliga reagenset på r = 0,9998 och Bland-Altman analys visade en spridning av resultaten på < 10 %; inomserieprecisionsstudien gav CV 1,56 %. Elecsys® BRAHMS PCT hade en korrelation på r = 0,9997 och Bland-Altman analysen visade en spridning på > 10 %; inomserieprecisionsstudien gav CV 1,70 %. För Elecsys® total PSA och free PSA fanns korrelationen till det befintliga reagenset på r = 1 respektive 0,9997 och Bland- Altman analysen visade en spridning på < 10 % hos båda reagensen. Inomserieprecisionsstudien gav CV 0,44 % respektive CV 2,67 %. Resultaten för samtliga reagens uppvisar god korrelation till det befintliga reagenset och en hög mätnoggrannhet vilket talar för att de fyra nya reagensen kan tas i bruk.
Biotin is naturally found in foods, and we obtain this vitamin through our daily diet. Biotin supplements as well as high doses of biotin in drugs can lead to biotin interference in clinical immunochemical analyzes. Therefore, the purpose of this study was to methodically verify four new reagents from Roche Diagnostics® with a higher threshold for biotin interference, used in the diagnosis and treatment of heart faliure, sepsis and prostate cancer. The four reagents, Elecsys® proBNP II, Elecsys® BRAHMS PCT, Elecsys® total PSA and Elecsys® free PSA were method-verified for use on Cobas® e801. The study material consisted of 20 patient samples of lithium heparin plasma per reagent. In total 80 samples were analyzed.The result of the verification of Elecsys® proBNP II showed a correlation to the existing reagent of r = 0.9998 and Bland-Altman analysis showed a distribution of the results of <10 %. The withinseries precision study yielded CV 1.56 %. Elecsys® BRAHMS PCT had a correlation of r = 0.9997 and the Bland-Altman analysis showed a distribution of > 10 %. The withinseries precision study gave CV 1.70 %. For Elecsys® total PSA and free PSA, the correlation to the existing reagent was r = 1 and 0.9997, respectively, and the Bland-Altman analysis showed a distribution of <10 % in both reagents. The withinseries precision study yielded CV 0.44 % and CV 2.67 % respectively.The results for all reagents show a good correlation to the existing reagent and a high accuracy of measurement, which indicates that the four new reagents can be used.

Etylenglykol (etan-1,2-diol) är en dihydroxyalkohol som är en komponent i kylarvätska och andra frost- och kylskyddsmedel. Förtäring av etylenglykol leder till allvarliga skador och i värsta fall död utan behandling. I Sverige år 2020 fanns det endast ett tiotal laboratorier som erbjöd analys av etylenglykol dygnet runt. Detta leder till att prover ofta behöver skickas till större laboratorier med taxi vilket i sin tur leder till en försenad diagnosticering av patienten. Syftet med examensarbetet var att verifiera en enzymatisk kolorimetrisk metod för analys av etylenglykol i plasma på instrumentet Roche Cobas® 8000 modul c502. Reagenset som verifierades var DiscretPak™ Ethylene Glycol Reagents från företaget Catachem. Verifieringen gjordes med avseende på total precision (repeterbarhet), inomserieprecision och linjäritet. Resultaten jämfördes med analys på gaskromatograf. Provmaterialet bestod av patientprover av litiumheparinplasma,  patientprover av serum och kontrollprover från Equalis. Resultatet som erhölls vid verifieringen visade på linjär korrelation mellan den enzymatiska metoden och GC-analys. En negativ bias observerades dock i jämförelse med analys på gaskromatograf. Utvärdering av repeterbarhet gav CV 4,6% vid 9,0 mmol/L och 3,66% vid 40,0 mmol/L. Inomserieprecisionstudie gav CV 14,7% vid 1 mmol/L, 5,2% vid 4 mmol/L och 1,4% vid 17 mmol/L. Precisionen är viktigast vid de lägre koncentrationerna. Insättning av behandling med antidot är aktuellt vid 4 mmol/L. Utvärdering av linjäritet visade på ett starkt linjärt samband hos analysen vid koncentrationer <50 mmol/L. Vid koncentrationer >50 mmol/L fanns ett linjärt samband men en minskad överensstämmelse mellan den beräknade och den uppmätta koncentrationen observerades. Metodverifieringen ansågs vara godkänd för kliniskt bruk och analysen kommer att införas i analyssortimentet hos Klinisk Kemi i Växjö.
Ethylene glycol is an alcohol that is a common component in antifreeze. Ingestion of ethylene glycol will, without treatment, lead to severe organ damage and in worst-case death. In 2020 there was only a few laboratories in Sweden that offered analysis of ethylene glycol all hours of the day and week. This means that samples often need to be transported to laboratories at larger hospitals which leads delayed diagnosis of the patient. The purpose of this study was to verify an enzymatic method for analysis of ethylene glycol in plasma on the instrument Roche Cobas® 8000 module c502. The reagent that was used was DiscretPak™ Ethylene Glycol Reagents from Catachem. The study included evaluation of total precision, within-run precision, linearity, and a comparison with analysis with gas chromatography (GC). The sample material consisted of patient samples of plasma, patient samples of serum and quality controls from Equalis. The result of the study showed linear correlation between the enzymatic method and analysis with GC. A negative bias was observed in comparison to analysis with GC. The coefficient of variation (CV) for total precision was 4,7% at 9,0 mmol/L and 3,7% at 40,0 mmol/L. The CV for within-run was 14,7% at 1 mmol/L, 5,2% at 4 mmol/L and 1,4% at 17 mmol/L. The precision of the method is most important at lower concentrations. The evaluation of linearity showed linear correlation at concentrations <50 mmol/L with. A linear correlation was observed at concentrations >50 mmol/L, although the agreement with the calculated concentrations decreased. The method verification was successful as the results were deemed acceptable for clinical use.

Pankreatit anses vara en vanligt förekommande sjukdom hos hundar och katter och kan diagnostiseras genom mätningar av koncentrationen Canine Pancreas-specific Lipase (cPL) respektive Feline Pancreas-specific Lipase (fPL) i serum. Utifrån dessa koncentrationer graderas patienten enligt normalvärde, gråzon eller indikation på pankreatit. Golden standardmetoden för att analysera cPL/fPL är Spec cPL respektive Spec fPL. Nya metoder har utvecklats för kvantitativ mätning av pankreas-specifik lipas såsom Vcheck V200, ett instrument, som analyserar cPL/fPL med en fluorescerande immunoassay. Syftet med studien var att utvärdera analys av cPL/fPL på Vcheck V200 samt jämföra resultatet från detta instrument med värdena från ett referenslaboratorium i Tyskland för att se om det fanns en signifikant skillnad mellan metoderna. Koncentrationen cPL i hundserum (n=37) och koncentrationen fPL i kattserum (n=29) analyserades på Vcheck V200. Dessa prover skickades även till referenslaboratoriet där analysen Spec cPL respektive Spec fPL utfördes. Spridningen var stor kring bias i Bland-Altman diagram för både cPL och fPL och jämförelsen mellan metoderna för de specifika koncentrationerna av cPL/fPL bedömdes vara statistiskt signifikant (p<0,05). 27% av hundproverna graderas olika enligt de båda metoderna och skillnaden var signifikant (p<0,05). 24% av kattproverna graderades olika men skillnaden var inte signifikant (p=0,257). Studien tyder på att jämförelsen mellan de båda metoderna var signifikant förutom vid graderingen av kattproverna. Beaktande detta och det faktum att kvalitetssäkringen brister vid analys av fPL på grund av avsaknad av kontroller kan i dagsläget inte cPL/fPL på Vcheck V200 ersätta den nuvarande golden standardmetoden, trots att ingen signifikant skillnad sågs vid gradering av kattprover.
Pancreatitis is a common disease in canine and felines and can be diagnosed by measuring the concentration of Canine Pancreas-specific Lipase (cPL) or Feline Pancreas-specific Lipase (fPL) in serum. Based on the concentration of cPL/fPL, the patient is then classified in different diagnostic categories (normal value, gray zone or indication of pancreatitis). Spec cPL and Spec fPL is currently the golden standard method for analysis of cPL and fPL. New methods have been developed for the quantitative measurement of pancreatic lipases. Vcheck V200, being one example, utilizing a fluorescent immunoassay for quantification of the lipase. The aim of this study was to evaluate the cPL and fPL analysis on the Vcheck V200 and to examine if there was a significant difference (p≤0,05) when comparing the result from Vcheck V200 with the results from a reference laboratory. The concentration of cPL (n=37) and fPL (n=29) in serum from canine or felines were analyzed using Vcheck V200. The samples were also sent to the reference laboratory where Spec cPL and Spec cPL were performed. A Bland-Altman plot comparison between the two methods showed a large spread for both analysis of cPL and fPL. Comparison of the specific values for analysis of cPL and fPL between the two methods revealed a significant difference (p<0,05). 27% of the dog samples were categorized differently according to the two methods and this difference was significant (p<0,05). 24% of the cat samples were categorized differently and no significant difference were observed (p=0,257). This study indicates that the difference between the two methods was significant, besides the classification of cat samples. Considering this and the lack of quality assurance regarding analysis of fPL due to lack of controls, the cPL/fPL analysis on Vcheck V200 cannot replace the Spec cPL or Spec fPL at present.

Chronic pain affects 20 % of the global population, causes suffering, is difficult to treat, and constitutes a large economic burden for society. So far, the characterization of molecular mechanisms of chronic pain-like behaviors in animal models has not translated into effective treatments. In this thesis, consisting of five studies, pain patient biofluids were analyzed with modern proteomic methods to identify biomarker candidates that can be used to improve our understanding of the pathophysiology chronic pain and lead to more effective treatments. Paper I is a proof of concept study, where a multiplex solid phase-proximity ligation assay (SP-PLA) was applied to cerebrospinal fluid (CSF) for the first time. CSF reference protein levels and four biomarker candidates for ALS were presented. The investigated proteins were not altered by spinal cord stimulation (SCS) treatment for neuropathic pain. In Paper II, patient CSF was explored by dimethyl and label-free mass spectrometric (MS) proteomic methods. Twelve proteins, known for their roles in neuroprotection, nociceptive signaling, immune regulation, and synaptic plasticity, were identified to be associated with SCS treatment of neuropathic pain. In Paper III, proximity extension assay (PEA) was used to analyze levels of 92 proteins in serum from patients one year after painful disc herniation. Patients with residual pain had significantly higher serum levels of 41 inflammatory proteins. In Paper IV, levels of 55 proteins were analyzed by a 100-plex antibody suspension bead array (ASBA) in CSF samples from two neuropathic pain patient cohorts, one cohort of fibromyalgia patients and two control cohorts. CSF protein profiles consisting of levels of apolipoprotein C1, ectonucleotide pyrophosphatase/phosphodiesterase family member 2, angiotensinogen, prostaglandin-H2 D-isomerase, neurexin-1, superoxide dismutases 1 and 3 were found to be associated with neuropathic pain and fibromyalgia. In Paper V, higher CSF levels of five chemokines and LAPTGF-beta-1were detected in two patient cohorts with neuropathic pain compared with healthy controls. In conclusion, we demonstrate that combining MS proteomic and multiplex antibody-based methods for analysis of patient biofluid samples is a viable approach for discovery of biomarker candidates for the pathophysiology and treatment of chronic pain. Several biomarker candidates possibly reflecting systemic inflammation, lipid metabolism, and neuroinflammation in different pain conditions were identified for further investigation.
Uppsala Berzelii Technology Centre for Neurodiagnostics