V I S I T W O R L D ’ S C L I N I C A L L A B O R AT O RY N E W S L E A D E R ISSN 1068-1760 Vol. 29 No. 2 • 4 / 2012 Molecular Test Accurately Detects Colon Cancer A n innovative multimarker stool DNA test is highly accurate at detecting precancerous polyps and early-stage colorectal cancer (CRC). The stool DNA test works by finding signature genetic markers in stool samples mailed in by patients and a positive test would Cord Blood Analysis Provides Wealth of Biomarkers B lood derived from the human umbilical cord has been analyzed to provide vital health information and identify potential biomarkers. A detailed analysis of umbilical cord blood (UCB) has been performed using mass spectroscopy, which gave a broader spectrum of the proteins present sensitive diagnostic technique has been developed that rapidly detects the pathogenic virus that causes pandemic influenza. The technique, which is based on molecular biological methods, swiftly identifies from patient swab samples, the Influenza A virus, designated H1N1 that caused the Cont’d on page 4 Cont’d on page 6 A biochemical assay combined with an algorithm accurately identified the risk of fetal trisomy 21 and 18 from maternal-blood cell-free DNA (cfDNS). The noninvasive test enables scientists to detect the risk that a fetus has the chromosomal abnormalities that cause Down syndrome and a technique has been developed that could form the basis of a noninvasive diagnostic method for the Adenovirus. The biosensor technology developed can detect the presence of the virus and it can also identify the individual strain as well as the number of virus particles present. A Cont’d on page 4 INSIDE Cont’d on page 8 S I T LINKXPRESS COM R E A D E R S E R V I C E ® P O R T A L Renew /Start your Free Subscription Access Interactive Digital Magazine Instant Online Product Information: Identify LinkXpress codes of 1 interest as you read magazine ® on LinkXpress.com 2 Click to reach reader service portal code(s) of interest on 3 Mark LinkXpress inquiry matrix ® If your subscription is not renewed every 12 months your Free Subscription may be automatically discontinued A Two Trisomies Detected by Assay Plus Algorithm Viruses Diagnosed by Electronic Sensor I Rapid Test Developed for Pandemic Influenza than was previously identified. Scientists at the Arizona State University (Tempe, Arizona, USA; www.asu.edu) in a multiinstitutional effort, pooled UCB samples from 12 newborns, whose maternal backgrounds varied in terms of ethnicity, educational background, body weight, exposure to Cont’d on page 2 V DAILY CLINICAL LAB NEWS Image: Molecular model of an Adenovirus 6 New Assays Added to Specialist Protein Analyzer ix fully automated, easy-to-use assays were added to a specialist protein analyzer. They provide quantitative results to aid the assessment of a patient’s immune system. The six assays include four cerebrospinal fluid S Clinical News . . . . . . . 2-40 IFCC Annual Report . . . 19 IFCC News . . . . . . . . . . 33 EFLM Corner . . . . . . . . . 38 Product News . . . . . 16-30 Technical Literature . . . 32 Industry News . . . . . . . . 41 International Calendar . 42 PUBLISHED IN COOPERATION WITH Cont’d on page 10 Simple Blood Test for Early Detection of Cancers A Rapid Diagnostic Test for Mixed Malaria Infections A simple blood test is being developed that may provide early detection of many different types of cancer. The test uses infrared light to detect infinitesimal changes in the blood of a person who has a malignant growth somewhere in the body, even before the disease has metastasized. rapid diagnostic test (RDT) has been developed and evaluated as a mixed-species infections malaria antigen (FVM Ag) detection kit. The kit, which uses monoclonal antibodies, can identify both single-species Plasmodium falciparum or P. vivax infections, and mixed infections Cont’d on page 6 Cont’d on page 12 International Federation of Clinical Chemistry and Laboratory Medicine GLOBETECH >>> M E D I A <<< Scan with Smartphone to Access Latest News LabMedica for daily laboratory medicine news click to www.labmedica.com Molecular Test Accurately Detects Colon Cancer cont’d from cover be followed by a colonoscopy to remove the polyps and prevent a subsequent cancer from forming. The screening test was developed in a collaboration between Mayo Clinic (Rochester, MN, USA; www. mayoclinic.org) and Exact Sciences Inc (Madison, WI, USA; www. exactsciences.com). It is highly accurate and significantly more sensitive than other noninvasive tests at detecting precancerous tumors such as adenomas and early-stage cancer. The scientists performed a blinded, multicenter, case-control study using archived stool samples collected in preservative buffer from 252 patients with colorectal cancer (CRC), 133 with adenomas equal to or greater than 1 cm, and 293 individuals with normal colonoscopy results acting as controls. The stool DNA (sDNA) test detects four methylated genes, a mutant form of the Kirsten rat sarcoma viral oncogene (KRAS), and as a reference value the α-actin gene, using quantitative, allele-specific, real-time target and signal amplification; it also quantifies hemoglobin. The sDNA test identified 85% of patients with CRC and 54% of patients with adenomas equal to or greater than 1 cm with 90% specificity. The test had a high rate of detection for all nonmetastatic stages of CRC, with an aggregate 87% detection rate for CRC stages I-III. Detection rates increased with adenoma size: sensitivity was 64% for polyps larger than 1 cm, 77% for those larger than 2 cm, 86% for those larger than 3 cm, and 92% for those larger than four cm. The stool DNA test detected 87% of curable-stage colorectal cancer in nearly 400 cases. Importantly, detection sensitivity was not affected by tumor location or stage. The authors concluded that earlystage CRC and large adenomas can be detected throughout the colorectum and with high levels of accuracy by the sDNA test. Neoplasm size, but not anatomical site, affected detection rates. Further studies are needed to validate the findings in a larger population and optimize the sDNA test. Stephen Thibodeau, PhD, a geneticist at Mayo Clinic, said, “These data illustrate the strength of the multimarker stool DNA test to the critical screening targets - precancers and early-stage cancer, and, importantly, this test appears to uniquely represent an accurate noninvasive approach to large polyp detection, which offers the promise of actually preventing cancers from developing.” The study was available online since November 2011 in the journal Gastroenterology. Image: Colored scanning electron micrograph (SEM) of colorectal cancer cells undergoing cell division (Photo courtesy of Steve Gschmeissner / SPL). LINKXPRESS COM LMI-04-12 102 LabMedica International April/2012 2 LINKXPRESS COM LMI-04-12 103 LabMedica Cord Blood Analysis Provides Wealth of Biomarkers EDITORIAL BOARD cont’d from cover environmental toxins, and also, to cigarette smoke. With the aid of modern highthroughput mass spectroscopy, UCB can be rapidly screened to reveal hundreds of proteins in parallel from a single sample having a volume of as small as 0.236 cm3. The samples from the 12 newborns were combined into a composite. Among the UCB donors, six were African-American, five were Caucasian and one was Asian. The team identified a total of 1,210 proteins using mass spectroscopy. The findings represent a 6-fold increase in the number UCB proteins thus far described, which is a significant advance. The proteins identified are associated with 138 different metabolic and disease pathways and provide invaluable information for the identification of biomarkers, which act as early warning indices of disease, toxic exposure, or disruptions in cellular processes. In addition to presenting intriguing candidates for new biomarkers in UCB, the study also identified 38 proteins corresponding to existing Food and Drug Administration (FDA; Silver Spring, MD, USA; www.fda.gov) approved biomarkers for adult blood. This type of study improves prospects for early disease diagnosis, by prioritizing biomarkers based on known proteins linked with disease. The group was able to obtain the protein data with as little as 240 µL of blood. This is important, as cord blood is a precious resource, exploited for other medical uses. Stem cells obtained from UCB for example are used for bone marrow transplantation and other therapeutic purposes. Of the proteins detected in UCB, around 25% were previously detected in adults. Rolf Halden, PhD, the senior author of the study Rosa I. Sierra-Amor Mexico Edward J. Bottone United States Claus Christiansen Denmark Bernard Gouget France Jocelyn M. Hicks United States Anders Kallner Sweden John A. Koepke United States Christopher Price United Kingdom Andreas Rothstein Colombia Dmitry B. Saprygin Russia Gérard Siest France Andrew Wootton United Kingdom A GLOBETECH PUBLICATION Published in cooperation with the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). HospiMedica International • HospiMedica en Español • HospiMedica China LabMedica International • LabMedica en Español • LabMedica China Medical Imaging International • Bio Research International • Medimaging.net HospiMedica.com • LabMedica.com • BiotechDaily.com • TradeMed.com said, “Mapping of the full spectrum of proteins detectable in cord blood is the first, critical step in the discovery of biomarkers to improve human health.” Mass spectroscopic analysis of UCB offers the prospect of a global approach to assessing health risks in newborns, allowing the simultaneous observation of numerous indicators of health and disease. The technique should be an invaluable aid to early diagnosis for a range of conditions, with the potential to dramatically improve health outcomes. The study was published online on January 21, 2012 in the journal Environmental Health Perspectives Image: Gloved hand testing white blood cells from umbilical cord blood (Photo courtesy of Colin Cuthbert / SPL). Two Trisomies Detected by Assay Plus Algorithm cont’d from cover genetic disorder known as Edwards’ syndrome. The new approach is more scalable than other recently developed genetic screening tests and has the potential to reduce unnecessary amniocentesis or chorionic villus sampling (CVS). The digital analysis of selected regions (DASR) combined with the algorithm, fetal-fraction optimized risk of trisomy evaluation (FORTE), was studied by Andrew B. Sparks, PhD, from Aria Diagnostics (San Jose, CA, USA; www.ariadx.com) and colleagues. Using cfDNA obtained from maternal blood in a training set (163 subjects) and a blinded validation set (167 subjects) Dr. Sparks’ group produced an individualized trisomy risk score for each subject, which correctly discriminated all cases of trisomy 21 and 18 from disomic cases. All subjects in the validation set passed quality control, and FORTE performance discriminated 36 of 36 cases of trisomy 21 and 8 of 8 cases of trisomy 18 from 123 of 123 disomic cases. The DANSR assay and the FORTE algorithm were also validated for detection of the two trisomies by Ghalia Ashoor, MD, and colleagues from the University of London (London, United Kingdom; www.lon.ac.uk). They assessed the prenatal detection of trisomies 21 labmedica.com and 18 using maternal-plasma cfDNA obtained at 11 to 13 weeks of gestation. Risk scores for trisomy 21 and 18 were given for 397 samples. The sensitivity for detecting trisomy 21 and 18 was 100 and 98%, respectively, and the specificity was 100%. These two studies appeared online January 27, 2012, in the American Journal of Obstetrics & Gynecology. Dr. Ashoor and her colleagues wrote, “This nested case-control study has demonstrated that the DANSR assay with FORTE algorithm represent a promising method for accurate detection of fetal trisomy 21 and trisomy 18.” Currently, diagnosis of fetal chromosomal abnormalities, or aneuploidies, relies on invasive testing in pregnancies identified as high-risk. A technique known as massively parallel shotgun sequencing (MPSS) analyzes cell-free DNA (cfDNA) from the mother’s plasma and has been used to detect trisomy 21 (T21) pregnancies, those with an extra copy of chromosome 21 that leads to Down syndrome, and trisomy 18 (T18), the chromosomal defect underlying Edwards’ syndrome. MPSS accurately identifies the conditions by analyzing the entire genome, but it requires a large amount of DNA sequencing, limiting its clinical usefulness Dan Gueron Jill Roberge Jacqueline Miller, PhD Raymond L Jacobson, PhD Gerald Slutzky, PhD Andreas Rothstein Marcela Jensen Joseph Ciprut Brenda Silva Paul Mills Doris Mendieta Renata Castro Dr. Jutta Ciolek Christina Chang Arda Turac Elif Erkan Publisher Editorial Director News Director News Editor News Editor News Editor Assistant Editor Assistant Editor New Products Editor Regional Director Regional Director Regional Director Regional Director Regional Director Production Director Reader Service Manager HOW TO CONTACT US Subscriptions: Send Press Releases to: Advertising & Ad Material: Other Contacts: www.LinkXpress.com LMNews@globetech.net ads@globetech.net info@globetech.net ADVERTISING SALES OFFICES USA P.O.Box 800806, Miami, FL 33280, USA Doris.Mendieta@globetech.net Tel: (1) 954-893-0003 GERMANY, SWITZ., AUSTRIA Bad Neustadt, Germany Jutta.Ciolek@globetech.net Tel: (49) 9771-3528 UK, FRANCE, NORDIC REG. 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For change of address or questions on your subscription, write to: LabMedica lnternational, Circulation Services at above address; or visit: www.LinkXpress.com ISSN 1068-1760 Vol.29 No.1. Published, under license, by Globetech Media LLC; Copyright © 2012. All rights reserved. Reproduction in any form is forbidden without express permission. Opinions expressed are solely those of the authors, and do not represent an endorsement, or lack thereof, by the Publisher of any products or services. Teknopress Yayıncılık ve Ticaret Ltd. Şti. adına İmtiyaz Sahibi: M. Geren • Yazı işleri Müdürü: Ersin Köklü Tevfik Erdönmez Sok. 24/4, 34394 Esentepe, Şişli, İstanbul, Türkiye Faks: (212) 216-6997 • P. K. 1, AVPIM, 34001 İstanbul Baskı: Promat Web Ofset Tesisi • Sanayi Mahallesi 1673. Sokak No: 34 • 34510 Esenyurt, B. Çekmece • İstanbul, Türkiye Yerel süreli yayındır. Yılda sekiz kere yayınlanır, ücretsiz dağıtılır. LabMedica International April/2012 4 LINKXPRESS COM LMI-04-12 105 LabMedica to read this issue in an interactive digital magazine format click to www.LinkXpress.com Rapid Test Developed for Pandemic Influenza cont’d from cover 2009 pandemic. Scientists at the RIKEN Omics Science Center (OSC; Yokohama, Japan; www.osc.riken.jp) combined both reverse transcriptase (RT) and isothermal DNA amplification reactions in one step for the assay, which does away with the need for ribonucleic acid (RNA) extraction and polymerase chain reaction (PCR). They adapted the real-time smart-amplification process (RT-SmartAmp) technique using a fluorescent primer to specifically detect the 2009 influenza A (H1N1) virus within 40 minutes, without cross reacting with the seasonal A (H1N1), A (H3N2), or B-type (Victoria) viruses. The effectiveness of the RT-SmartAmp method was confirmed in clinical studies carried out at Japanese hospitals during the period of October 2009 to January 2010, where it outperformed standard diagnosis tests in both speed and sensitivity. Of a total 255 clinical samples, 140 (54.9%) were identified as 2009 pandemic A (H1N1)-positive by RT-SmartAmp, compared to only 110 (43.1%) detected by standard diagnostic tests. In 72.8% of all 140 infection-positive cases, the RTSmartAmp assay detected the presence of the pandemic influenza virus within 24 hours of fever onset. The human-to-human transmission of new, highly pathogenic strains of influenza virus poses today a major threat to human health and to the security of global society. With its rapid global spread, the 2009 pandemic influenza virus reminded the world of this threat, resulting in an estimated 18,000 deaths worldwide. In Japan, infected patients over the winter season of 2009 accounted for a staggering 16% of the total population. The scientists concluded that their results set a new standard for infection diagnosis speed, providing a highly effective tool for rapidly detecting subtypes of the H5N1 virus and drug-resistant influenza viruses and promising support in the battle to prevent global pandemic infection. Image: Colored scanning electron micrograph (SEM) of H1N1 flu virus particles on a cell (Photo courtesy of the NIBSC). Simple Blood Test for Early Detection of Cancers PRINT MAGAZINE Image: Colored scanning electron micrograph (SEM) of lung cancer cells (Photo courtesy of Steve Gschmeissner / SPL). INTERACTIVE DIGITAL EDITION cont’d from cover WEB PORTAL MOBILE VERSION A team of scientists at Ben-Gurion University of the Negev (BGU; Be’er Sheva, Israel; www.bgu.ac.il) developed a device that illuminates cancer cells with less than 5 mL blood. Various molecules are released into the bloodstream of patients with cancerous growths that cause the blood to absorb infrared light slightly differently compared to that of healthy people. In the latest clinical trial with 200 patients and a control group, the test identified specific cancers in 90% of the patients and found other types of cancer, as well. The researchers are focused on detection of common cancers, such as lung and ovarian cancer. Doctors believe that it is critical to increase cancer detection in early stages to prevent the need for long, difficult, and costly treatments in more advanced stages. Joseph Kapelushnik, MD, who is head of the Department of Pediatric Hemato-Oncology at Soroka hospital (Be’er Sheva, Israel; www.soroka.org) said, “This investigation is still in the early stages of clinical trials. But the purpose is to develop an efficient, cheap, and simple method to detect as many types of cancers as possible. We want to be able to detect cancer while a patient is still feeling good, before it has a chance to metastasize, meaning fewer treatments, less suffering and many more lives saved.” More clinical trials will be conducted in the next 18 months. LabMedica International April/2012 6 LINKXPRESS .COM LINKXPRESS .COM LMI-04-12 254 LINKXPRESS .COM LMI-04-12 260 LINKXPRESS .COM LMI-04-12 261 LINKXPRESS .COM LMI-04-12 262 LMI-04-12 253 LINKXPRESS .COM LMI-04-12 255 LMI-04-12 251 LINKXPRESS .COM LINKXPRESS .COM LMI-04-12 259 LMI-04-12 250 LINKXPRESS .COM LINKXPRESS .COM LINKXPRESS .COM LMI-04-12 256 LMI-04-12 252 LINKXPRESS .COM LMI-04-12 257 LINKXPRESS COM LINKXPRESS .COM LMI-04-12 107 LMI-04-12 258 LabMedica H. Pylori Breath Test for Children Approved breath test for children aged 3 to 17 can detect Helicobacter pylori bacterial infections. The urea breath test (UBT) method is more convenient compared with invasive H. pylori tests. It is accurate and noninvasive. No blood, stool, or biopsy is needed – patients avoid the potential risks and discomforts associated with more invasive testing methods. The test is based on the ability of H. pylori to break down urea into carbon dioxide, which is then absorbed from the stomach and eliminated in the breath. For the test, patients swallow a capsule containing urea made from an isotope of carbon. If H. pylori are present in the stomach, the urea is broken up and turned into carbon dioxide. The carbon dioxide is absorbed across the lining of the stomach and into the blood. It then travels in the blood to the lungs where it is excreted in the breath. Samples of exhaled breath are collected, and the isotopic carbon in the exhaled carbon dioxide is measured. The BreathTek UBT test for H.pylori is manufactured by Otsuka America Pharmaceutical (Rockville, MD, USA; www.otsuka-us.com). It was approved by the US Food and Drug Administration (FDA; Silver Spring, MD, USA; www.fda.gov) for adults in 1996. The first breath test for use in children was approved by the FDA on February 22, 2012. The FDA based its approval of the BreathTek UBT test for children on a multicenter study of 176 patients, comparing its performance to a composite reference method and demonstrating 95.8 % sensitivity and 99.2 % specificity. An additional study was done at 1 to 6 months after therapy to support use for post-treatment monitoring of patients. The sensitivity was 83.3 % and the specificity was 100 %. The American College of Gastroenterology A (http://gi.org) considers the urea breath test (UBT) to be the most reliable nonendoscopic method for discovering H.pylori infections. By assessing the entire gastric mucosa, BreathTek UBT avoids the sampling errors seen in biopsy methods. H. pylori infections cause chronic stomach inflammation (gastritis) and ulcers. Most people with this infection do not have any symptoms but have a two- to six-fold increased risk of developing gastric cancer and mucosal-associated-lymphoid-type lymphoma compared with uninfected people. “Results from this test, when considered with a physician’s assessment of the patient’s history, other risk factors, and professional guidelines, can quickly indicate infection, which allows a physician to initiate appropriate health measures in a timely manner,” said Alberto Gutierrez, PhD, director of the Office of In Vitro Diagnostic device evaluation and safety in FDA’s Center for Devices and Radiological Health. Image: The BreathTek UBT test is designed to detect H. pylori bacterial infections (Photo courtesy of Levent Konuk / Shutterstock). Viruses Diagnosed by Electronic Sensor cont’d from cover Scientists at the University of Leeds (West Yorkshire, UK; www.leeds.ac.uk) fabricated novel immunosensors using polyclonal antibodies raised against a human Adenovirus (Ad5) capsid protein, which were selectively cleaved into antibody fragments by 2-mercaptoethylamine. The fragments were immobilized onto a functionalized conducting copolymer matrix comprising polyaniline and 2aminobenzylamine. The new technique therefore uses antibodies attached to an electrical sensor. By measuring the sensor’s electrical changes, the investigators were able to identify how many virus particles were present, and determine the type of virus dependent on its response. They demonstrated that the immunosensor constructed shows high affinity to its Ad5 virus ligand, detectable by electrochemical impedance spectroscopy over a broad range of concentrations from 10 to 1012 virus particles/mL, with a limit of detection (LOD) of 103-virus particles/mL. Currently, testing for viruses is complicated, time consuming and requires specialist prepara- LINKXPRESS COM LMI-04-12 108 tion of samples to identify virus DNA. Testing for viruses could be much quicker, simpler, and ultimately less costly using this new technique. For patients, this sort of diagnostic would mean faster treatment. Adenovirus is a common virus found in vertebrates and causes many illnesses, from the common cold through to gastroenteritis. People with strong immune systems are not badly affected by the virus, but for those with a compromised or immature immune system, it can have fatal consequences. Paul A. Milner, PhD, who supervised the study, said, “For the first time we’ve been able to test for the presence of a whole virus, rather than having to seek out its genetic material, and the first time the number of virus particles has been counted using a lab-on-a-chip device. These are both exciting developments.” ELISHA Systems Ltd. (Buxton, UK; www.immunosensors.com) will be the company commercializing this adenovirus biosensor and other biosensors for healthcare applications. The study was published on February 15, 2012, in the journal Biosensors and Bioelectronics. LabMedica International April/2012 8 LINKXPRESS COM LMI-04-12 109 LabMedica to read this issue in an interactive digital magazine format click to www.LinkXpress.com Collection Device for Sputum Introduced new tool has been introduced that makes collecting oral fluids more accurate and much easier. The collection tube apparatus will enable saliva analytes to be integrated effectively into the clinical laboratory testing process, precisely and hygienically. The tool, which was developed by the Johns Hopkins University School of Nursing Center for Interdisciplinary Salivary Bioscience Research (CISBR; Baltimore MD, USA; www.nursing.jhu. edu), will improve the ease of oral fluid collection, while maintaining the integrity of the biospecimen. The new Whole Saliva Collection Device is a small, polypropylene collection tube with an integral adapter that comes individually wrapped in a clean, foil pouch with ready-to-go instructions, and is a universal fit with common cryogenic vials. The planned availability for the device was February 2012. Saliva is full of analytes and biomarkers that create a biological journal of exposure to chemicals and disease, and genetic variability. However, the collection of oral fluid has always proved cumbersome, with scientists depending on swabs or collection A cups. Whole saliva is the gold standard when collecting oral fluid for biological testing. Its collection avoids the localized secretions of specific salivary glands making it a more consistent specimen. Whole Saliva can be easily evaluated for volume collected and for salivary flow rate. Free from being compromised by absorbing materials used with other collection methods, Whole Saliva can be assayed for any salivary analyte of interest. Douglas A. Granger, PhD, director of CISBR and professor of Medicine, Nursing, and Public Health at Johns Hopkins is cofounder of the newly formed commercial company SalivaBio, LLC (Baltimore, MD, USA; www.salivabio.com). Professor Granger said, “Our studies show that swabs used to collect saliva can retain analytes, cause interference with assays, result in inaccurate estimates of saliva flow rates, and may even produce inaccurate assay results. It’s not rocket science; it’s a practical solution that will enable saliva analytes to be integrated effectively into basic and clinical studies and consumer applications.” Image: The Whole Saliva collection device (Photo courtesy of Johns Hopkins University School of Nursing Center for Interdisciplinary Salivary Bioscience Research). Six New Assays Added to Specialist Protein Analyzer cont’d from cover (CSF) assays: immunoglobulin G (IgG), IgA, IgM, and albumin. Complement 1(C1) inactivator in plasma and serum, for the investigation of hereditary angioedema, and transferrin in serum, for estimation of iron deficiency anaemia, were also added to the analyzer menu. These additions complement the panel of assays currently available on SPAplus including Hevylite immunoglobulin heavy chain/light chain assays, Freelite serum free light chain assays, and various complement assays. Binding Site’s (Birmingham, United Kingdom; www.bindingsite.co.uk) SPAplus specialist protein analyzer was designed to bring together instrument, reagents, and support as a package. A compact, turbidimetric platform, the fully automated SPAPLUS system enables laboratories to maintain the quality of results and high throughput required for specialized protein assays. It can be placed alongside the laboratory’s main-line analyzers or in LINKXPRESS COM LMI-04-12 110 other areas of the laboratory. Preprogrammed protocols, developed and manufactured by Binding Site, provide sensitive and reproducible results that match or have greater sensitivity than nephelometry. The modular design with intuitive Windows based software makes the SPAplus very easy to use. SPAplus has an expanding menu of diagnostic tests related to disease state management and clinical practice guidelines. More assays will be added during 2012. LabMedica International April/2012 10 LINKXPRESS COM LMI-04-12 111 LabMedica to read this issue in an interactive digital magazine format click to www.LinkXpress.com Rapid Diagnostic Test for Mixed Malaria Infections cont’d from cover with these two species. Scientists at the Chungbuk National University (Republic of Korea; www.cnu.ac.kr) prepared colloidal gold–conjugated monoclonal antibodies applied to cellulose paper strips. They produced three monoclonal antibodies that recognize the lactate dehydrogenase of P. falciparum, P. vivax, or both to develop the first mixed-species infections malaria antigen-detection kit. They evaluated the sensitivity of the test and compared it with comparable commercial RDTs. The sensitivity and specificity of the kit was assessed with 722 clinical specimens. The detection limit of 150 parasites/µL for the FVM Ag RDT for P. falciparum-positive blood samples was higher than that of the two commercial RDTs, which was less than 60 parasites/µL. The detection limit of the RDT for P. vivax-positive specimens was 250 parasites/µL, which was the same as that of the NanoSign Malaria Pf/Pan Ag kit (Bioland Ltd; Ochang, Korea; www. biolandkorea.com) and lower than that of the 500 parasites/µL for the BioLine Malaria Pf/Pan Ag kit (Standard Diagnostics Inc.; Suwon, Korea; www.standardia.com). The results of the study SIGN U FOR F P REE! showed that the FVM Ag RDT has sensitivities for P. falciparum, P. vivax, and mixed-species infection were 96.5%, 95.3%, and 85.7%, respectively. In addition, its specificity was as high as 99.4%. P. falciparum and P. vivax malaria are endemic to many parts of the world and humans can be coinfected with both species. Because each Plasmodium species has different biological and clinical characteristics, accurate differentiation of the infecting species is essential for effective treatment. Although microscopy is still the gold standard for malaria diagnosis, it requires experienced technicians and a microscope, which are not always available in remote areas. The authors of the study concluded that the FVM Ag kit is the first RDT with the capability to differentiate malaria species. They anticipate that their RDT will be a useful diagnostic tool that will help improve the diagnosis and treatment of malaria, particularly in remote areas of the world. The study was published the December 2011 issue the American Journal of Tropical Medicine and Hygiene. Identifying Patients Treated with Tysabri at Risk for PML he risk for a rare brain infection called progressive multifocal leukoencephalopathy (PML) occurs in people using the drug Tysabri (natalizumab) to treat multiple sclerosis (MS) or Crohn’s disease (CD). The Stratify JCV antibody enzymelinked immunosorbent assay (ELISA), when used with other clinical data from the patient, can help health care providers determine the risk of developing PML in MS and CD patients. Currently, there is no treatment, prevention, or cure for PML, and no certain way to predict who will develop it. This test, in conjunction with other factors, will enable physicians and patients to assess carefully the risks and benefits of continuing Tysabri treatment. Risk factors have been identified that increase the chance of Tysabri-treated patients developing PML. These include the presence of anti-JCV antibodies, which reflects prior exposure to JCV, treatment with Tysabri for more than 2 years, and treatments with immunosuppressants before receiving Tysabri. The US Food and Drug Administration (FDA; Silver Spring, MD, USA; www.fda. gov) permitted marketing of the first test, the Stratify JCV antibody ELISA to help determine risk of patients developing PML. The Stratify JCV antibody ELISA test is manufactured by Focus Diagnostics (Cypress, CA, USA; www.focusdx.com). T LabMedica International April/2012 12 LabMedica for daily laboratory medicine news click to www.labmedica.com Noninvasive Probe Characterizes Skin Cancers Morphologically and Biochemically joint US-Dutch team has developed a noninvasive probe capable of both morphological and biochemical characterization of skin cancers. The portable instrument combines a Raman spectroscopy (RS) system with an optical coherence tomography (OCT) device and enables the sequential acquisition of coregistered OCT and RS data sets. An Andor (Belfast, Northern Ireland; www.andor.com) high-resolution, near-infraredenhanced Newton camera was chosen as the core element of the Raman diagnosis module. The probe was developed under the direction of Anita Mahadevan-Jansen from Vanderbilt University (Nashville, TN, USA; www.vanderbilt.edu). It screens large areas of skin up to 15 mm wide to a depth of 2.4 mm with OCT to visualize microstructural irregularities and perform an initial morphological analysis of lesions. The OCT images are then used to identify locations to acquire biochemically specific Raman spectra. “Having demonstrated the clinical potential of the RS-OCT instrument to rapidly screen at risk patients, we are continuing to develop the dual-modal technique for other applications where noninvasive assessment of both microstructure and biochemical composition are critical to accurate assessment of pathology,” said Chetan Patil from Vanderbilt University. Skin cancer is the most common form of human cancer with annual rates continuing to climb from their current estimate of just over three million new cases each year. Although all skin cancers share the likelihood of a favorable outcome if early diagnosis and complete resection are achieved, diagnosis is invasive, subjective, lengthy, and expensive, involving expert visual inspection, biopsy, and histopathology. A Image: An OCT image (upper) shows a set of hyporeflective regions in the dermis beneath the red arrow that probably correspond to cancerous tumor cell nests based on the pathology. The tumor cells are also shown in a representative histology (middle; 10x magnification, scale bar = 150 µm). The mean Raman spectra exhibit distinct differences between the cancerous and normal cells in the regions centered at 1090, 1300, and 1440 cm-1 (Photo courtesy of Andor Technology). V I S I T LINKXPRESS COM R E A D E R S E R V I C E ® P O R T A L Renew / Start your Free Subscription Access Interactive Digital Magazine Instant Online Product Information: 1 2 3 13 Identify LinkXpress ® codes of interest as you read magazine Click on LinkXpress.com to reach reader service portal Mark code(s) of interest on LinkXpress ® inquiry matrix LabMedica International April/2012 LINKXPRESS COM LMI-04-12 113 LabMedica Gastroenterologists View Tissue In Situ Using Confocal Laser Endomicroscope he confocal laser endomicroscope allows physicians to examine a patient’s GI tissue at the cellular level in its natural environment. This results in fewer biopsies being sent to pathology labs. The tiny microscope is called Cell viZio and is manufactured by Mauna Kea Technologies (MKEA; Newtown, PA, USA; www.maunakea tech.com), a French company with offices in the United States. Cell viZio is a miniature microscope that, once inserted into the GI tract, enables the physician to select cells for microscopic examination in order to make a more immediate decision regarding a diagnosis, as well as treatment. The Cell viZio system was cleared by the Food and Drug Administration (FDA) and has received CE mark in Europe. The company’s second-generation system, the Cell viZio 100 series was cleared in Europe and the United States in 2011. Although this micro-miniature microscope allows gastroenterologists to evaluate individual cells and identify abnormal or malignant tissue, there will still be a need to collect a tissue biopsy for analysis of its DNA, RNA, and/or proteins. The complexity of those genetic tests and molecular diagnostics assays means that most of these tissue referrals T will continue to be sent to pathologists. One contributing technology that went into this micro-miniature microscope is a high-density chip capable of performing several functions within a tiny module. Essentially, the Cell viZio system is a focal probe threaded through a traditional endoscope. Dangerous tissue can be identified during the initial diagnostic exam. This allows gastroenterologists to remove this tissue the same day, and then go back to ensure that all of the diseased tissue was removed. This new approach will be applied to gastrointestinal cancers and other GI diseases, including those of the colon, bile duct, pancreas, and esophagus. The Cell viZio system has the potential to pull more testing away from the traditional anatomic pathology laboratory. Michael J. Cima, PhD, at the Massachusetts Institute of Technology (MIT; Cambridge, MA, USA; http://mit.edu), recognized that possibility when he stated that, by using these types of systems to look at tissue in situ, “we are going to bring the laboratory into the patient.” Image: Surgeon using the Cell viZio imaging system with an endoscope to examine a patient (Photo courtesy of Mauna Kea Technologies). Recombinant Human Serum Albumin Is Animal-Free company that develops, manufactures, and markets a portfolio of products used in cell culture, diagnostics, and bioproduction has developed recombinant human serum albumin that is completely animal-free. Animal-derived media components carry safety concerns involving the risk of viral and prion contamination. As a result, regulatory bodies in the United States, Europe, and Japan have discouraged the use of these components in biomanufacturing. In addition to safety concerns, animal components frequently have high batch-to-batch variation, which leads to unpredictable manufacturing results. InVitria (Fort Collins, CO, USA; www.invitria. com) was awarded a USD 725,000 Phase II, Small Business Innovation Research (SBIR) Grant to broaden the applications for InVitria’s recombinant human serum albumin product Cellastim. A LINKXPRESS COM LMI-04-12 114 The Phase II grant was awarded in 2009 by the National Institutes of Health (NIH; Bethesda, MD, USA; www.nih.gov) as a two-year project, which was successfully completed on time in 2011. “We are delighted that the objectives of the grant were achieved. The team exceeded those objectives and also implemented current Good Manufacturing Process (cGMP) quality standards for manufacturing recombinant human serum albumin,” said Scott Deeter, president of InVitria. InVitria is a Division of Ventria Bioscience, the developer of the ExpressTec biomanufacturing system. ExpressTec is the first biomanufacturing system to commercialize recombinant protein manufacturing utilizing plants as the host. InVitria’s product line consists of completely animal-free cell culture media supplements and reagents that are distributed globally by leading distributors in life sciences and cell culture media. LabMedica International April/2012 14 LabMedica for daily laboratory medicine news click to www.labmedica.com Air Ambulance Upgrades Blood Glucose Monitoring System n Air Ambulance company has upgraded its blood glucose monitoring system used across a wide range of glucose levels prior to, during, and after emergency flight transfers. CEGA Air Ambulance (www.cega-air-ambulance.com) is now using using Roche (Basel, Switzerland; www.roche.com) Accu-Chek Inform II blood glucose monitoring strips. The Accu-Chek Inform II test strips have undergone extensive evaluation, including studies at over 30 external sites as well as thorough internal testing. These evaluations demonstrated that the strips provide accurate and reliable blood glucose measurements under a variety conditions, including wide haematocrit and environmental ranges, and in presence of maltose. The strips require a minimal sample volume of A Methylation-Based Biomarker Indicates Chemo Resistance of Colorectal Cancer just 0.6 µL and deliver accurate results from alternative sampling sites, such as the palm and forearm. The air company’s senior flight nurse, Stuart Cox commented, “After reviewing all the kits that are available on the market, we felt that the Roche Accu-Chek Inform II test strips best met our requirements for high quality patient care in the air ambulance. The user interface is very simple and straightforward to use anywhere and by any of our trained staff. In addition, the strips have a very good range compared to other systems, giving accurate results at both high and low glucose levels, which is essential for patient safety.” Stress-induced insulin resistance and hyperglycaemia is common in critically ill patients and close monitoring of blood glucose levels is an important part of their care. Studies have shown that mainte- Click on the nance of appropriate glycaemic control in such patients improves morbidity and mortality. CEGA was established in 1973 as an air taxi service. Operations soon changed to meet a growing demand for worldwide repatriation of sick and injured holidaymakers and domestic National Health Service (NHS; www.nhs.uk) transfers by Ambulance Aircraft. Image: CEGA Air Ambulance uses Accu-Chek Inform II blood glucose testing strips for patient safety during emergency flight transfers (Photo courtesy of CEGA Air Ambulance / Roche). below to watch the video ypermethylation of the TFAP2E gene was correlated with nonresponsiveness of colorectal cancer to a commonly used chemotherapeutic agent. In a study involving more than 200 patients in four independent cohorts, Prof. Ebert at the University of Heidelberg (Germany; www. uni-heidelberg.de) and his team demonstrated that hypermethylation of the TFAP2E gene was correlated with nonresponsiveness of colorectal cancer to the commonly used chemotherapeutic agent 5-fluorouracil (5-FU). The study was reported in the January 2012 edition of the New England Journal of Medicine (www.nejm.org). Using a combination of data from cancer cell lines and patient samples, the authors demonstrated that this effect was potentially mediated through up-regulation of the DKK4 gene, previously implicated in 5FU resistance. Resistance to treatment was observed with 5-FU based chemotherapy or 5-FU chemotherapy combined with radiation, indicating that TFAP2E methylation may be a valuable biomarker for response prediction in either setting. The study demonstrates the growing role that biomarkers can play in the management of cancer and other diseases. Prof. Ebert commented: “In practical terms, we believe this study demonstrates the potential that novel DNA methylation biomarkers may have in improving the selection of therapies for this deadly disease. A prospective validation of the marker is, however, still required.” Epigenomics AG (Berlin, Germany, and Seattle, WA, USA; www.epigenomics.com) scientists believe that the study demonstrates the potential of TFAP2E and other biomarkers identified in Epigenomics’ DNA methylation discovery pipeline in supporting clinical decision making. Epigenomics’ lead product, Epi proColon, is a blood-based test for the early detection of colorectal cancer, which is currently marketed in Europe and is in development for the United States. H 15 LabMedica International April/2012 LINKXPRESS COM LMI-04-12 115 PRODUCT NEWS REAL-TIME QPCR KIT Daan Diagnostics The RT qPCR product range includes hepatitis, STD, respiratory pathogen, digestive pathogen, avian influenza virus, tumor markers, torch, and public health. Key benefits include enhanced sensitivity, accuracy, flexibility, and cost-effectiveness. LINKXPRESS COM LMI-04-12 201 To receive prompt and free information on products, log on to www.LinkXpress.com or fill out reader service form located on last page RANDOM ACCESS ANALYZER FACE SHIELD Karl Hecht AdvanDx Erba Mannheim The Assistent face shield covers the entire face, can be used with goggles, and is designed to decrease contamination risk. It can be autoclaved at 121°C for up to 20 minutes, and is disposed of after use. The QuickFISH tests features only a five-minute hands-on time, and a 20minute turnaround time for fast identification of bacteria. The tests have built-in universal controls, and limited required instrumentation allows for easy and inexpensive implementation and testing. The XL-1000 automated analyzer features sample clot detection, three-reagent capacity, and diffraction grating with 15 wavelengths from 340-800 nm. The system also offers a nine-cuvette wash station, and throughput up to 1120 tests/hr. LINKXPRESS COM LMI-04-12 202 LINKXPRESS COM RAPID PATHOGEN TESTS LMI-04-12 203 LINKXPRESS COM LMI-04-12 204 Extraction Methods Compared for Molecular Detection of Pathogens hree mechanistically different sample extraction methodologies were evaluated for their abilities to purify nucleic acids from blood culture fluids. The three methods were silica spin columns, phenol-chloroform, and an automated magnetic capture of polymer-complexed DNA via an Automate Express instrument, and were followed by polymerase chain reaction (PCR) assays for the detection of Staphylococcus aureus. Scientists at Applied Molecular Testing, (Life Technologies, Carlsbad, CA, USA; www. lifetechnologies.com) analyzed 60 blood cultures spiked with bacterial pathogens. On separate days, three replicates from each of the sample aliquots were thawed and processed using the DNeasy blood and tissue kit (Qiagen, Hilden, Germany; www.qiagen.com), phenol-chloroform, or an ABI Automate Express forensic DNA extraction system. The extracts from silica columns required 100- T LINKXPRESS COM to 1,000-fold dilutions to reduce sufficiently the powerful PCR inhibitory effects of the anticoagulant sodium polyanetholsulfonate, a common additive in blood culture media. In contrast, samples extracted by either phenol-chloroform or the Automate Express instrument required little or no dilution, respectively, allowing for an approximate 100-fold improvement in assay sensitivity. Analysis of 60 blood culture bottles indicated that the phenol-chloroform (Invitrogen, Carlsbad, CA; www.invitrogen.com)and the ABI extraction (Foster City, CA, USA; www.appliedbiosystems. com) methodologies could be used to detect lower numbers of pathogens and that a growing S. aureus culture could be detected two hours earlier than when using silica columns. Of the three tested methodologies, the Automate Express instrument had the shortest time to result, requiring only approximately 80 minutes to process 12 samples. The authors concluded that their findings highlight the importance of considering the LMI-04-12 116 mechanism when selecting a DNA extraction methodology, given that certain PCR inhibitors act in a similar fashion to DNA in certain chemical environments, resulting in copurification, whereas other methodologies use different chemistries that have advantages during the DNA purification of certain types of samples. The study was published in March 2012, in the Journal of Molecular Diagnostics Assay Detects Antibodies Associated with HeparinInduced Thrombocytopenia fully automated panel for the detection of heparin-induced thrombocytopenia (HIT) has been released. The assays provide enhanced detection of HIT antibodies in specialty and hospital hemostasis laboratories. The panel includes HemosIL AcuStar HIT-IgG (PF4-H) and HemosIL AcuStar HIT-Ab (PF4-H) assays. These are on-demand, fully automated, chemiluminescent reagents on a hemostasis testing system for the detection of antibodies associated with HIT. The ready-to-use, cartridge-based assays offer results in approximately 30 minutes, on-demand, 24/7. The precalibrated reagent cartridges offer significant time- and cost-efficiencies. HIT is a severe immunologic adverse reaction to heparin, paradoxically resulting in venous and/or arterial thrombosis. It is one of the most common of all adverse drug effects, due to the large number of patients receiving heparin therapy. If HIT is untreated, the risk of dangerous conditions developing such as stroke, pulmonary embolism, and even death increases significantly. The assays are products of Instrumentation Laboratory (Bedford, MA, USA; www.ilus.com). The new HemosIL AcuStar HIT Assay Panel assay has been released as a European CE in vitro diagnostic (IVD) Mark product. The assays are not currently 510(k) cleared. A LabMedica International April/2012 16 LINKXPRESS COM LMI-04-12 117 PRODUCT NEWS To receive prompt and free information on products, log on to www.LinkXpress.com or fill out reader service form located on last page CHEMISTRY ANALYZER HEMOSTATIS ANALYZER ELECTRONIC PIPETTES POCT TEST Spinreact Tcoag Socorex Wondfo Biotech The Spin640 features 90 positions for primary or secondary tubes and sample cups. Added benefits include interior and exterior automatic probe washing, STAT sample priority, 80 positions for reagent handling, and a throughput of 400 tests per hour / up to 640 tests per hour with ISE. The Destiny Max offers optical or micromechanical clot detection with reliable cap piercing and standardization of results. Operational software features a user-friendly graphic interface that enables flexible and convenient operation with continuous sample processing. The Acura electro pipette line consists of three models designed for an extended range of sample handling performance. Key features of the user-friendly and energy-efficient line include intuitive interface, easy tip ejection, enhanced hand comfort and control. The HIV 1/2 one-step test is designed for use with whole blood, serum or plasma. The test offers high sensitivity and specificity, can be stored in room temperature, and allows for a shelf life of 24 months. LINKXPRESS COM LMI-04-12 205 LINKXPRESS COM LMI-04-12 206 LINKXPRESS COM LMI-04-12 207 LINKXPRESS COM LMI-04-12 208 One in Six Pregnant Women Tested Positive for Hypothyroidism he study of half a million pregnant women in the United States found 15.5% of those tested were positive for gestational hypothyroidism, much higher than previously estimated. Scientists at Quest Diagnostics (Madison, NJ, USA; www.questdiagnostics.com) performed the first largescale study to analyze the prevalence of hypothyroidism during pregnancy. The study was based on clinical guidelines issued by the American Thyroid Association (ATA; Falls Church, VI, USA; www.thyroid.org) in 2011, and strongly suggests far more women are at risk for the disorder than suggested by prior studies. Gestational hypothyroidism is increasingly being associated with a range of medical complications for women and their babies, including miscarriage, pregnancy-induced hypertension, gestational diabetes, lowbirth weight, and abnormal fetal brain development, which may lead to a lower IQ. The ATA’s guidelines are the first from a medical association to recommend specific reference ranges for TSH blood levels based on recent data showing an association between low TSH levels, once believed to be harmless, and adverse health outcomes. The condition can be treated with FDA-approved oral therapies. Pediatric endocrinologist Jon M. Nakamoto, MD, PhD, medical director for Quest Diagnostics and associate clinical professor at Rady Children’s Hospital (San Diego, CA, USA; www.rchsd.org) and the University of California, San Diego (CA, USA; T LINKXPRESS COM LMI-04-12 118 http://ucsd.edu) said, “With the growing awareness of risks that even subclinical hypothyroidism can pose for the mother and fetus, it’s important that practitioners recognize the true prevalence of this condition.” The study assessed results of 502,036 pregnant women who received lab testing through Quest Diagnostics between 2005 and 2008. Of these women, only about one in four, or 23% (117,892), was tested for TSH level. Among the pregnant women who were tested for TSH level, 18,291, or 15.5%, had heightened levels of TSH consistent with hypothyroidism as defined by the ATA guidelines. The study also found that women aged 35 through 40 years were 1.8 times more likely to develop gestational hypothyroidism as those ages 18 through 24 years. Nearly one in five Asian women (19.3%) tested had TSH results consistent with hypothyroidism, the highest of any other ethnic group. Women weighing over 124 kg were 2.5 times as likely to develop gestational hypothyroidism as those weighing between 45 kg and 56 kg. Only one in five women, or 20.7%, with gestational hypothyroidism were tested within six months after giving birth. Of these women, 11.5% tested positive for hypothyroidism. Symptoms of postpartum hypothyroidism can range from fatigue and depression, to irritability and weight gain. The present study was published online in the December 2011 in the Journal of Clinical Endocrinology & Metabolism (JCEM). LabMedica International April/2012 18 International Federation of Clinical Chemistry and Laboratory Medicine 2011 ANNUAL REPORT HIGHLIGHTS OF THE YEAR WorldLab Berlin, May 15-19, 2011 IFCC Council in Berlin on May 15, 2011 IFCC-Beckman Coulter Distinguished Clinical Chemist Award: Prof. Emeritus Ulf-Hakan Stenman, Finland IFCC-Siemens Henry Wishinsky Award for Distinguished International Services: Dr. Carl A Burtis, USA IFCC-Abbott Award for Distinguished Contributions in Education: Prof. Mary F Burritt, USA IFCC-Abbott Award for Significant Contributions in Molecular Diagnostics: Prof. Michael Neumaier, Germany IFCC Distinguished Award for Laboratory Medicine and Patient Care: Prof. Ronald J A Wanders, The Netherlands IFCC-Robert Schaffer Award for Outstanding Achievements in the Development of Standards for Use in Laboratory Medicine Co-sponsored by NIST and CLSI: Prof. Linda Thienpont, Belgium IFCC-Roche Young Investigator Award (from 2011): Prof. Rossa W K Chiu, Hong Kong IUPAC International Year of Chemistry 2011 Congress of the Latin-American Confederation of Clinical Biochemistry (COLABIOCLI) in Punta Cana, Dominican Republic Congress of the African Federation of Clinical Chemistry in Nairobi, Kenya The second Ortho Clinical Diagnostics Conference held in Paris Molecular Biology Course in Guatemala, December 2011 Abbott Laboratories' annual sponsorship of the IFCC-VLP program IFCC Speakers Bureau Joint IFCC-“Labs are Vital” campaign, sponsored by Abbott Diagnostics Laboratories IFCC Siemens Healthcare Diagnostics Distance Learning Project Roche / IFCC Travel Scholarship New IFCC Website launched PRESIDENT’S MESSAGE 2011: The Year When the World of Clinical Chemistry Came to Berlin by Graham Beastall, IFCC President t is a pleasure to write this summary of the year 2011 on behalf Ienjoyable, of IFCC. My third year as president has been just as busy and as the first two years, but with the added bonus of the three yearly Council meeting and the IFCC WorldLab congress in Berlin. As this Annual Report will demonstrate, IFCC remains strong and in good heart; 2011 was a year of progress on many fronts. Membership. IFCC once again increased its membership during 2011. We now have 85 Full Members with the Nepal Association for Medical Laboratory Science joining during the year. We increased our Affiliate Membership by two in 2011 with the welcome addition of the “Association of Medical Biochemists of India” and the “Association of Clinical Chemistry and Laboratory Medicine of Ukraine” Corporate Membership of IFCC is also growing despite the continued consolidation in the industry and during 2011 we added Labquality Unilabs Ltd, Shenzhen Mindray Bio-Medical Electronics Co. Ltd., Nova Biomedical Corporation, Immunodiagnostic Systems (IDS), Response Biomedical Corporation. I am delighted to report that all the new IFCC members are actively engaged with the work of the Federation. Implementation of the Strategic Plan. The Executive Board achieved further success with the implementation of its Strategic Plan. Amongst the 2011 achievements were: • The launch of the new IFCC Website, which is less fussy, more responsive, and easy for the IFCC Office team to update (www.ifcc.org) • A decision by Council to change the composition of the Executive Board and to adopt electronic voting for the election of future executive Boards • A decision by Council to introduce a differential membership fee • Acceptance for publication of a document entitled "Proposals for the mitigation of the environmental impact of clinical laboratories.” This project was led by Joseph Lopez and Tony Badrick and represents the first significant review of this important topic • Release of a distance learning program on laboratory accreditation and the creation of a support structure to enhance distance learning within IFCC • Launch of the “Appliance of Science” as a simple way to understand and promote the added value of clinical chemistry and laboratory medicine to healthcare. Overall, IFCC completed 23 of the 26 Strategic Actions that it set itself for the period 2009 to 2011. Congresses and Conferences. Congresses and conferences are an essential part of the work of IFCC. Not only do they provide an opportunity to update our scientific and clinical knowledge, skills and experience but they also provide a great forum to meet and make friends and to build long lasting professional networks. The highlight of 2011 was the IFCC WorldLab congress, which was held in conjunction with the EuroMedLab European congress in Berlin. This was a hugely successful international occasion with participation from delegates and exhibitors from almost one hundred countries. The excellent International Conference of Pediatric Laboratory Medicine was held as a satellite conference to the WorldLab event. Two other IFCC Regional Organizations also held successful congresses: • Latin-American Confederation of Clinical Biochemistry (COLABIOCLI) in Punta Cana in the Dominican Republic • African Federation of Clinical Chemistry in Nairobi, Kenya The second Ortho Clinical Diagnostics Conference was held in Paris. This focused event demonstrated a very high standard of presentation and discussion on the topic of “Pregnancy Related Disorders: Present Perspectives and Emerging Challenges” The Team Approach. Much of the most significant work of IFCC takes place in its Divisions, Committees, and Working Groups. This annual report contains many excellent examples and I encourage you to read these. In addition, the IFCC Task Forces and Integrated Projects address significant issues, often in partnership with international clinical organizations, as part of the work to position clinical chemistry and laboratory medicine at the center of the multidisciplinary healthcare team. During 2011, we agreed to commence a new Committee on Distance Learning and new Task Forces on Point of Care Testing and The Impact of Laboratory Medicine on Clinical Management and Outcomes. These new initiatives will start in 2012. Finances. The annual accounts for 2011 were audited in February 2012 and copies are available upon request from the IFCC Office. The success of the IFCC WorldLab congress in Berlin helped to produce a good year for IFCC finances. However, we must not be complacent because the global financial situation remains fragile and investment income is unpredictable. Further details can be seen in the Treasurer's report. People. During 2011, several key individuals completed their terms of office within IFCC and I thank them and pay tribute to their skill and commitment. These include: • Päivi Laitinen, Honorary Secretary (2006-2011) • Ghassan Shannan, Treasurer (2006-2011) • Joseph Lopez, Member of Executive (2006-2011) • Janet Smith, Chair of Education and Management Division (2006-2011) • Chris Lam, Vice President (2009-2011) A new Executive Board will commence its work in January 2012 and it is a pleasure to welcome Howard Morris, Sergio Bernardini, Vanessa Steenkamp, and Larry Kricka to the team. Maurizio Ferrari will succeed Janet Smith. The three-yearly IFCC Awards were presented during the IFCC WorldLab congress in Berlin. Details will be reported elsewhere in this Report. I wish to express my personal congratulations, both to the seven winners and also to the many other outstanding scientists who were nominated by their national societies. Thanks. I wish to thank the Executive Board and the Chairs of Divisions for their skill, commitment, and inspiration and especially Päivi Laitinen, in her capacity as Honorary Secretary, who has been responsible for the production of this Annual Report and so much more. Paola Bramati, Silvia Cattaneo, and Silvia Colli-Lanzi, appointed during the year, have demonstrated their dedication and a high level of professionalism in supporting members from our IFCC Office in Milan. IFCC owes a great debt to the hundreds of scientists and medical doctors who work on a voluntary basis to give freely of their time and expertise in the interests of improving the quality, delivery, and relevance of clinical chemistry and laboratory medicine on a worldwide basis. It is gratifying that we are seeing an increase in the number of experts who want to work for IFCC. These people are the true strength of IFCC and I thank them all. Personal Note. I had expected that this would be my final Annual Report, written at the end of my three-year term of Office as President. It was a surprise to me when I was asked by several colleagues to offer myself for reelection and I regard it as a great honor that Council elected me for a second term. I will work hard to repay the faith that you have shown in me and I look forward to connecting with more Members and to helping work with other agencies to promote the essential contribution of clinical chemistry and laboratory medicine to healthcare and to the safety and wellbeing of patients and the public. Special Supplement to Lab Medica International 2 2011 Annual Report EXECUTIVE BOARD (EB) The Executive Board held three meetings during 2011. The first meeting was held in connection with the IFCC OCD Conference in Paris on February 27-28, 2011. The second EB meeting was held prior the WorldLab Berlin 2011 on May 13-14, 2011. The new Executive Board was elected at a Council meeting held in Berlin on May 15, 2011. The third EB meeting was held in Milan on November 19-21, 2011. This was a joint meeting of the newly elected EB members and retiring member. This was also a budget meeting in which all the Division Chairs also attended and presented the work of their respective Division and its budget proposal for the next year. IFCC family gained a new member during the year. The Nepal Association for Medical Laboratory Science (NAMLS) was approved unanimously as a new Full Member by the IFCC membership via a mail ballot. The application of the Association of Clinical Biochemists in Zimbabwe - ACBZ, was sent out for voting with a deadline of January 31, 2012. At the end of 2011, the IFCC had thus 85 Full Members. IFCC also gained new Corporate Members (Immunodiagnostic Systems, Merck Millipore, Mindray, Nova Biomedical, Labquality, Response Biomedical Corporation). They all are warmly welcomed into the Federation A letter was sent to National Societies of the Full and Affiliate Members requesting for their annual reports. Forty-five reports were received to be included in the IFCC Annual Report 2011, which is available on the IFCC Website (www.ifcc.org). The full detailed annual reports of the Divisions as well as Task Forces' activ- A QUICK VIEW OF IFCC FINANCES IFCC ASSET PERFORMANCE 2011 (%) % IFCC Office 9% MAJOR EXPENSES Finance & Domicile 2% Regional Organizations 8% Special Projects 4% CPD 5% International Organizations 3% GC 1% Awards 3% SD 7% C-CC 50% MAJOR INCOME Full & Affiliate Members 6% Corporate Members 9% EuroMedLab 3% Royalties 2% Bank Profit 1% EMD 2% SD 2% ities are included in the IFCC Annual Report. Regional Federations are an essential part of the IFCC and they also give their annual reports to be part of the IFCC Annual Report. Please, visit the Website to know more of IFCC. This IFCC Annual Report 2011 closes my two terms as IFCC Secretary. These have been remarkable six years during which I have learned a great deal of laboratory medicine as well as people, different cultures and countries. I wish to express my sincere thanks and great gratitude to Executive Board members in 20062011 as well as all IFCC officials and the staff of Emmezeta-MZ Congressi. It has been a privilege to work with you. I also want to express my special thanks to the staff of the IFCC office in Milan; you have helped me greatly in my work as IFCC Secretary. Päivi Laitinen, Secretary IFCC Treasurer 2011 was one of the best years financially for a long time; income from WorldLab was the largest since this series started. In addition, IFCC had received several late payments, namely income from EuroMedLab in Glasgow 2005 and travel sponsorship from Roche. However, the bad news is that the performance of IFCC assets was still poor due to the continuous recession in the global market. The issue of the IFCC assets was discussed extensively at the Executive Board who recommended a visit to LGT Bank in Geneva by the President and the new Treasurer of the IFCC to explore the best possible ways to improve the profitability of the IFCC assets. The understanding of the Executive Board, Division and Committee Chairs and IFCC officers had contributed to the saving made in 2011 as they tried to minimize their expenses to the minimum. The reimbursement process went smoothly in 2011, thanks to the online banking and the efficiency and hard work of the IFCC office staff. With the valuable help and assistance of IFCC office, we were able to secure the payment of the annual dues of Full, Affiliate and Corporate Members for 2011. Below is a diagram showing the percentage of the major income of IFCC during 2011. There was a significant increase from Corporate Members contribution due to the joining of several new members during 2011. The income from Full & Affiliate Members had also increased due to the expansion of membership by adding new countries to IFCC club. Sponsorship from IVD still plays a major role in assisting IFCC to implement the scientific activities. As one can gather from the diagram, most expenses went to C-CC, as IFCC had to pay the costs associated with WorldLab Berlin 2011, the linked International Conference of Pediatric Laboratory Medicine and other partners. The operating cost of IFCC declined; but still made about 9% of total expenses. The contribution to Regional Organizations made about 8% of the total expenses. IFCC Divisions & Committees continued to support the scientific activities of various regions through sponsoring Workshops & Symposia; in addition, IFCC continued to sponsor various programs like VLP, PSEP, and Analytical Quality. The IFCC Financial Advisory Committee is pleased with the present Auditors, Humphreys & Gates, who perform professional auditing of IFCC accounting, whose contract was extended until the end of 2014. IFCC continues to maintain investment account at LGT and three accounts in EUR, USD, and CHF at Credit Suisse. Both banks have shown a great deal of cooperation and understanding with the treasurer and the office staff. The graph below shows the performance of IFCC assets in 2011. It was another disappointment as the total loss was about 6.5% at the end of the year. Such performance raises again the question; is there a better way to invest the IFCC assets? Finally, I wish to extend my sincere thanks and gratitude to the Executive Boards, Division Chairs, IFCC officers, National Societies, Corporate Members, MZ and above all IFCC office staff for the unlimited support I received during my two terms as a Treasurer of the IFCC. I hope I was up to your expectations and looking forward to meeting you all in the future. Ghassan Shannan, Treasurer Awards Committee The Federation confers several distinguished awards to scientists and clinicians who work in clinical chemistry and laboratory medicine or related disciplines. These triennial or annual awards are the highest honors that our Federation can bestow to colleagues worldwide in recognition of their outstanding achievements, to publicize their exceptional research and other contributions that have improved medical and healthcare, and to stimulate and encourage other scientists to accelerate their efforts in advancing clinical chemistry and laboratory medicine. EB 3% EMD 5% Pediatric Conf. 2% IFCC Awards Committee. Members of the present 2009 to 2011 IFCC Awards Committee conducting the nominations and selection of honorees comprise: Chair C W K Lam (Hong Kong), Members: Jean-Claude Forest (Canada), Vladimir Palicka (Czeck Republic), Mohamed Shaarawy (Egypt), Rosa Sierra-Amor (Mexico), Consultant: Y M Dennis Lo (Hong Kong). Presentation of 2011 Award. Currently there are seven IFCC distinguished awards: The awards were announced at the Opening Ceremony of WorldLab Berlin 2011 and they were presented to the Awardees at a Awards Gala Dinner during the congress. IFCC-Beckman Coulter Distinguished Clinical Chemist Award. Outstanding contributions to the science of Clinical Chemistry and Laboratory Medicine, or the application of Clinical Chemistry to the understanding or solution of medical problems. Professor Emeritus Ulf-Håkan Stenman, Finland IFCC-Siemens Henry Wishinsky Award for Distinguished International Services. Unique contributions to the promotion and understanding of Clinical Chemistry and Laboratory Medicine throughout the world. Dr. Carl A Burtis, USA Sponsorship 5% IFCC-Abbott Award for Distinguished Contributions in Education. Extraordinary contributions in establishing and developing educational materials for our discipline to improve training and educational programs worldwide or in a region. Prof. Mary F Burritt, USA Awards 2% IFCC-Abbott Award for Significant Contributions in Molecular Diagnostics. Unique contributions to the promotion and understanding of molecular biology and its application In Clinical Chemistry and Laboratory Medicine worldwide. Prof. Michael Neumaier, Germany IFCC Distinguished Award for Laboratory Medicine and Patient Care. Unique contributions in Laboratory Medicine, its application in improving patient care and having a worldwide impact in clinical medicine. Prof. Ronald J A Wanders, The Netherlands WorldLab 66% IFCC-Robert Schaffer Award for Outstanding Achievements in the Development of Standards for Use in Laboratory Medicine Cosponsored by NIST and CLSI. Outstanding and unique contributions to the advancement of reference methods and/or reference materials for Laboratory Medicine to facilitate improved quality of clinical diagnostics and therapies, which would in turn lead to reduced costs and improved patient care . Prof. Linda Thienpont, Belgium Special Supplement to Lab Medica International • 20 IFCC 2011 Annual Report IFCC-ROCHE Young Investigator Award . Recognizes and encourages the academic and professional development of a young investigator who has demonstrated exceptional scientific achievements in Clinical Chemistry and Laboratory Medicine early in his/ her career. Prof. Rossa W K Chiu, Hong Kong C W K Lam, Awards Committee, Chair CORPORATE MEMBERS 3 were 6 Platinum Sponsors, 2 Gold Sponsors, 11 Bronze Sponsors (17 of them are IFCC Corporate Members), and 74 exhibitors. According to a request by IFCC Corporate Members, the opening hours of the exhibition were reduced to only three days, from Monday to Wednesday, instead of the whole congress, from 10:00 to 17:00. EuroMedLab 2013, Milan, Italy. Francesco Caggiano, Menarini, has been appointed as consultant at the Congress Organizing Committee (COC) representing IFCC Corporate Members. 2011 was another year with extremely challenging global economical conditions and budget constraints for the majority of IVD companies. Nevertheless, Corporate Members contributed significantly to the overall IFCC budget, sponsored IFCC Scientific Awards, and continued supporting IFCC activities e.g. working in all three IFCC Divisions in their Executive Committees. In addition, numerous delegates from Corporate Members actively collaborated in most of the scientific workgroups. WorldLab 2014, Istanbul, Turkey. Thomas Brinkmann, Unilabs, has been appointed as member of the Congress Organizing Committee (COC) representing IFCC Corporate Members. Number of Corporate Members. In 2011, six IVD companies joined IFCC as Corporate Members: Immunodiagnostics Systems (UK), Labquality (Finland), Nova Biomedical Corporation (France), Response Biomedical Corporation (Canada), Shenzhen Mindray Bio-Medical Electronics (China), Unilabs (Switzerland). Due to the acquisition of Phadia by ThermoFisher one member was lost. By the end of 2011, the total number of Corporate Members increased to 46 with a total annual dues of CHF 327,500 representing 20% of the IFCC annual budget. There are five main Regional Professional Laboratory Medicine Organizations which can be considered IFCC regional partners • European Federation of Clinical Chemistry and Laboratory Medicine (EFCC) • Asian-Pacific Federation of Clinical Biochemistry (APFCB) • Arab Federation of Clinical Biochemistry (AFCB) • Latin-American Confederation of Clinical Biochemistry / Confederación Latinoamericana de Bioquímica Clínica (COLABIOCLI) • African Federation of Clinical Chemistry (AFCC) More information about these affiliated organizations and their activities can be found on our website www.ifcc.org Corporate Members' Meeting. In 2011, two Corporate Members' meetings were organized in conjunction with international conferences: EuroMedLab in Berlin (May 2011) and AACC in Atlanta, USA (July 2011). IFCC officers of the Executive Board participated in the first third of these meetings to welcome new members and to discuss with Corporate Members. The direct contact with IFCC officers strengthens communication and equal partnership collaboration between IVD industry and IFCC. IFCC Committees. Corporate Members contributed in the following three IFCC Divisions: Scientific Division, Joseph Passarelli (Roche); Education & Management Division, Rolf Hinzmann (Roche); Communications & Publications Division, Bruce Jordan (Roche). In addition, Corporate Members worked in many IFCC committees. EMD Executive Committee (EC). The EMD Executive Committee (EC) met twice: in January in Varese, ltaly, and in May in Berlin during IFCC EuroMedLab / WorldLab. Educational activities, mainly lectures, have been very successful. A very important task of EMD is the Visiting Lecture program, sponsored by Abbott with EUR 40,000 per annum. Another teaching activity was a beginners' lab course on molecular diagnostics held in Guatemala in December, which was organized by Prof. Michael Neumaier, Mannheim, Germany. The Committee on Analytical Quality (chaired by Janice Gill, Australia, and Egon Amann, Siemens, Germany) is quite successfully pursuing the establishment of a quality assurance program in Vietnam by lectures, on-site training and invitation of a Vietnamese physician to an Australian lab. A monograph on laboratory management is currently being written and now in the process of finalization. A distance learning material from Siemens (on natriuretic peptides) can be reached on the Siemens Website (via an IFCC link). Other distance learning materials are in process. The Working Group on New Bone Marker Standards in Osteoporosis has completed a publication, and will move to the Scientific Division. The Working Group on Flow Cytometry is now chaired by Prof. Ulrich Sack. Beckman Coulter will continue sponsorship for flow cytometry courses. SD Executive Committee (EC). Two face-to-face meetings were held within the Scientific Division in 2011. Both were two days in duration. The first was held on May 14-15 in conjunction with the IFCC EuroMedLab / WorldLab in Berlin, Germany. The second occurred in Milan, Italy, at the IFCC offices on October 7-8. The publication by Nader Rifai that appeared in Clinical Chemistry and the subsequent rebuttal that was sent in by EDMA and AdvaMed to explain Corporate Members alternative position. By-and-large CM supports disclosure of manufacturer's names in most cases but manufacturers believe there should be flexibility in certain circumstances to allow exceptions to this. The SD understood CM's position, especially with the concern that this could limit funding from industry for important studies that they want to initiate or continue. The SD also discussed the “Global Reference Interval Study” from Prof. Ichihara and the C-RIDL. Several meetings took place together with CM in Munich (December 2010), Berlin (May 2011), and Atlanta (July 2011). Corporate Members still had several significant questions and concerns with the proposed studies. In the end, the SD agreed only to the common collection protocol so that sample collection could proceed. SD decided in favor of regional reference intervals following a common protocol. Request by Corporate Members to have at least 9 months and preferably, 12 months prior notice of any requests for funding new studies given CM's internal budgeting processes. The SD fully understood this position. Further discussions are ongoing. As previously mentioned in open meetings with Corporate Members, it was discussed that the SD requires new Committees and Working Groups to demonstrate the clinical and economic value whenever requesting funding. Given the significant reductions in R&D spending and the more stringent guidelines being placed on external funding, it is no longer enough to provide just an explanation of the scientific interest. Also the medical value (both to patients and payers) has to be defined and demonstrated. Many Corporate Members expressed their scientific interest in POCT. They will support the new Task Force being formed. EuroMedLab / WorldLab 2011 Berlin, Germany. The EuroMedLab / WorldLab conference in Berlin was a great success with 4,685 participants from 98 countries and 93 industry exhibitors. IFCC Corporate Members were represented by the Corporate Representative at the Congress Organizing Committee (COC). The Industry Sponsored Workshops (ISW) were again a excellent way for in vitro diagnostic companies to contact and improve their relations with participants. It turned out that sometimes ISW were better attended than the main sessions, especially when the latter dealt with more abstract scientific topics. The ISW were of possible immediate practical use. Number of ISW and corresponding number of attendants: day 1, 16 ISW with 2,248 attendants; day 2, 16 ISW with 2,324 attendants; day 3, 10 ISW with 908 attendants; day 4, 2 ISW with 269 attendants. The IFCC EuroMedLab / WorldLab Berlin 2011 COC decided to modify the usual categories of promotional involvement employed for the last IFCC/EFCC events into Platinum, Gold, Silver, and Bronze Sponsors in order to implement the possibilities offered to Corporate Members in addition to standard exhibitors and sponsors. One significant advantage granted to Platinum, Gold, Silver, and Bronze Sponsors was the priority in the selection of exhibition space and sponsorship, according to a chronological order of reservation. IFCC corporate member were given the advantage of a discount of 20% on the official price. Finally there Thomas Brinkmann, Corporate Representative REGIONAL ORGANIZATIONS AFFILIATED WITH IFCC COMMITTEE ON CONGRESSES AND CONFERENCES (C-CC) C-CC Meetings. The C-CC held one committee meeting (28th Meeting) on Sunday, May 15, 2011, at ICC Berlin-International Congress Center, Berlin Germany. C-CC Membership. The C-CC received 11 applications from Full Member Societies for the vacant Full Member position commencing January 2012 for a three-year period. IFCC EB accepted Dr. Joseph LOPEZ nominated by Malaysia and APFCB for the vacant Full Member position in C-CC. The IFCC EB also accepted the recommendations of Orla Maguire from Ireland; Montserrat Blanes Gonzalez from Paraguay; Pierre Carayon from France; and Tomas Zima from Czech Republic as Corresponding Members for a three-year period commencing January 1, 2012. Upon recommendation of C-CC, IFCC EB accepted Dr. Peng Yin from Abbott as the Corporate Member of C-CC, and Dr. Mauri Keinanen from Labquality as the Corresponding Corporate Member effective January 1, 2012. International Congresses of Clinical Chemistry and Laboratory Medicine Berlin WorldLab 2011 (XXI International Congress of Clinical Chemistry and Laboratory Medicine, ICCCLM), Berlin Germany, May 15-19, 2011 The IFCC WorldLab Berlin 2011 (XXI ICCCLM) was held concurrently with the IFCC-EFCC EuroMedLab from May 15-19, 2011, in Berlin, Germany. The congress was hosted by the German Society of Clinical Chemistry and Laboratory Medicine (DKGL). The congress was an outstanding success. Some statistics are given in the Corporate Members report above. ICCCLM ISTANBUL WorldLab 2014 The first Congress Organizing Committee (COC) meeting was held on February 9, 2012, in Istanbul, Turkey. ICCCLM WorldLab 2017, Durban, South Africa IFCC received a record number of eight bids from four continents to host this congress (Argentina, Austria, India, Ireland, South Africa, Spain, Sweden, and Tunisia). Each of the bids, together with letters of support, was evaluated by the C-CC. The evaluation was performed and scored in line with the published “Guidelines and Rules for Organizing the IFCC International Congresses of Clinical Chemistry and Laboratory Medicine.” Working independently each of the five C-CC assessors scored Durban in the first place. Accordingly, the CCC made a recommendation that “IFCC WorldLab 2017” should be awarded to Durban and the Executive Board has endorsed this recommendation. IFCC WorldLab 2017 will be held in Durban in the Republic of South Africa during the last week of October 2017. The official announcement of the venue for “IFCC WorldLab 2017” was made during the IFCC Council meeting in Berlin in May 2011. Regional Congresses XIX COLABIOCLI Congress, Punta Cana, Dominican Republic 2011 The COLABIOCLI meeting was held in Punta Cana in the Dominican Republic in November 2011. EuroMedLab Milan 2013 The congress, will take place from May 19-23, 2013, (Sunday-Thursday). Preparations for the congress are progressing smoothly as planned. EuroMedLab 2015 Six National Societies submitted their applications to host the EuroMedLab 2015. The IFCC Congresses and Conferences Committee (C-CC) and the EFCC Education and Training Committee (C-ET) evaluated the submitted applications and issued advice to national societies. The venue for the IFCC-EFCC EuroMedLab Congress in 2015 was selected by ballot at the EFCC General Assembly in Berlin on Sunday, May 15. According to the results of the ballot, EuroMedLab 2015 will be organized by the French Society of Clinical Biology (SFBC) at “Palais des Congrés de Paris.” IFCC Specialized Conferences IFCC Ortho Clinical Diagnostics (OCD) Conference, Paris February 25-26, 2011 The Second Ortho Clinical Diagnostics (OCD) Conference entitled "Disease and the Clinical Laboratory Pregnancy Related Disorders: Present Perspectives and Emerging Challenges" was held in Paris, February 25-26, 2011. This conference had 4 sessions with topics - prenatal screening, preeclampsia, prediction of Special Supplement to Lab Medica International • 21 4 2011 Annual Report preterm birth and novel biomarkers and 13 lectures were presented. The participants (approx. 90) came to Paris from 28 countries around the word. The presentations will be inserted into the IFCC Website and will be published also in CCLM. CONGRESSES WITH IFCC AUSPICES A total of 32 meetings in 2011 and 26 meetings in 2012 have applied for IFCC auspices for their meetings, and since the meeting topics are directly related to the goals of the IFCC, all of them were granted IFCC auspices. Revision of the Documents and Guidelines The reviewed and revised documents and guidelines are available on the IFCC Website. Tomris Ozben, C-CC Chair SCIENTIFIC DIVISION (SD) During 2011, the following members served on the SD Executive Committee: Ian Young (UK) Chair), Philippe Gillery (France) (Vice-Chair), Gary Myers (United States) (Secretary), Giampaolo Merlini (Italy), Lothar Siekmann (Germany), Naotaka Hamasaki (Japan), and Joseph Passarelli (Germany) (corporate representative). Three representatives of International Organizations are invited to attend the SD meetings as consultants: Mathias M_ller (JCTLM), Heinz Schimmel (IRMM), and David Bunk (NIST). Two meetings were held during the year 2011: May 14-15 (Berlin, Germany) and October 7-8 (Milan, Italy). IFCC Committees • C-Nomenclature, Properties and Units (C-NPU) During 2011 ongoing progress towards C-NPU terms of reference included: Term of Reference 1. Provide advice for the management, updating and publishing of the NPU terminology. Accomplishments include: The revision of the "Silver Book": Compendium of Terminology and Nomenclature of Properties in Clinical Laboratory Sciences (IUPAC and IFCC Recommendations 1995) has been extended. The objective is to finalize the updating of the first edition of the Silver Book (project #2007033-1) by inserting a new chapter on nominal properties and adding a concise summary of the content as a double sheet leaflet. This extension is supported by SD and CPD. Term of Reference 2. Make recommendations on NPU for reporting clinical laboratory data that conform to or adopt current standards of authoritative organizations and that will improve their utilization for health care. Accomplishments include: A manuscript entitled “Vocabulary for nominal properties and nominal examinations-Basic and general concepts and associated terms” was adopted by IUPAC and distributed for review. The document was submitted to Pure and Applied Chemistry for publication. SD was under the impression that the document would be published in CCLM as a discussion document only. The editor of Pure and Applied Chemistry was contacted to request a hold be placed on publication to allow IFCC to follow its publication guidelines and send the manuscript out for comment and vote. Term of Reference 3. To provide a connection with other organizations concerned with NPU, such as the Bureau International des Poids et Mesures (BIPM), the European Committee for Standardization (CEN) and the International Organization for Standardization (ISO), and, by extension, clinical laboratory sciences societies, such as the International Union of Pure and Applied Chemistry (IUPAC). Accomplishments include: All of the above activities were jointly performed with IUPAC. • C-Molecular Diagnostics (C-MD) Relationship with International Organizations The SD continues to pursue its activities to partner with international organizations to promote the implementation of the concept of traceability in laboratory medicine and the implementation of reference measurement systems. • Joint Committee on Traceability in Laboratory Medicine (JCTLM) The work of JCTLM is available for review on its database at www.bipm.org/jctlm. The Working Group 1 on Reference Measurement Procedures and Reference Materials continues its program of identifying and reviewing new proposals against agreed criteria (ISO standards 15193 and 15194). More than 200 certified reference materials for about 130 measurands together with more than 125 reference measurement methods/procedures for 76 different health markers are presently listed in the JCTLM database. These have been reviewed and internationally agreed to be consistent with the criteria described in the standard ISO 15194 and 15193, respectively. The Working Group 2 on Reference Measurement Services has reviewed new nominations from candidate laboratories. Laboratories will now need to participate in RELA EQAS once in 3 years for each measurand for which the laboratory is listed on the JCTLM database. To be listed as a laboratory providing reference services, a laboratory will need to be accredited by January 2011. A procedure is in place to periodically review the lists and to remove entries when they no longer meet the established criteria. A new working group (WG 3) charged with managing, writing, and reviewing material and publications on behalf of JCTLM is being considered. The database has become a reliable source of information particularly for the In Vitro Diagnostics (IVD) industry. • Insitute for Reference Material and Measurement (IRMM) Close collaboration with IRMM continues through a number of joint ventures involving SD Committees and Working Groups. A new material for cystatin C has been released. Projects continue for the preparation of materials for HbA1c (primary and secondary materials), HbA2, and myoglobin. • Clinical and Laboratory Standards Institute (CLSI) (Formerly NCCLS) An updated list of joint CLSI/IFCC documents is available on the IFCC Website at: www.ifcc.org/ ifcc-communications-publications-division-(cpd)/ifcc-publications/clsi-ifcc-joint-projects/. • National Institute of Standards and Technology (NIST) NIST continues to undertake a large number of projects, many of which are of considerable interest to IFCC. Standard Reference Materials (SRM) released or slated for release in 2011 include: SRM 968e (Fat soluble Vitamins and Carotenoids), SRM 1950 (Metabolites in human plasma) is a one level fresh frozen human plasma with concentrations established for glucose, creatinine, fatty acids, folate, homocysteine, cholesterol, cortisol, progesterone, testosterone, retinol, tocopherol, carotenoids, 25-hydroxyvitamin D, uric acid, amino acids, total protein, and electrolytes, SRM 3951 (Vitamin B12), SRM 900a (Antiepilepsy Drugs), SRM 3667 (creatinine in urine), and SRM 1951c (lipids in frozen human serum). NIST indicated it would like SD assistance with conducting commutability studies of its reference materials including; logistical help to conduct commutability studies, assistance obtaining patient samples, and assistance in contacting manufactures. There was discussion that there may be a need for an oversight group within SD for commutability issues and logistics. • International Congress of Clinical Chemistry (ICCC) XXI INTERNATIONAL CONGRESS OF CLINICAL CHEMISTRY AND LABORATORY MEDICINE (WORLDLAB 2011) Berlin, Germany (May 15-20, 2011). Two SD submitted sessions were presented during the IFCC Congress. Topics were; 1. IFCC Program on Molecular Diagnostics (Ian Young as Chair) and 2. What IFCC/JCTLM is doing in traceability (Philippe Gillery as Chair). IFCC Specialized Conferences IFCC-ORTHO CLINICAL DIAGNOSTICS. The 2011 Conference held in Paris, France (February 25-26, 2011): “Pregnancy-related disorders: present perspectives and emerging challenges” was attended by 100 participants. A special issue of CCLM will contain presentations from the conference. Congresses with IFCC Auspices 4th CIRME INTERNATIONAL SCIENTIFIC MEETING Milan, Italy (November 30, 2011). onference title: Standardization of Cardiac Troponin I: The Ongoing International Effort. Under the auspices of the IFCC, JCTLM, and the EFCC. Activities of Committees and Working Groups The Committees (Cs), which are theme-oriented, carry out much of the scientific and professional activities of the SD. Their work is often in close collaboration with other international organizations. For more specific tasks, the activities are usually accomplished through Working Groups (WGs). During 2011 ongoing progress towards C-MD terms of reference included: Term of Reference 1. To foster dynamic exchanges between IFCC and Mol DX labs and industry. Accomplishments include: The C-MD Web page contains a link to the CanGeneTest Newsletter. The eNewsletter on genetic laboratory services aims at disseminating timely and relevant information in this area to all stakeholders. Term of Reference 2. Guidelines on validation, conduct, and reporting of Mol DX tests. Accomplishments include: A consensus of available guidelines on molecular DX testing is available on the C-MD Web page. Term of Reference 3. Provision of well-defined reference materials. Accomplishments include: The C-MD Website provides a listing of available reference materials and EQA programs for Mol DX. A project (GETTIN) was submitted to the EU Commission in partnership with IRMM for a reference material for molecular methods possessing suitable characteristics to be used in the clinical environment. Unfortunately, the project did not pass to the second step. Term of Reference 4. Creation of a network of locus specific IFCC Molecular Diagnostic Centers. Accomplishments include: C-MD has not clarified the position on roles of MDCs. The goal was to have a network of MDCs as a resource of expertise within IFCC. However, the visibility of the MDC's is relatively low and there were concerns that the network was overlapping with the EuroGentest initiative. A letter was sent in January 2011 to the MD Centers requesting a report on the specific activities performed by each Center. Term of Reference 5. C-MD Web page within IFCC Website. Accomplishments include: The Website contains links to other Websites relevant to molecular diagnostics including genetic and molecular genetics societies, gene sequence and mutation databases, primer design sites, and a number of other molecular diagnostic utilities. • C-Plasma Proteins (C-PP) SD closed C-PP at the end of 2010. Members of C-PP were invited to propose the formation of WGs to take forward specific tasks arising out of C-PP work. One proposal was to form a WG for the development and preparation of a new international reference material for cerebrospinal fluid (CSF) proteins. The aim of this project would be to develop an international reference material for cerebrospinal fluid. The detection and quantification of proteins is an essential part of the diagnosis and monitoring of a number of neurological diseases. For a correct diagnosis of CSF analytes, it is important that there is an international standardization of CSF tests traceable to an international reference material. SD supported the proposal and the formation of a WG has been agreed. • C-Reference Systems for Enzymes (C-RSE) During 2011 ongoing progress towards C-RSE terms of reference included: Term of Reference 1. IFCC Enzyme Reference Measurement Procedures: New 37 °C IFCC enzyme reference procedures are being developed on the basis of the existing 30 °C IFCC. Accomplishments include: Work on the development of a reference measurement procedure for pancreatic lipase continues. The results of the experiments planned to compare the performances of two candidate reference methods for pancreatic lipase catalytic activity were completed in spring 2011. The experimental results were contradictory and not satisfactory for both methods, therefore optimization of both methods is proceeding in parallel. Term of Reference 2 and 3. Network of Enzyme Reference Laboratories: Coordination of a group of reference laboratories from hospitals, academy and industry, which are able to perform adequate measurements according to a list of stated requirements. Enzyme Reference Materials: Evaluate reference materials provided by IRMM within the network of reference laboratories prior to certification. Accomplishments include: No activity on these Terms of Reference occurred. • C-Traceability in Laboratory Medicine (C-TLM) During 2011 ongoing progress towards C-TLM terms of reference included: Term of Reference 1. Support activities of the JCTLM - based on a harmonized opinion among IFCC members - concerning the identification of reference measurement procedures, reference materials, and reference laboratories. Accomplishments include: C-TLM provided input into the activities and operations of JCTLM Working Groups 1 and 2. Term of Reference 2. Establish an External Quality Assessment Scheme (EQAS) for reference laboratories and act as an advisory committee. Accomplishments include: To date, RELA ring trials are provided for 34 measurands. Starting with RELA 2010, Total Thyroxine and Total Triiodthyronine are provided in a separate group “Thyroid Hormones (THYR).” The number of participants and of published results is increasing. The results with disclosed identities of the laboratories are published on the RELA Website (www.dgkl-rfb.de:81). The measurand alkaline phosphatase has been running for the first time and eight laboratories participated. In September 2011 the next RELA survey (RELA 2011) was started. The results will be available in June 2012. Term of Reference 3. Promote the establishment and maintenance of IFCC reference laboratory networks for clinically relevant measurands. Accomplishments include: The annual meeting of the Reference Laboratories operating the IFCC Reference Measurement Procedure for HbA1c was held during the IFCC Special Supplement to Lab Medica International • 22 IFCC 2011 Annual Report WorldLab 2011 in Berlin on May 15, 2011. Candidate reference laboratories in China (Shanghai; Dr. Li Qing) and India (Calcutta; Dr. Bhattacharya) were introduced. A third Asian candidate reference laboratory (Korea, Seoul) exists, however it was not introduced to the network. The 2011 intercomparison study of the network laboratory performance has been started. Results will be available in 2012. • C-Reference Intervals and Decision Limits (C-RIDL) During 2011 ongoing progress towards C-RIDL terms of reference included: Term of Reference 1. Review current concepts of establishing reference intervals and decision limits and to prepare state-of-the-art position statements regarding new avenues to make available reference intervals and decision limits that respect the requirements of international directives, such as the European IVD Directive 98/79, and relevant ISO standards. Accomplishments include: No activity on this Term of Reference occurred. Term of Reference 2. To monitor and evaluate currently proposed reference intervals for selected analytes in the light of the concept of traceability and of the identification of the uncertainty. Accomplishments include: 53 analytes (26 biochemistry; 27 immunoassays) were selected to be tested as part of phase 1 of the worldwide study. Term of Reference 3. To monitor and evaluate currently proposed reference intervals for selected analytes in the light of the concept of traceability and of the identification of the uncertainty. Accomplishments include: A common collection protocol was developed and finalized in September 2011 for the worldwide project on reference values. The study will focus on developing regional reference intervals following the common protocol in favor of global reference intervals. A pilot study was carried out in April-May of 2011 to evaluate the validity of the panel-of-sera strategy in streamlining test results with participation of four testing centers in the US, Turkey, and Japan. The first phase of the worldwide study was launched in November 2011 with participation of 7 major laboratories located in five countries: US, UK, Turkey, China, and Japan. Term of Reference 4. To establish transferability protocols of reference intervals and decision limits, which take into consideration inter-routine laboratory method variations and achieve better applicability in clinical practice. Accomplishments include: There was no activity relevant to this term. Term of Reference 5. To collaborate with other organizations and/or to undertake establishment of reference intervals or decision limits for analytes identified as a priority. Accomplishments include: A workshop was presented during the IFCC WorldLab 2011 in Berlin on May 24 (Tue): Lessons from the Asian - Pacific multicenter reference interval study. A symposium during 2011 AACC annual meeting in Atlanta on July 25 (Mon): Is that normal? Reference interval studies around the world. Term of Reference 6. To work in close collaboration with other Cs and WGs of SD for the development and appropriate clinical utilization of reference intervals and decision limits. Accomplishments include: Collaborated with C-RSE to collect samples from reference subjects for ALP. Working Groups • WG - Standardization of Thyroid Function Tests (WG-STFT) During 2011 ongoing progress towards WG-STFT terms of reference included: Term of Reference. Development of reference measurement systems for thyroid hormones (total T4 and T3, free T4 & T3) and TSH. Accomplishments include: The University of Ghent (UGent) developed and published Equilibrium Dialysis Isotope Dilution-Liquid Chromatography/Tandem Mass Spectrometry (ED IDLC/tandem MS) measurement procedure for serum free T4 was accepted by the IFCC as an international conventional reference measurement procedure (RMP). The RMP has also been approved by the JCTLM for listing in the JCTLM database of approved RMPs. The same is expected for the reference measurement service provided by the UGent laboratory, after accreditation of the laboratory according to ISO 17025/15195. The accreditation is anticipated to happen in 2012; SD approved the closure of the WG-STFT at the end of 2011 and the formation of a committee on thyroid function. The aims for the transformation of the WG-STFT into a committee are to prepare the implementation of standardization, to involve a broader forum of stakeholders and to accomplish the commitment of the stakeholders to standardization. The SD approved the Terms of Reference for the Committee. • WG - Standardization of Hemoglobin A2 (WG-HbA2) During 2011 ongoing progress towards WG-HbA2 terms of reference included: Term of Reference. To promote the standardization of hemoglobin A2 measurement through the definition of an international reference system, including a reference measurement procedure and primary and secondary reference materials. Accomplishments include: Development of the reference method: Two labeled peptides have been defined (i.e. aT11 and dT2 peptides, having one labeled valine with all the C atoms as 13 C), purchased and analyzed by amino acid analysis. The development of an isotopic dilution mass spectrometry method using these peptides is under evaluation. An alternate approach using LC-ESI/MS on intact globin chains, by adapting the method described by Davison et al (Clin Chem Lab Med 2008;1230-8), is also being investigated. A third approach, based on the implementation of the proteolytic and isotopically labeled method by LC-ESI-MS/MS proposed by Dalton et al. (Clin Chem 2007; 53:1448-54) is under discussion for evaluation. Secondary reference materials: The stability study at -20 °C on the first pilot batch of candidate reference material (CRM) prepared back in April 2008, has been continued. The stability and homogeneity of a second batch of materials with other vials, as well as other gas atmospheres (oxygen free) inside the vials, is planned in the first part of 2012. • WG - Standardization of Carbohydrate-Deficient Transferrin (WG-CDT) During 2011 ongoing progress towards WG-CDT terms of reference included: Term of Reference 1. Establish a network of CDT reference laboratories that perform the HPLC candidate reference method. Accomplishments include: Six laboratories belonging to WG members are running the HPLC candidate reference method. A multicenter study (Study 3) in March 2011 confirmed the homogeneity of the results given by the candidate reference method within the network. Results showed low and very good CV (a calibrated mean CV of 1.7%) and true linearity (r >0.99) for both native and spiked materials. All CDT assays involved in Study 3 showed excellent or acceptable linearity. However, the inter-method CV was relatively high (13-16%) and the calibration curves were not parallel, indicating that multiple-point calibration will be needed. Due to slight differences in the response between native and spiked samples, use of native samples was considered necessary. The non-HPLC methods showed variable matrix effects for the spiked samples. These results demonstrated that calibration of the different CDT assays is possible. A draft manuscript describing the HPLC candidate reference method is in preparation. Term of Reference 2. Development of a reference material for CDT. Accomplishments include: A confirmatory calibration study (Study 4) based on native samples from 40 different individuals with variable CDT levels was performed according to CLSI protocols 14a and 53 using the HPLC reference method and available methods on the market. Study 4 is designed to demonstrate that standardization can be achieved using individual patient samples. .A multilevel secondary calibrator based on native material will be required. 5 • WG - Standardization of Cystatin C Assays (WG-SCC) 2011 was the last official working year for the WG-SCC. During 2011 ongoing progress towards WG-SCC terms of reference included: Term of Reference 1. Promote the standardization of cystatin C measurement through the definition of an international reference system including a reference measurement procedure and primary and secondary reference materials. Accomplishments include: The WG, in cooperation with major diagnostic companies, worked to establish a method-independent cystatin C-based GFR-prediction equation, using samples from 4000 patients with known GFR. Results for 2000 samples have been produced and results for the remaining 2000 samples will be obtained in early 2012. The large number of patients differing in GFR, age, health status, etc, will allow reliable statistical characterization of the diagnostic performance of the GFRprediction equation in various subgroups of patients/healthy persons and will allow decisions concerning if different prediction equations will be required for different subgroups of subjects. • WG - Standardization of Glomerular Filtration Rate Assessment (WG-GFRA) During 2011 ongoing progress towards WG-GFRA terms of reference included: Term of Reference 1. Coordinate, support, and undertake collaborative international studies to evaluate and define performance characteristics of available clinical laboratory measurement procedures for creatinine, supporting the use of eGFR, and enabling development of best-practices analytical recommendations for clinical laboratories. Accomplishments include: In cooperation with NKDEP Lab Working Group (including funding from NIH/NIDDK), completed analysis of data from the collaborative specificity study for 3 Jaffe and 4 enzymatic serum creatinine measurement procedures from four major global IVD systems manufacturers (Roche, Siemens, Beckman, and Ortho). Manuscript was submitted (July 2011) to Clinical Chemistry for publication, and was accepted for publication (October 2011). Term of Reference 2. Promote the establishment and growth of a reference laboratory network for creatinine measurements in serum and urine. Accomplishments include: Creatinine specificity study report (online supplement), to be published in Clinical Chemistry, 2012, includes full disclosure/ procedural detail for the Evelina Children's Hospital, London, UK, creatinine LC tandem mass spectrometry procedure used as the designated comparison measurement procedure. It is anticipated that reference and calibration laboratories may have significant interest in this measurement procedure, and publication of these details is expected to facilitate wider availability of higher order creatinine measurements. • WG - Standardization of Albumin Assay in Urine (WG-SAU) During 2011 ongoing progress towards WG-SAU terms of reference included: Term of Reference 1. Establish a reference procedure and reference materials for the measurement of albumin in urine. Accomplishments include: The NIST is developing an LC-MS/MS reference measurement procedure for urine albumin that measures eight tryptic peptides of human serum albumin with ~1% CV for replicates. NIST will validate this procedure by comparison with the procedure developed at the Mayo Clinic. The Mayo Clinic procedure uses five tryptic peptides that are consistently seen by LC IDMS and averages the results for a final value. Inter- and intra-assay precision is about 1%-2%. The NIST has prepared SRM 3667 (Creatinine in Human Urine), which is a single concentration of pooled urine, collected from healthy males/females (minimum of 10 donors). LC-IDMS reference measurement procedure-target values have been assigned. The NIST has prepared SRM 2925 (Human Serum Albumin Solution) from recombinant human serum albumin and is intended for use as a primary certified reference material for reference measurement procedures for albumin in urine. Quantification by amino acid analysis using isotope dilution LCMS/MS has been completed. A candidate secondary urine albumin reference material has been prepared by the Japanese Society of Clinical Chemistry. The material is a buffer based purified monomeric human serum albumin in lyophilized form. The assigned value was by transfer from ERM-DA470 using qualified immunoassay procedures. A commutability study using 129 urine samples was performed with seven different immunoassay methods. A reduction in between method CV was observed using the new reference material to calibrate the immunoassays. Term of Reference 2. Establish recommendations for sample collection and handling to improve uniformity of results. Accomplishments include: A study to evaluate adsorption of albumin onto containers used for urine collection and urine albumin measurement has been completed by CDC and a manuscript is being prepared. Planning of a study to evaluate urine albumin physiologic variability was delayed due to administrative issues with funding and a need to revise the protocol to reduce complexity to ensure successful completion by recruited patients. A revised project plan has been developed and a new budget and IRB submission are in preparation. Terms of Reference 3. Status of harmonization among commercial immunoassays for UA (funded by NKDEP). The objectives of this project are to: 1) evaluate harmonization among methods for urine albumin using native human urine samples; 2) assess agreement of routine methods with an LC-IDMS procedure; 3) evaluate commutability characteristics of JSCC and diluted ERM-DA470k/IFCC reference materials for urine albumin; 4) evaluate basic performance characteristics of the urine albumin methods; and 5) compare harmonization of urine total protein and creatinine methods. Accomplishments include: Fresh, nonfrozen human urine samples (343) that had been submitted for routine urine albumin measurement were measured by 17 routine procedures from 5 manufacturers. Frozen aliquots of each sample were measured by LCIDMS. Preliminary data analysis suggested an approximate 40% difference among medians of the measurement procedures. The reference materials and some supplemented urine samples were also measured. The data is in the process of statistical analysis and a manuscript will be prepared. • WG - Standardization of Pregnacy-Associated Plasma Protein A (WG-PAPPA) During 2011 ongoing progress towards WG-PAPP A terms of reference included: Term of Reference: Develop a reference system for standardization of PAPP-A measurement employed as marker for prenatal screening. Accomplishments include: The participation of five companies (including funding and reagents) was secured in May 2011. In August 2011, a project agreement was made between IFCC and the University of Turku, Finland. Company antibodies (2/company) + 8 index antibodies from Hytest (selected from a previous epitope map study) were tested in all two-site combinations: 18 Mabs - 324 combinations. Various standard diluents from the participating companies and from the University of Turku were included in the study. The second phase initially intended to be carried out during 2011 - distribution of preparations of the candidate standard materials to the corporate members - was delayed as 1st trimester clinical specimens (pools) were not obtained according to the planned schedule. The second phase of the project will be carried out in 2012. • WG - Growth Hormone (WG-GH) Progress by the WG during 2011 continued to be extremely slow with basically no documented accomplishments. SD Chair attempted to communicate with the WG Chair but received no response. SD questioned Special Supplement to Lab Medica International • 23 6 2011 Annual Report whether there is a need for standardization in this area. SD decided to terminate WG with the intent to reactivate group at some future time when a new chair can be identified and specific Terms of Reference can be established. • WG - Standardization of Insulin Assays (WG-SIA) During 2011 ongoing progress towards WG-SIA terms of reference included: Term of Reference. Improve the standardization of assays for insulin by the development of a candidate reference method and materials. Accomplishments include: A letter from SD and WG Chairs was sent in July to IFCC corporate members soliciting USD 10,000 contributions to support the next phase of work to develop a complete reference system for insulin that will be listed by JCTLM. Engaged a laboratory (Albert Einstein Medical School, USA) to establish and perform the IDMS reference method procedure for insulin. Validation of the Einstein RMP will against the IDMS procedure at the University of Ghent will be completed in 2012. Nearly all the serum samples and pools have been collected, processed, and stored as aliquots. These materials will be value assigned for insulin by the IDMS RMP and will be used to sustain the program to harmonize results from manufacturers of insulin assays. The WG-SIA continued active discussions with the NIDDK supported C-peptide Working Group (Chair Prof. R. Little) with regard to delineating common approaches and the establishment of a RMP for C-peptide. Continued emphasis on how both groups can achieve their goals by sharing plans, materials, and activities. • WG - Standardization of Troponin I (WG-TnI) During 2011 ongoing progress towards WG-TNI terms of reference included: Term of Reference 1. Develop a candidate secondary reference measurement procedure and candidate secondary reference material for cardiac troponin I (cTnI). Accomplishments include: Candidate secondary reference procedure (immunoassay based measurement procedure of higher metrological order) for cTnI: 1. The ELISA method has been developed. Further work has been done to try to reduce the variation in imprecision for the chemiluminescence (CL) assay but without success. The current fluorescence (FL) detection method (CV <5%) will be able to measure all of the medium & high level cTnI patient samples for the pilot study but only a quarter of low level samples. NIST will try the CL method on their new plate reader. 2. The higher-order cTnI method has been transferred to CCQM (Consultative Committee for the Amount of Substance) network laboratories in 2011 as part of their NMI work. Candidate Secondary Reference Material for cTnI: The WG has developed a pilot study protocol to investigate the feasibility of preparing a commutable and stable secondary reference material for cTnI by use of serum pools. The study will involve NIST, NPL, University of Maryland, and industry. Patient samples have been collected by University of Maryland and the pools prepared at NIST. Samples & pools have been dispatched to participating labs in the USA and overseas. The final study protocol was rewritten and will be sent out to labs with samples for analysis to be completed by the end of January 2012. Samples will be analyzed at NIST & NPL once the cRMP is ready. The pilot study will provide information about: 1) current degree of results harmonization between commercial cTnI assays and comparability with the cTnI cRMP; 2) commutability of cTnI serum pools versus patient samples used in routine practice; 3) stability of the pools in all assays; and 4) possible presence of interferences. A preliminary data analysis will be done to obtain a general assessment prior to determination of acceptance criteria for commutability, etc. The POINT/COUNTERPOINT article concerning troponin I standardization appeared in Clinical Chemistry online September 22, 2011 - POINT: Put Simply, Standardization of Cardiac Troponin I Is Complicated. Robert H. Christenson, David M. Bunk, Heinz Schimmel, and Jillian R. Tate, on behalf of the IFCC Working Group on Standardization of Troponin I† - COUNTERPOINT: Standardization of Cardiac Troponin I Assays Will Not Occur in My Lifetime. Fred S. Apple. The articles are planned for publication in the January 2012 issue of Clinical Chemistry. Term of Reference 2. Testing for cTnI standardization and clinical validation by comparison with validated commercial assays in a round robin study. Accomplishments include: There was no activity relevant to this term. Table of Analytical Characteristics. WG-TNI assumed responsibility for maintaining up to date information on the IFCC Website in the table of “Analytical characteristics of commercial and research high sensitivity cardiac Troponin I & T assays per manufacturers.” Table is linked to by European clinical societies so it is important to keep information current. WG also keeps the BNP table up to date. The updated Troponin table reports units in µg/L and ng/L. The WG proposes reporting units of troponin in ng/L only. The next update of the Troponin table is planned for 2012. • WG - Allowable Error for Traceable Results (WG-AETR) During 2011 ongoing progress towards WG-AETR terms of reference included: Term of Reference 1. To define clinically acceptable limits for metrological traceability of specific analytes. Accomplishments include: The WG is considering various ways to define clinically acceptable limits and has decided to initially work on analytes that have a traceability chain with well-defined individual steps. The WG considered the approach, which uses biological variation and although this is the preferred approach, in practice it is not feasible as the limits are too tight for use by manufacturers. The WG aims to develop limits, which are acceptable for use in a traceability chain and not only theoretical limits. Term of Reference 2. To cooperate with manufacturers, regulatory bodies and end-users to work towards patient results being traceable to higher order reference materials and methods. Accomplishments include: As part of developing allowable errors, the Chair again contacted all the major companies (previously done in 2010) asking how they define their in-house limits for the traceability chain. Specifically the request was for information on how the companies set reject limits for the various steps in the chain. Replies were received from 4 major manufacturers but from the responses it was not possible to derive a single consistent process. Term of Reference 3. Harmonization of patient results independent of assay platform, manufacturer or testing laboratory. Accomplishments include: There was no activity relevant to this term. • WG - Harmonization of Autoantibody Test (WG-HAT) During 2011 ongoing progress towards WG-HAT terms of reference included: Term of Reference 1. To evaluate what are the main causes of variability for a number of diagnostically critical autoantibodies. Accomplishments include: Three main areas for variability in autoimmune serology testing have been identified for investigation. 1. The antigen - and the variation in antigen preparations between different reagent producers. 2. The antibody - and the variation between the standard antibody preparation used to calibrate the various assays and the difference between the various calibrant materials and the samples being analyze and 3. The methods used for autoimmune serology testing. The HAT-WG addressed the antibody preparations used in the assays. IFCC Term of Reference 2. To identify autoantibodies where a common calibrator could reduce the interassay variability. Accomplishments include: The WG identified the following autoantibodies as candidates for common calibration: .IgG antibodies to proteinase III; IgG antibodies to myeloperoxidase; IgG antibodies to glomerular basement membrane; IgG antibodies to cardiolipin and beta-2 glycoprotein 1; and IgG antibodies to cyclic citrullinated peptides. Term of Reference 3. To identify or produce commutable materials that could be used as interim calibration material for autoantibody assays. Accomplishments include: The WG has concentrated on developing materials for IgG antibodies to myeloperoxidase and running a preliminary commutability study. The IRMM produced 18 candidate materials in total - a combination of different plasmaphoresis samples and affinity purified IgG antibodies to myeloperoxidase and prepared in a variety of ways. This was specifically to address the impact of preservatives, freeze-drying, and freezing. The commutability feasibility study was done at St. George's using 29 anonymized patient samples. Results suggest that there is clear potential for harmonization of results using a common reference material. Term of Reference 4. To produce well-characterized pure antibody preparations with known concentration and identity and use these to transfer values to a matrix preparation. Accomplishments include: There was no activity relevant to this term. • WG - Quality Specifications for Glucose POCT (WG-GPOCT) During 2011 ongoing progress towards WG-GPOCT terms of reference included: Term of Reference. To investigate the quality specifications required for glucose PoCT meters as glucose testing is used in a wide variety of health care settings including: Hospitals; General practice/Physicians Office; Specialists; Ambulances; Air Ambulances; Patients/Caregivers; Nursing Homes; Population Surveys. Accomplishments include: The WG agreed that the group would focus on glucose testing performed in the intensive care/critical care unit. This setting was chosen first as it potentially poses the highest risk to patients if not performed properly. A literature search for relevant papers was undertaken by each group member. Results from the literature search established that this work had not yet been performed and therefore the WG should address this gap in the literature. A meeting with FDA officials was held to review the work planned by the WG. The FDA was extremely positive with the work planned by the IFCC working group. FDA has agreed to work with the WG on this issue and potentially have one of its staff sit in on the WG. WG has planned an initial paper titled “Glucose meters - Does one size fit all.” The paper will discuss: - Use of meters in different clinical settings - guidelines that are currently available from different associations - interfering substances and patient populations they will affect - and introduce a checklist to assist with meter selection. This paper will also emphasize that good education is paramount to achieving good results no matter how good the meter performance is. • WG - Quantitative Mass Spectrometry Proteomics (WG-cMSP) This was a newly formed WG in 2011. The terms of reference include: Term of Reference 1. To review the state of the art in quantitative proteomics and to evaluate the capacity of different analytical (and preanalytical) approaches to play in the future a significant role for clinical biology. Term of Reference 2. To evaluate the specification and the need for reference materials for quantitative proteomics applied to clinical biology. Accomplishments include: To realize these terms of reference the WG decided to write a general review (“white paper”) on the subject (see sections below). First of all, to make the distinction with regular clinical proteomics, which deals mostly with biomarker discovery and validation, and with the different applications of Mass Spectrometry in clinical biology (bacteriology etc.), the WG choose the appellation “quantitative Clinical Chemistry Proteomics” (qCCP). qCCP will refer to the body fluid mass spectrometry quantitative measurement of peptides and proteins for clinical diagnosis. The review on qCCP will have the following sections: 1) Reference material: 2) Sample preparation: 3) MS approaches: 4) Criteria to select analytes for qCCP: 5) Review of the literature. Term of Reference 3. To design of a Quality Assurance/Quality Control (QA/QC) Program and to select a small series of analytes to be the subject of a future multisite validation study Accomplishments include: A shortlist of candidates included: Apo A1 / Herceptin / PTH / Renin / Haemoglobin / Hepcidin. Hepcidin was selected in the first place since it can be measured in different body fluids, with different MS approaches, ELISA and reference RIA method exist for comparison, and it has a clinical interest. However, this analyte is already the subject of a thoughtful multisite evaluation that includes MS approaches (see Kroot, J. J., H. Tjalsma, et al. (2011). "Hepcidin in human iron disorders: diagnostic implications." Clin Chem 57(12): 1650-1669). Therefore, the WG is considering Apo A1 /ApoB for a multisite evaluation of qCPP. Ian Young, SD Chair EDUCATION AND MANAGEMENT DIVISION (EMD) The committees and working groups of the Education and Management Division (EMD) have worked hard during the year to improve educational resources for IFCC member countries, particularly those developing their laboratory medicine services. The emphasis has continued to be on analytical and service quality and on emerging technologies. The EMD Executive Committee (EC) met twice during the year, in January in Orta San Giulio, Italy, and in Berlin during the 21st IFCC Congress. All the members participated to the two meetings except Rolf Hinzmann who was unable to be present in Berlin. The contributions of all the members were always very productive. Much of the work of the EMD requires both EMD Officers and international scientific experts to travel to conduct workshops and make presentations at congresses in IFCC member countries. To finance this, we are dependent on the generous sponsorship of our Corporate members, particularly Abbott Diagnostics, which provides very generous support for the Visiting Lecturer Program (VLP), very ably coordinated by Leslie Lai. During 2011, the following countries have benefited of VLP funding; Philippines, Argentina, Romania, Vietnam, Kenya, Uruguay, Nepal, Dominican Republic, and Poland. Several VLPs are already scheduled for 2012 and we would welcome applications from National Societies for visiting lectureships for the coming year. These should be made to Leslie Lai, who is able to provide advice on the process, lecturers, and topics. The EMD remains committed to the project for developing quality competence in medical laboratories (DQCML), chaired by Michael Thomas who has been reappointed for the second term as a Consultant and Chair. The DQCML sponsored the visit of Dr. Huy Quang Vu to the RCPA Chemical Pathology Quality Assurance Programs Office in Adelaide, Australia in July. Janice Gill tutored him and his colleagues on the practical aspects of organizing an EQA scheme and she will provide ongoing consultation to the Vietnam Center for QA/QC. Elizabeth Frank, Chair of the Committee on Clinical Laboratory Management (C-CLM), with T. Badrick, J. Special Supplement to Lab Medica International • 24 IFCC 2011 Annual Report Smith, and L. Lai organized a QA workshop in Manila in the Philippines in March. J Hicks worked a lot with the African Federation of Clinical Chemistry and organized a VLP in Kenya in September. The EMD welcomes applications from member Societies to host workshops on all aspects of laboratory quality. Travel Scholarships were approved for attendance at the IFCC WorldLab in Berlin. Only 8 out 12 were able to come because of visa problems. A meeting of the DQCML project team was held in Berlin on 16 May, during the IFCC WorldLab. It was interesting to hear updates on initiatives organized through the project, in particular, the activity in the Africa region, and in Nepal. Representatives of National Societies interested in the work of the different projects should contact Silvia Cattaneo. Following the success of the second course on molecular biology (C-CMBC) to be held outside Milan, in Uruguay in December 2010, a third course has been held in Guatemala in December 2011. This course was very successful and for the first time, there was a student from the previous course, Maria Eugenia Schroder from Uruguay, who was briefed to transfer her experience of the course to the new participants. It is the intention of the EMD that a course should be held on an annual basis, in a country, which has identified an educational need, to enable development of molecular biology services in their clinical laboratories. The course is extremely comprehensive and includes precourse training for a young scientist from the host country, in the laboratory of the Chair of the C-CMBC, Michael Neumaier, in Heidelberg, Germany. The success of these courses is a major achievement for Michael and his hard work and personal commitment to the initiative is recognized and much appreciated by the EMD. C-CMBC organized the Symposium “Biobanking and laboratory Medicine” during the IFCC-WorldLab in Berlin and held a committee meeting on May 16. Andrea Ferreira-Gonzalez from Richmond University is a new member and Evi Lianidou, and Kenji Izuhara were reappointed for second terms of office. Committee on Analytical Quality (C-AQ): Janice Gill and Egon Amann organized a teleconference on March 2011 and a full day meeting in Berlin on Sunday, May 15. An IFCC Visiting Lecture Program was held in Nepal from November 22-24, 2011. The program was entitled the International Workshop on Clinical Laboratory Management and there were 160 attendees. The VLP team was Janice Gill (Australia), Elizabeth Frank (India), and Clare Murphy (New Zealand) with the assistance of Dr. Ashpal Singh (BD India). The IFCC EMD, through Dr. Leslie Lai has arranged for Randox to sponsor a number of Nepali laboratories with their RIQAS external quality assessment scheme. Dr. Huy is currently setting up an EQA program for 120 labs using previous purchased EQA material. The Committee for Evidence-Based Laboratory Medicine (C-EBLM), under the chairmanship of Robert Christenson, has continued its excellent work in the provision of presentations and workshops on EBLM techniques. Workshops and lectures involving C-EBLM members were held in Berlin by Dr. Christenson on cardiac markers and in Atlanta in conjunction with AACC's EBM committee on July 27. Hernan Taie has continued to be very active, and has participated and led a number of educational sessions throughout South America and of Central America. To spread knowledge of the concepts of EBLM more widely, The Committee is hoping to use the new IFCC Website as a means to deliver training in evidence based laboratory medicine. The Committee on Education and Curriculum Development (C-ECD) was closed at the end of 2010. It is inevitable that distance learning will become a major educational tool for the EMD in the future; for this reason after a discussion in Berlin, a new Committee on Distance learning has been planned to start in 2012. The Committee on Clinical Laboratory Management (C-CLM) completed the Manila workshop in March 2011. Elizabeth Frank, with T. Badrick, J. Smith, and L. Lai organized a very successful QA workshop and a workshop on clinical interpretation. Two new members of the C-CLM, Barbara Goldsmith (USA) and Ravi Erasmus (ZA) have been welcomed to the Committee and a committee meeting was held in Berlin in May, at which there were extensive discussions on future directions for its work. Elizabeth Frank was involved in the International Workshop on Clinical Laboratory Management in Nepal from 22-24 November 2011. The second C-CLM monograph, Quality of Management & Quality of Analysis, prepared by past and present members of the C-CLM and C-AQ is at the review stage. The work of the Working Group on Bone Marker Standards in Osteoporosis (WG-BMS) is now complete with the publication of their paper in Clinical Chemistry and Laboratory Medicine, highlighting the IFCC and IOF position on bone marker standards. The recommendations of the WG have been widely publicized in national and international journals. The next phase of the project will be the standardization/harmonization of the measurement of the two reference standard bone markers, namely s-CTX and s-PINP and this new WG will be within the Scientific Division. Working Group on Laboratory Errors and Patient Safety (WG-LEPS): After the meeting of the WG Chair, Mauro Plebani with the EMD-EC in Lago d'Orta at the beginning of 2011 and the recommendations received by the IFCC President, the activities of the WG have been publicized, to spread information on the work on quality indicators and to appoint some leaders in each country to make possible a better interaction at a national level (Brazil, Turkey, Ireland, China, Croatia, Serbia). Dr. Plebani delivered several lectures on this topic (UK, USA, Brazil, Turkey, Ireland). Flow cytometry (WG-FC): Ulrich Sachs is the new Chair of this working group. He has agreed to work with Beckman Coulter to organize future flow-cytometry courses. Next course will be held during the spring in Leipzig, Germany. At the end of 2011, Janet Smith completed her second term of office as EMD chair and I would like to take this opportunity to thank her for their commitment to the work of the EMD over many years and to help me so much in this transitional phase. I would also like to thank all members of EMD Committees and Divisions for their hard work and support during the year. Maurizio Ferrari, EMD Chair COMMUNICATION AND PUBLICATIONS DIVISION (CPD) Activities and Reports 7 COMMITTEES Committee - Public Relations The IFCC promotional brochure was updated after the elections in Berlin and is/will be available in nine languages (Arabic, Chinese, English, French, German, Italian, Portuguese, Spanish, and Russian.) Print copies in these languages are available in the IFCC office for distribution at different meetings. A Turkish version will be prepared in time for the 2014 IFCC in Istanbul. An IFCC laboratory medicine slide kit (PowerPoint presentation) for the general public, describing the role and value of laboratory medicine, has been developed and is available for use by all IFCC officers and National Societies. A proposal for an IFCC Task Force on the Value of Laboratory Medicine in Healthcare and in Clinical Outcomes was developed and submitted to the EB. It was approved in concept but some changes were requested. The proposal will be finalized in early 2012 and be resent to the EB. A PR brochure for the general public is being developed and is expected to be completed in 2012. Joint IFCC-“Labs are Vital” PR Initiative - The PR committee has been interacting with the managers of the LAV program and two of the committee members are members of the KOL(key opinion leaders) board of the LAV program. The mission of the LAV program has been modified to have a particular emphasis of developing evidence for the vital role of the clinical laboratory in the healthcare delivery system. Labs are Vital advisory board is getting more active. Working Groups Working Group - eJIFCC This is the last year of Prof. Grazyna Sypniewska's term as chair of the eJIFCC Working Group (eJIFCC Editorial Board) and Editor in Chief of the eJIFCC Editorial Board). Prof. Gabor Kovacs (Hungary) will be the next chair/Editor in Chief. The publication schedule, consisting of 4 issues per year (see Appendix 1), is being adhered to. Starting last year there are no longer themes to the issues, because of the difficulty in obtaining enough manuscripts on a selected subject within a reasonable time, rather the content is now oriented toward practice issues and audits. This decision is being reviewed in light of the upcoming changes in the Editorial Board and that it is anticipated that the new publisher will work with the IFCC in developing, promoting, indexing, and building impact factor of the eJIFCC. Working Group - IFCC News WG membership consists of representation from Belgium, Brazil, Canada, Cyprus, Malaysia, Mexico, Morocco, Nepal, Nigeria, Poland, Slovenia, South Africa, Spain, Tunisia, Uruguay, and Vietnam. Additionally, there are now National Society liaisons from Australasia, Serbia, UK, USA, Paraguay, and Vietnam. Members are required to submit at least two articles per year. The schedule of six issues per year has been maintained with good content (see Appendix 2). However, the shortage of opinion, position papers, and letters to the editor still remains somewhat problematic. Letters have been sent to the chairs of divisions and committees reminding them to provide news items, along with the submission deadlines for the various issues.The relationship between IFCC and LabMedica International for the print publication of IFCC News continues to be smooth and without issues. Working Group - Internet and Distant Learning There were over 104,000 visits to the IFCC Website during 2011, with 32% being return visitors. The first phase of the launch of a new Website occurred on December 1. It is based on a content management system and has a cleaner look and easier navigation. Maintenance/file updating has been simplified. Some of the archive files still need to be transferred. The C-NPU database has been placed on the Website and a special search function is being developed. There is a scrolling banner on the Website homepage that contains the logos of the Corporate Members, which are hotlinks to their Website. The second phase of the Website launch is plan to include a: 1) IFCC Digital Library, 2) NPU database query engine, 3) IFCC Store with a payment function, and 4) controlled access (protected) areas. The C-EBLM database has to be rebuilt. A Wikipedia entry for the IFCC was created in December in English and now acts as the second major contributor of Website traffic (after search engines). IFCC Facebook and LinkedIn pages have been established and it is expected that these will be used as forum sites for the IFCC, rather than the Website. Siemens/IFCC Distance Learning Program The first part of the multipart distance learning program on developing a quality system in line with ISO 15189, based on the EMD workshop, has been developed and is being reviewed by the EMD. Working Group - Spanish (Ibero-American) Nomenclature and Translations The WG is working very diligently to continuously refine and update the RIA section. Reports on Publications Documents from Committees and Working Groups The database (available on the Website) continues to be updated, as publications are forthcoming. See appendix 3 for the list of 2011 publications. Books The 2012-14 IFCC Handbook is being prepared and will be distributed on a CD, as well as being available on the IFCC Website. Revision and updating of the "Silver Book": Compendium of Terminology and Nomenclature of Properties in Clinical Laboratory Sciences (IUPAC and IFCC Recommendations) is expected to be completed and published in mid 2012. Journals This was the second year of Ellis Jacobs' second term as CPD chair. Three face-to-face committee meetings were held (Milan in January, Berlin in May, and Toronto in September). A meeting was held with editors and publishers of National Society biomedical journals at WorldLab 2011 in Berlin. There was a joint CPD/EMD symposium at WorldLab2011 on eLearning and distance education, and a CPD symposium on peer review and ethics in publications at the COLABIOCLI congress in Punta Cana, DR. Additionally, the entire CPD EC presented in a special half day IFCC Symposium that was held in Toronto, CA. A new IFCC Website was launched in December. A Request for Proposal for publishing the eJIFCC as the official journal of the IFCC was sent. The WG-Internet and Distance Learning will be closed at the end of 2011 and be replaced by a Committee on Internet and eLearning (C-IeL) that will start in 2012 with Peter Vervaart as chair. Meeting of National Society Journal Editors / Publishers This year's meeting was held in Berlin, Germany at the International Congress of Clinical Chemistry. Nine society journals and one publisher were represented at the meeting. There were discussions concerning copublications/copyright issues, free (open) access, electronic vs. print publishing, and ethics policies. Clinical Chemistry & Laboratory Medicine (CCLM) The contract with Walter deGruyter relative to CCLM being the official journal of the IFCC expires July 22, 2013. Currently, all IFCC documents are available free on the CCLM Website. Free access to full online version is available for all NR & PR of member societies, CR, EB, DC, and IFCC Regional presidents. There are Special Supplement to Lab Medica International • 25 8 2011 Annual Report also reduced-rate subscriptions available for the paper CCLM through National Societies. A request for proposal for publishing the eJournal as the official journal of the IFCC, rather than an existing journal, was sent. Corporate Member Activities The new corporate representative, Bruce Jordan (Roche Diagnostics), has been a very active participant in the CPD EC meetings and was a presenter at the symposium in Toronto. He has been working with the WGIDL in helping get distance-learning content. Membership Gabor Kovac has been appointed to replace Grazyna Sypniewska at the end of her term. Call for Nominations for Vice Chair and IFCC News editor, with terms starting in 2013 have been sent out. Ellis Jacobs, Chair CPD IFCC TASK FORCES • TASK FORCE FOR YOUNG SCIENTISTS (TF-YS) The aim of IFCC Task Force for Young Scientists (TF-YS) is to ensure that young scientists make a significant and growing contribution to the activities of IFCC and to the promotion of laboratory medicine at the center of healthcare. TF-YS projects Core-members are interacting and reviewing the evolution of the TF-YS projects mainly through Skype conference call (bimonthly). Furthermore, different meetings with some core-members, members and the IFCCEB Liaison Dr. B. Gouget were organized in Berlin (Euromedlab 2011), Rabat (SMCC 2011), Atlanta (AACC 2011), and Paris (JIB 2011). and in Anaheim within the AACC annual meeting in July. Networking and identification of young scientists One of the most important goals of the TF-YS is to contribute to a part of the future of IFCC through the identification of young scientists (YS) who may develop into future experts capable of leading IFCC Divisions, Committees and Working Groups and becoming IFCC Officers. In 2011, the TF-YS proposed several networking sessions to stimulate other YS from national societies and corporate members to participate to IFCC and TF-YS projects. Sessions were held in Rabat (SMCC 2011), Berlin (Euromedlab 2011), Atlanta (AACC 2011), Bucarest (BCLF 2011), Paris (JIB 2011), and Gwalior (ACBI 2011). These sessions have allowed identifying young scientists, from different fields of expertise, in 35 countries. YS have thus been identified in Romania, Poland, Morocco, Algeria, Tunisia, China, Nepal, United Kingdom, Ireland, Singapore, Turkey, Albania, South Africa, Brazil, Korea, Malaysia, India, Egypt, Ukraine, Serbia, Venezuela, Mexico, Canada, Greece, Democratic Republic of Congo, Qatar, China, Italy, Austria, Australia, Czech Republic, Russia, France, USA, and Belgium. A clear strategy for our task force is to federate these new forces and to ask those YS to create groups of YS in their respective country/area. Exchanges have also been initiated with other groups of young scientists: Young Scientists of Ireland, Young Active Researchers Endocrinology, Belgian Young Cardiologists Club, and Young Scientists of the Asian Society of Autoimmunity. Our task force is also maintaining active the group created on Linkedin one year ago is also precious to disseminate the information of these networking activities but also to interact with YS and catch their wishes. This Linkedin group is still growing. IFCC Seccombe and Graham Jones [via pre-taped slide presentation]). An outcome of this meeting was the establishment of the Mexican Steering Committee for Early Detection of Renal Disease. A joint symposium of the IFCC and WASPaLM Task Force was presented at the IFCC meeting in Berlin. Symposium Title: Chronic Kidney Disease - Developing a National Testing Program. Speakers: Flavio Alcantara: CKD - A Global Clinical Perspective. David Seccombe: Why a national program for CKD testing? Graham Jones: Key factors in successful national CKD programs. The contents of the talks were submitted to the Conference organisers for inclusion in a publication arising from the conference. The Task Force had a face-to-face meeting in Berlin to coincide with the IFCC meeting with a number of guests present. Graham Jones, TF Chair • TASK FORCE ON ETHICS - (TF-E) The TF held an interactive educational session on ethics during WorldLab in Berlin. Attendance was limited, but above the average attendance at the concurrent sessions held at that time. Ethical issues in publishing were discussed. The focus remained on publication ethics for half of the workshop and then moved to broader areas of ethics in laboratory medicine. Participants were concerned that ethics receives too little attention and is not even covered in textbooks of clinical chemistry. The demands of laboratory medicine lead clinical chemists to focus on keeping up to date on new technical and medical developments at the expense of learning about ethics. The wide range of cultures in IFCC leads to differences in approach to ethics. Resources on ethics to be made available on IFCC Website The TF will provide on the IFCC Website examples of available resources in ethics. The group identified topics for inclusion on the Website: resources for publication ethics (e.g., links to ICMJE, COPE, Clin Chem), conflict of Interest Policies of organizations (e.g., AACC), codes of Ethics, Clinical Chemistry and Laboratory Medicine ethics. Conflict of interest (COI) policies The TF has recommended a policy on conflict of interest (COI) for use within IFCC. Policy on relations with industry The relations of professional societies with industry are being scrutinized by media and governments. Policies on these relations have been developed by individual companies in the IVD industry, by industry associations (such as AdvaMed and EDMA) and by professional societies. The sentiment of the TF was that IFCC should have an explicit policy. Statement on publication ethics The TF has discussed a statement on publication ethics David Bruns, TF Chair • TASK FORCE ON IMPLEMENTATION OF HEMOGLOBIN A1c STANDARDIZATION (TF-HbA1c) Publication of articles The exchanges between TF-YS members have also provided written materials discussing needs and visions about laboratory medicine future. Based on all the collected information, a new manuscript about the YS environment is in preparation. Several articles have been published by YS in the IFCC news as well as in the newsletter of the congresses were a TF-YS session was held. The TF met in Berlin and agreed on a number of projects: • A questionnaire about national experience would be devised: This has been drafted and will be circulated using Survey Monkey. • A short position paper would be drawn up outlining the traceable link between the IFCC and NGSP networks. This will be sent to a Clinical Journal; JAMA has been approached and are interested in taking it. • A full review will be written on HbA1c outlining the current situation and the future (Analytical and Clinical). Background work for this paper is well underway; it will be further discussed at the International Diabetes Federation. This has been a very successful and productive year; communication is important and this year both GJ and CW have had the opportunity to talk about IFCC standardization at several international meetings. There is a lot of interest especially from Asia with applications from three laboratories to become IFCC reference laboratories. Web-based activities Web-based activities are important for the appropriate growth and efficiency of the TF-YS but were lacking in 2011. As the new IFCC Website has been released, we hope that 2012 will allow us to use this tool more. • TASK FORCE ON CLINICAL APPLICATIONS OF CARDIAC BIOMARKERS - (TF-CB) Garry John, TF Chair Damien Gruson, TF Chair • TASK FORCE ON PEDIATRIC LABORATORY MEDICINE (TF-PLM) The purpose of this Task Force is to develop procedures and processes to improve the diagnosis and management of patients from birth (or even before) to adolescence. The International Conference of Pediatric Laboratory Medicine (ICPLM) 2011 was held in Berlin, May 1315, 2011, with more than 330 registered participants, 4 Plenary Lectures, 10 Symposia with more than 30 speakers, and over 90 Scientific Posters. With more than EUR 60,000 in sponsoring money and more than EUR 50,000 from registrations, it was also a financially successful congress. A Task Force Meeting was held during the AACC Annual Meeting, Atlanta (GA, USA; July 27), where ICPLM 2011 was evaluated, and first planning for ICPLM 2014 was started. Klaus P. Kohse, TF Chair • TASK FORCE ON PHARMACOGENETIC - (TF-PG) The Task Force had a face-to-face meeting in Berlin to coincide with the IFCC meeting with a number of guests present. A draft version TPMT guideline was sent out for review to committee members and to representative of the British association for Dermatology. Two feedbacks were obtained. The TF extended international contacts regarding Pharmacogenetics. TF also obtained information on current status and potential applications from pharmacogenetics through contacts and presence during international Pharmacogenetics meetings. TF created contacts with other societies, which aim for guideline development on Pharmacogenetics. The TF Chair Ron van Schaik was appointed as advisory member EMA Working group Pharmacogenetics. TF promoted TF-PG initiative at several meetings (a.o. IFCC World-lab-Berlin, IATDMCT-Stuttgart, SBAC-Curitiba, Turkey PGx meeting-Bodrum, PharmSciFair-Prague, Pharmacogenomics meeting-Welcome Trust Hinxton, NVKC-Utrecht, NACGG-Utrecht). Ron HN van Schaik, TF Chair • IFCC and WASPaLM TASK FORCE ON CHRONIC KIDNEY DISEASE (TF-CKD) Two members of the Task Force contributed to a symposium on CKD in Mexico on January 8, 2011, (David TF-CB include 3 cardiologists (Jaffe, Lindahl, Möckel), 2 ED physicians (Hollander, Than) and 5 laboratorians (Apple, Collinson, Chan, Ordonez, Plebani) and all them are also Editors or members of Editorial Boards of Clinical Laboratory, Cardiology or Emergency Medicine journals and members of Committees working in similar objectives than those of the TF-CB. Accordingly, the TF composition seems quite appropriated for addressing the IFCC objectives of directing laboratory activities towards the patients and promoting publications and educational materials. The TF has also eight companies as corporate members. The companies share the TF aim of developing educational materials for the medical community and offer both economical and logistic support for reaching the TF aims. The TF met in Berlin (IFCC EFCC EuroMedLab Berlin), Atlanta (AACC meeting), and Paris (European Society of Cardiology meeting). Current Projects The first project will be the development of educational materials about high-sensitive troponin uses, since they are being introduced in the clinical practice without an extensive knowledge of their pros and cons. Lab issues production Two of the TF members were committed by Clinical Chemistry Journal to write a paper analyzing the lab issues of high-sensitivity troponin (hs-Tn) assays for a special issue on Cardiac Biomarkers (“Analytical Characteristics of High-Sensitivity Cardiac Troponin Assays”), written by Fred S. Apple and Paul O. Collinson on behalf of the IFCC Task Force on Clinical Applications of Cardiac Biomarkers will appear in the monographic issue of January 2012 of Clinical Chemistry. Jorge Ordoñez-Llanos, TF Chair IFCC Annual Report 2011 has been compiled and edited by Päivi Laitinen, Secretary of IFCC from the reports of the respective IFCC Officers and Regional Federations. FOR MORE INFORMATION ON THE IFCC CONTACT: IFCC Office • Via Carlo Farini 81, 20159 Milan, ITALY Tel: (39) 02-6680-9912 • Fax: (39) 02-6078-1846 e-Mail: ifcc@ifcc.org • Web: www.ifcc.org Special Supplement to Lab Medica International • 26 LabMedica for daily laboratory medicine news click to www.labmedica.com NIST Standard Will Help Diagnosis, Treatment of Cytomegalovirus new clinical Standard Reference Material (SRM) will help healthcare professionals more accurately diagnose and treat Cytomegalovirus (CMV), a common pathogen that is particularly dangerous for infants and persons with weakened immune systems. If a CMV infection becomes dangerous, antiviral agents can be used to moderate the impact. Many of these compounds are toxic, so the physician must know the severity of the infection – a measure known as viral load (number of virus copies per microliter of blood) – to prescribe the optimal dosage and duration of treatment. A Test Identifies Early Signs of Mucopolyscaccharidoses team of scientists has developed a simple, reliable test for identifying biomarkers for mucopolysaccharidoses (MPS), a group of inherited metabolic disorders that are currently diagnosed in patients only after symptoms have become serious and the damage possibly irreversible. The scientists developed an innovative method to detect carbohydrate structures specific to glycosaminoglycans in the cells, blood, and urine of MPS patients. The biomarker assay identifies all known forms of the disease. The effects of MPS range from mild to severe. It is caused by the absence or malfunctioning of a lysosomal enzyme required to break down and recycle complex sugar molecules called glycosaminoglycans, which are used to build bone, tendons, skin, and other tissues. If not degraded and removed, glycosaminoglycans can accumulate in cells and tissues, resulting in progressive, permanent damage affecting appearance, physical abilities, organ function, and often mental development in young children. There are 11 known forms of MPS, each involving a different lysosomal enzyme. A number of treatments exist, including enzyme replacement therapy and hematopoietic stem cell transplantation, but efficacy depends upon diagnosing the disease and its specific form as early as possible. That has been problematic, said Jeffrey D. Esko, PhD, professor in the Department of Cellular and Molecular Medicine and codirector of the Glycobiology Research and Training Center at University of California (San Diego, CA, USA; http://cmm.ucsd.edu). “The typical time from seeing first symptoms to diagnosis of MPS is about three years. Since the early signs of disease are common childhood issues like ear infections and learning disorders, the disease is usually not immediately recognized,” Prof. Esko said. Prof. Esko is collaborating with Zacharon Pharmaceuticals (San Diego, CA, USA; www. zacharon.com), a biotechnology company, to develop a commercial diagnostic assay for differentiating forms of MPS from urine and blood samples, a screening test for newborns, and a tool for measuring the biochemical response of MPS patients to existing and novel therapies. The findings were published online January 8, 2012, in the journal Nature Chemical Biology. A 27 LabMedica International April/2012 The current means of measuring viral load is to use polymerase chain reaction (PCR) to amplify a region of the CMV gene and then use a calibration curve to estimate the number of virus particles in the original sample. Accuracy of these measurements can vary greatly from one test facility to another, as there are many different PCR protocols used to determine viral load, including commercial and “in-house” laboratory assays. The new [US] National Institute of Standards and Technology (NIST; Gaithersburg, MD, USA; www.nist.gov) reference, SRM 2366, provides a standardized CMV DNA. Consistency of the viral DNA in the standard was ensured by manufacturing it in Escherichia coli bacteria. These E. coli cells each contain a copy of the CMV genome in a “DNA construct” – an artificially constructed segment of nucleic acid that codes for a specific product, in this case, CMV DNA. The DNA copies made by this E. coli cell culture can then be purified and quantified LINKXPRESS COM using digital polymerase chain reaction (PCR). SRM 2366 consists of three solutions, each with a specific concentration of CMV DNA copies per microliter: 420, 1,702, and 19,641. These are designed to qualify prepared calibration samples. They also can be used as quality control samples for diagnostic equipment. For added traceability, the SRM certificate of analysis includes the genetic sequences of the nine CMV genome regions copied for the standard. CMV is found in 50% to 80 % of the population. CMV generally remains latent in an infected person unless certain conditions trigger its activation. CMV poses a significant health risk to people who are immunocompromised and babies who receive the virus from their mothers before birth. Congenital CMV infections cause more long-term problems and childhood deaths than many other prenatal disorders including fetal alcohol syndrome, Down syndrome, and neural tube defects such as spina bifida. LMI-04-12 127 PRODUCT NEWS To receive prompt and free information on products, log on to www.LinkXpress.com or fill out reader service form located on last page LAB SOFTWARE HEMATOLOGY ANALYZER ATOMIZING NOZZLES Sunquest Information Systems URIT The Lee Company The Sunquest Laboratory Version 7.0 features an intuitive, interactive, and customizable graphical user interface for a more personalized user experience. The Clinical Validation module serves to automate the review process for test results requiring multilevel analysis. The URIT-5500 is a 5-Part-Diff automatic analyzer that allows for walkaway automation, high efficiency, and accuracy. Other key benefits include double mode for WBC counting, high precision sample rotary valve, helium-neon laser light, and a throughput of up to 110 samples per hour. The atomizing nozzles generate a 50-degree cone spray pattern, and offer precise, controlled atomization. The compact nozzles will atomize with pressures as low as 137.9 kPa on water, and are available in airless and air-assisted styles. LINKXPRESS COM LMI-04-12 209 LINKXPRESS COM LMI-04-12 210 LINKXPRESS COM LMI-04-12 211 ESR ANALYZER Vital Diagnostics The Excyte 40 automated analyzer performs a complete sedimentationrate test in only 30 minutes, with preindication in nine minutes. The system holds up to 40 samples, allowing for up to 80 tests per hour, and offers on-board QC, as well as optional printer, mixer, and barcode scanner. LINKXPRESS COM LMI-04-12 212 Centrifugal Speed Affects Light Transmission Aggregometry ight transmission aggregometry (LTA) is considered the gold standard for investigating platelet activity ex vivo, but LTA protocols are not standardized. Centrifugation speed is an essential component of platelet preparation in LTA and has yet to be standardized, which may affect platelet aggregation leading to a potential source of variance in results. In a study, conducted at the New York University School of Medicine (NY, USA; www.med.nyu.edu) the effect of relative centrifugal force (RCF) intensity on LTA results was investigated. Ten healthy controls had venous blood drawn and centrifuged at 150, 200, 300, and 500 x g for 10 minutes. Cell counts in whole blood and platelet-rich plasma (PRP) were measured using a hematology analyzer. LTA was performed using 1.0 µM adenosine diphosphate (ADP) and 0.4 µM epinephrine as an agonist. The percentage of aggregation was compared at 60, 120, 180, and 300 seconds and at maximum L aggregation. Centrifugation speed was associated with a statistically significant decrease in platelet counts and decrease in mean platelet volume in PRP. Consistently, platelet aggregation in response to 0.4 µM of epinephrine decreased significantly with increasing centrifuge RCF at 60, 120, 180, 300 seconds and at maximum aggregation. Whole blood and PRP cell blood count were performed using a Sysmex XE-2100 analyzer (Mundelein, IL, USA; www. sysmex.com). LTA was performed using the AggRAM light transmission aggregometer, reagents, cuvettes, and stir bars (Helena Laboratories, Beaumont, TX, USA; www.helena.com). The authors concluded that using different centrifuge RCF results in changes in PRP properties and LTA. This difference in methodology gives pause to comparing LTA from studies with different protocols and may help explain some of the inconsistencies observed in the field. Consequently, consideration should be given to standardize centrifugation parameters in performing LTA. The study appeared in the February 2012 edition of the International Journal of Laboratory Hematology Image: The XE-2100 hematology analyzer (Photo courtesy of Sysmex). Multiple Candida Species Detected by Molecular Technique simplified, specific, and sensitive seminested (PCR) method has been developed to identify medically important Candida species. Novel primer sequences were designed and the seminested PCR was capable of detecting a larger number of Candida species by using annealing temperatures of either 60 °C or 65 °C in the second round of the seminested PCR. At the Universiti Putra Malaysia (Serdang, Selangor, Malaysia; www.upm.edu.my) scientists designed species-specific reverse primers (SSRPs) of 10 Candida species by retrieving at least three internal transcribed spacer (ITS) gene sequences of each species. DNA amplification was performed in a MasterCycler gradient thermocycler. To test the specificity of the method, 27 Candida A clinical isolates, 10 Candida American Type Culture Collection (ATCC; Manassas, VA, USA; www.atcc.org) strains, six Aspergillus ATCC strains, one Cryptococcus neoformans clinical isolate, and one human genomic DNA from an apparently healthy human volunteer were tested. After optimizing the PCR conditions on the MasterCycler thermocycler (Eppendorf; Hamburg, Germany; www.eppendorf.com), the targeted 10 Candida species showed an expected approximate size of PCR amplicons after the second round of PCR with their respective SSRPs. A similar observation was seen when tested on the 27 Candida clinical isolates of various species in the analytical specificity testing. The limit of detection for all Candida species ranged from 0.26 pg to 0.46 pg, except for Candida guilliermondii and Candida kefyr where a 10-fold increase in DNA amount was required. The authors concluded that the advantages of the high sensitivity feature of seminested PCR were successfully applied, while the drawback usually faced, especially on the limited capability of detecting more species, was overcome. Its usage is favorable in invasive types of fungal infection cases since early rapid detection can be done. This helps to lessen the rate of drug resistance emergence and the precarious use of costly and toxic antifungal drugs for prophylaxis and treatment purposes. The study was published on December 10, 2011, in the journal Diagnostic Microbiology and Infectious Disease. LabMedica International April/2012 28 LabMedica for daily laboratory medicine news click to www.labmedica.com Molecular Assay Compared to Urinary Culture for Congenital Infection real-time polymerase chain reaction (rt-PCR) assay has been evaluated to diagnose Cytomegalovirus (CMV) infection in the urine of neonates. The real-time CMV PCR was compared with shell vial culture of neonatal urine, which is referred to as the gold standard in the diagnosis of congenital CMV infection. A team of microbiologists at the Leiden University Medical Center (The Netherlands; www.lumc.nl) analyzed a series of 340 neonatal urines received for congenital CMV diagnostics and routinely assessed with shell vial CMV culture, was retrospectively tested by real-time CMV PCR. All 25 CMV culture positive samples and a large random selection A of 315 CMV culture negative urine samples dating from 2001 to 2011 were included in the analysis, irrespective of clinical characteristics of the newborns. DNA extraction was performed on the MagNA Pure LC station using the Total Nucleic Acid Isolation Kit – High Performance Kit Roche Diagnostics, (Almere, The Netherlands; www.roche.nl) and the PCR was carried out using a CFX96 TM real-time PCR detection system (BioRad; Veenendaal, The Netherlands; www. bio-rad.com). The proportion of newborns found to be congenitally infected by real-time CMV PCR was 8.2% (28/340), and 7.4% (25/340) by rapid culture. When considering rapid culture as reference, real-time PCR was highly sensitive (100%), whereas sensitivity of rapid culture was 89.3% when considering realtime PCR as reference. The authors concluded that supported by analytical and clinical data on CMV DNA detection in neonatal urine, their results suggest enhanced sensitivity of recent PCR techniques when compared to viral culture. There is considerable rationale to favor real-time CMV PCR as a gold standard in the diagnosis of congenital CMV infection. A large-scale study combining both laboratory and clinical data is required to determine the exact time frame for sampling of neonatal urine when using real-time Elevated Glucose Associated with Undetected Heart Damage levated levels of glycated hemoglobin (HbA1) are associated with minute levels of the protein troponin T (cTnT), a blood marker for heart damage. A high-sensitivity blood test has been used to detect levels of cTnT showed that the concentrations were tenfold lower than those found in patients diagnosed with a heart attack. Scientists at the Johns Hopkins Bloomberg School of Public Health (Baltimore, MD, USA; www.jhsph.edu) tested the hypothesis that in persons without clinically evident chronic heart disease (CHD) or heart failure, chronic hyperglycemia, assessed by HbA1c, would be independently associated with subclinical myocardial injury measured by elevated cTnT. The cTnT was measured using a novel high-sensitivity assay; Elecsys Troponin T (hs-cTnT) with a lower limit of detection of 3.0 ng/L. Elevated hs-cTnT was defined as levels above 4 ng/L in a healthy subpopulation, which were 20 to 70 year old. The scientists followed 9,662 participants from the Atherosclerosis Risk in Communities (ARIC) study. None of the participants had coronary heart disease or history of heart failure. Higher levels of HbA1c were associated in a graded fashion with elevated levels of high-sensitivity cTnT. This relationship was present at HbA1c levels even below the threshold used to diagnose diabetes. Using conventional tests, troponin T can be detected in 0.7% of the population and is associated with heart attacks and death. With the high-sensitivity Elecsys Troponin T test (Roche Diagnostics; Indianapolis, IN, USA; www.roche-diagnostics.us) low levels of troponin were found in 66% of the study population. Jonathan Rubin, MD, a lead author of the study, said, “Our study hints at other potential pathways by which diabetes and elevated glucose are associated with heart disease. Mainly, glucose might not only be related to increased atherosclerosis, but potentially elevated glucose levels may directly damage cardiac muscle.” The study was published on January 31, 2012, in the Journal of the American College of Cardiology. E 29 LabMedica International April/2012 LINKXPRESS COM LMI-04-12 129 PCR. The study was published in the February 2012 issue of the Journal of Clinical Virology. Image: The MagNA Pure LC workstation (Photo courtesy of Roche). PRODUCT NEWS CHEMILUMINESCENCE ANALYZER DiaSorin The Liaison XL is designed to provide 50%-90% higher throughput than the existing Liaison analyzer. The system features secure traceability of all processes, from the status of reagents and consumables to the information used to monitor work. LINKXPRESS COM LMI-04-12 213 To receive prompt and free information on products, log on to www.LinkXpress.com or fill out reader service form located on last page A1C SYSTEM ELISA READER EKF Diagnostics Erba Mannheim Euroimmun The Quo-Test analyzer features enhanced accuracy, bias, and repeatability for samples from diabetic patients in the critical clinical area. Key benefits include userfriendliness, consistent performance, reliability, and flexibility. The LisaScan EM is designed as an automated microplate reader that can perform various tests with reports and printing of graphs. Features include single, dual, and multiwavelength reading options, a built-in shaker with 3-variable mixing, and self-diagnostic capabilities. Two ELISA systems are intended to provide separate detection of antibodies in Bordetella pertussis infections. One ELISA detects antibodies against PT and the other detects antibodies against FHA, with both offering ease of use, accuracy, and reliability. LINKXPRESS COM LMI-04-12 214 LINKXPRESS COM LMI-04-12 215 ELISA SYSTEMS LINKXPRESS COM LMI-04-12 216 Oncology Biomarker Database Includes Cancer Companion Diagnostic Pathway comprehensive cancer biomarker database has been launched that can help in finding new diagnostic, prognostic, and companion diagnostic biomarkers. The database includes cancer A LINKXPRESS COM companion-diagnostics biomarker pathway maps. It contains more than 8,500 discovery phase, preclinical, or clinical cancer biomarkers that were identified or validated using patient derived samples. LMI-04-12 130 Sciclips (Madison, MI, USA; www.sciclips. com) launched the database, which covers a wide variety of biomarkers such as blood cancer biomarkers (peripheral blood, plasma, serum etc), tumor biomarkers, urinary cancer biomarkers, fecal cancer biomarkers, saliva cancer biomarkers, breath cancer biomarkers, etc. More than 100 types of cancer are included in the cancer biomarker database. For each cancer type, the biomarkers are classified into diagnostic biomarkers; for the diagnostics application, disease predictive/risk assessment biomarkers; for predicting the risk or genetic susceptibility in developing cancer; drug efficacy/response biomarkers; biomarkers for studying the efficacy of anticancer drug treatments, including predictive biomarkers and prognostic biomarkers; and for determining the clinical outcome in cancer patients. The types of cancer biomarkers include protein biomarkers, miRNA biomarkers, single-nucleotide polymorphism (SNP) biomarkers, gene expression biomarkers, epigenetic biomarkers, and metabolomic biomarkers. With the growing trend of personalized healthcare concept and advance in biomarker research, there is a need for development of innovative personalized cancer drugs with companion biomarker assays to identify the most appropriate cancer patient, tumor type, and disease state. Patient/sample details, experimental results, observations, biological and molecular functional analysis, biological process analysis, protein-protein interaction networks of each biomarker are listed in the database. The pathway maps will help to identify new anticancer drug predictive and response biomarkers for the discovery of new drug targets with improved efficacy or targeted therapy to overcome side effects, patient stratification, developing personalized strategies for monitoring cancer progression, treatment, diagnosis, and prognosis. Image: Companion diagnostics pathway analysis of biomarkers associated with doxorubicin cardiotoxicity in childhood acute lymphoblastic leukemia (Photo courtesy of Sciclips). LabMedica International April/2012 30 LabMedica for daily laboratory medicine news click to www.labmedica.com Lectin-Based Test Estimates Glycated Hemoglobin novel method has been developed for estimating the glycated hemoglobin (HbA1c) in normal and diabetic patients using a glucose specific lectin. The quantitative precipitin method was performed for the interaction between the glucosespecific lectin Concanavalin A (Con A) and the glucose-containing RBC-lysate for the estimation of calculated HbA1c% from a standard curve. Scientists at the Cancer Centre Welfare Home and Research Institute, (Kolkata, West Bengal, India; www.cancercentrecalcutta.org) selected 16 patients of both sexes with type-2 diabetes, age range 35–60 years, and four patients with newly diagnosed type-1 diabetes, age range 15–41 years. Twenty sex-matched normal healthy subjects, age range 33-65 years, were also included as controls. A precipitation test of red cell lysate and Con-A was performed and the precipitate estimated spectrophotometrically at 480 nm. For reference, plasma glucose was estimated from the diabetic and nondiabetic subjects by glucose oxidase method using A phenol 4-aminophenazone and HbA1c% were measured by ion-exchange high performance liquid chromatography (HPLC) method with the Bio-Rad D-10 analyzer (BioRad; Hercules, CA, USA; www.bio-rad.com). The absorbance range of the precipitate was 0.14–0.20 in normal subjects and the corresponding calculated HbA1c% along with plasma glucose levels was 4.1%-5.8% and 82-101 mg/dL, respectively. For the diabetic patients, HbA1c results were between 6.3%-12.2%, and the plasma glucose range was 120-292 mg/dL. Similar results were observed for HbA1c% (6.1%-11.9%) of the same diabetic samples measured by conventional ion-exchange HPLC. The nondiabetic and diabetic hemoglobin variant subjects consisted of HbE-β-thalassemia, β-thalassemia carrier state, HbE trait, and HbS trait, showed similar HbA1c% by the lectin-based assay when compared with standard HPLC method. The authors concluded that the lectin-based assay may be adopted to estimate glycated hemoglobin level in differentiating between normal and diabetic patients. This assay offers a good correlation with standard HPLC method, and moreover, the method globulin E (sIgE) testing is widely available to physicians, but the report sets out several caveats that physicians need to keep in mind when using these tests and before embarking on immunotherapy. Both serum sIgE tests and skinprick tests have similar diagnostic properties with specific pros and cons. Skin-prick tests offer immediate results and are low cost, but they require the availability of rash-free skin. Serologic tests are not affected by antihistamines or extensive dermatitis, but require a blood sample and cost more. The report also includes guidance on specific allergies: e.g., for asthma the physician is advised to follow national guidelines and test for indoor allergens (dust mites, mold). There is no current evidence that testing for total IgE will identify specific food allergies. In addition IgE tests are not relevant for many drug reactions. The diagnostic value of serum tests is not well characterized for latex allergies. A localized reaction at an insect bite or sting site does not indicate a risk for anaphylaxis; testing is not warranted. In vitro allergen-specific immunoglobulin E (sIgE) testing is widely available to physicians, but the report sets out several caveats that physicians need to keep in mind when using these tests and before embarking on immunotherapy. Immunoglobulin E Tests Not Always Reliable for Infants hysicians are warned not to rely on allergen-specific immunoglobulin E (IgE) tests for pediatric allergies. The mere detection of sensitization to an allergen on IgE tests is not always equivalent to a clinical diagnosis, cautioned a clinical report from the American Academy of Pediatrics (AAP; www.aap.org). The advisory from two allergists, Robert Wood of the Johns Hopkins Children’s Center (Baltimore, MD, USA; www.hopkinschildrens.org) and Scott Sicherer of Mt. Sinai Hospital (New York, NY, USA; www. mountsinai.org), urges clinicians to use caution when ordering allergy tests and to avoid making a diagnosis based solely on test results. Most allergies result in the production of IgE antibodies that are specific to that allergen. A report, published in the January 2012 issue of Pediatrics, offers aid to pediatricians in selecting the appropriate allergy tests, and interpreting the results in the context of a patient history and clinical presentation. The detailed medical history and tests must be interpreted in the presence of a clinical presentation, the authors noted. For instance, a child who eats eggs without any symptoms does not need to undergo testing for an egg allergy. The same holds true for pollen testing when a child is not physically exposed to a certain pollen. In vitro allergen-specific immuno- P 31 LabMedica International April/2012 is convenient, cheap, and needs no sophisticated instruments, and therefore suitable for laboratories in poor resource settings. The study was published online on January 24, 2012, in the Journal of Clinical Laboratory Analysis. Image: The D-10 hemoglobin testing system (Photo courtesy of Bio-Rad). LINKXPRESS COM LMI-04-12 131 TECHNICAL LITERATURE F R E E S E RV I C E • S E RV I C E G R AT U I T • K U N D E N D I E N S T G R AT I S • S E RV I C I O G R AT U I TO • S E RV I Z I O G R AT U I TO BORRELIA KITS Aesku Diagnostics Two Elisa kits are available for the detection of Borrelia-specific IgG and IgM antibodies. Both kits are fast, easy to handle, and adapted to routine use. LINKXPRESS COM LMI-04-12 287 CATALOG 2011-2012 PRODUCT CATALOG IMMUNOASSAY LAB CENTRIFUGE DiaSorin MPW Med. Instruments SUPPORT SOFTWARE Astra Biotech Axiom Diagnostics Products available include reagents and semi-products, Elisa test kits, tumor markers, molecular genetic test kits, and microarrays. Products available include clinical chemistry instruments, rapid tests, Elisa readers and instruments, pipettes, centrifuges, microscopes, and more. The Liaison XL murex HIV Ab/Ag is designed for the combined screening of HIV Ag and HIV Ab. The test offers high specificity, and is flexible and easy to use. The MPW 380R features a graphic LCD display, 99 operating programs, SHORT operation mode, automatic lid opening, and modern software. The STA Coag Connexion is designed for managing and supervising Stago systems. The software allows for management of patient results, as well as QC. LINKXPRESS COM LINKXPRESS COM LINKXPRESS COM LINKXPRESS COM LINKXPRESS COM LMI-04-12 288 LMI-04-12 289 LMI-04-12 290 LMI-04-12 291 Diagnostica Stago LMI-04-12 292 High Throughput System Automates Human Papillomavirus HR Test high throughput system automates the DNA extraction and detection steps of the Human Papillomavirus high risk (HPV HR) test allowing users to walk away after loading the instrument and return the next morning to review the test results. The Hologic (Bedford, MA, USA; www. hologic.com) HPV HR test utilizes the Invader technology to detect 14 high-risk types of HPV that are associated with cervical cancer and precancerous lesions. The US Food and Drug Administration (FDA; Silver Spring, MD, USA; www.fda.gov) have approved the Cervista high throughput automation system for cervical cancer screening. Better diagnosis and therapies have helped to reduce significantly the number of new cancer A cases, advanced-stage tumors, and ultimately deaths from cervical cancer in particular, which is predominantly caused by HPV. Next to breast cancer, cervical cancer remains the second most frequent cancer affecting women worldwide. “Our new Cervista represents a significant addition to our molecular diagnostics product portfolio,” said Rob Cascella, president and CEO of Hologic. “The Cervista HTA automation system automates the HPV HR test, providing higher throughput, improved chain of custody, and accurate results. We are extremely pleased to get this product approved as it materially changes the competitive landscape for Hologic.” Image: The Cervista testing kit, designed for cervical cancer screening (Photo courtesy of Hologic). Biomarker Detects Cardiac Event Immediately biomarker has been used to identify patients that have experienced a heart attack, enabling physicians to undertake aggressive treatment immediately. The diagnostic performance of newly developed highly sensitive troponin I (hsTnI) assay was compared with a contemporary troponin I (cTnI) assay and their serial changes in the diagnosis of heart attack. Scientists at the University Heart Center (Hamburg, Germany; www.uke.de) studied a cohort of 1,818 patients with suspected acute coronary syndrome, conditions such as heart attack or angina. The patients were enrolled in the study at chest pain units in Germany from 2007 to 2008. Twelve biomarkers including hsTnI and cTnI were measured on admission and six hours later. Heart attacks are clear in the public perception, and hospital admission for chest pains are one of the most common complaints. Highly sensitive troponin A assays have been developed recently, and these tests can reliably assess troponin levels in more than 50% of the general population. For the cTnI assay, the Architect STAT troponin I assay was used. The level of detection was 10 pg/mL, with a range of 0-50,000 pg/mL. The 99th percentile and the concentration with coefficient of variation of 10% is 32 pg/mL. The diagnostic threshold for myocardial infarction (MI) according to the World Health Organization’s (Geneva, Switzerland; www.who.int) definition was given as 300 pg/mL by the manufacturer (Abbott Diagnostics, Abbott Park, IL, USA; www.abbott.com). The same manufacturer’s prototype cardiac troponin I assay (Architect STAT High Sensitive Troponin) was used for hsTnI assay. For this assay, the level of detection is 3.4 pg/mL with a range, 0-50,000 pg/mL and the coefficient of variation is 10% at a concentration of 5.2 pg/mL. For discrimination of acute MI, both hsTnI and cTnI were superior to the other evaluated diagnostic biomarkers. Using the 99th percentile cutoff, hsTnI on admission had a sensitivity of 82.3% and negative predictive value (NPV) of 94.7%; hsTnI determined after three hours had a sensitivity of 98.2% with NPV of 99.4%. Compared with hsTnI, the cTnI assay, using the 99th percentile as cutoff had comparable sensitivity and NPV: 79.4% sensitivity and 94.0% NPV on admission, and 98.2% sensitivity and 99.4% NPV after three hours. Till Keller, MD, a senior author of the study, concluded that “The shortcoming of conventional troponin assays with low sensitivity within the first hours after chest pain onset led to the evaluation of various so-called early biomarkers in the diagnosis of MI. In our study, the diagnostic information of hsTnI was superior to all other evaluated biomarkers alone.” The study was published on December 28, 2011, in the Journal of the American Medical Association (JAMA). LabMedica International April/2012 32 Edited by Edgard Delvin, Ph.D., FCACB IFCC members may send news to: Edgard Delvin, Ph.D., FCACB, Head, Dept of Clin Biochemistry, CHU Ste-Justine, 3175 Cote Ste-Catherine, Montreal, Quebec H3T1C5 Tel: (1) 514-345-4831 (ext. 5635); E-mail: edgard.delvin@recherche-ste-justine.qc.ca NEWS Slovak Conference Focuses on Quality Control in Lab Diagnostics Contributed by Marko Kapalla, Slovakian EPMA Representative and Program Committee Chairman n November 2011, the beautiful city of Poprad, “Capital” of the Slovak High Tatras Mountains greeted the biennial international conference Labkvalita 2011, on quality in clinical laboratory diagnostics of the Slovak Society of Clinical Biochemistry (www.sskb.sk). Since 1993, this conference, accredited to give continuing medical education credits, attracts Slovak and foreign laboratory professionals, practitioners and specialists. This year the program focused on new trends in predictive, preventive, and personalized medicine (PPPM) not only from the technology and quality points of view but also from those of ethics, law, finance, and politics. Approximately 180 delegates registered, and 19 suppliers and manufacturers provided exhibits to promote new products in the field of clinical laboratory diagnostics. The Scientific program was divided into 5 sections: Preanalytics; Predictive, Preventive, and Personalized Medicine; Cooperation between the laboratory and the clinicians; Accreditation and quality in medical laboratory; and Quality of healthcare policy, visions, and ethics. Lecturers from Austria, Belgium, Czech Republic, Finland, Germany, United Kingdom, and Slovakia gave the various talks on particular topics. Details of the program are available at www.sskb.sk. Among invited lecturers, there were also top representatives of European Association for Predictive, Preventive, and Personalized Medicine (EPMA) who kindly accepted the invitation and were delighted by warm welcome and the interest of SSKB in promoting PPPM among clinical laboratory professionals in Slovakia. Implementation of PPPM at different levels has been repeatedly presented as an attribute of increased quality in healthcare. I Highlighted Themes and Debates The lectures given and the subsequent discussions have emphasized the role of new predictive markers, role of information systems, importance of good cooperation between laboratory and clinicians, essential role of education, interactive communication with health insurance, greater participation of Slovak laboratory professionals on shaping the healthcare policy for the benefit of the patient, and the role of communication with the patient. Among the highlighted themes were also the following: • PPPM will have impact on laboratory diagnostics and it may substantially improve the quality and complexity of the services in the field of laboratory diagnostics if implemented into daily routine of clinical laboratories. • Accreditation of the clinical laboratories in Slovakia continues and more laboratories realize that the benefits of accreditation outweigh the troubles, paperwork, and the required energy dedicated to keeping the accreditation once the lab is accredited. On the other hand, accreditation Cont’d on page 34 33 LabMedica International April/2012 Photo: (From left to right) Katarina Danova, president of the Slovak Society of Clinical Biochemistry, Jan Balla, IFCC representative in Slovakia and program committee member, Marko Kapalla, EPMA representative in Slovakia and program committee chairman. Photo by Magdalena Kacaniova News from the World of the International Federation of Clinical Chemistry and Laboratory Medicine Visit www.ifcc.org for more information NEWS My IFCC Professional Scientific Exchange Program (PSEP) Experience deoxyribonucleic acid (DNA). Observation and hands-on experience in the various phases of this process have greatly improved my confidence in the use of these techniques. These analyses require top quality controls and laboratory safety, to which the staff strictly adheres. The environment and friendly atmosphere are conducive to the success of the laboratory. I am now applying what I have learned to the molecular diagnosis of azoospermia. I designed the required primers and I am Photo: (From left to right) Prof. Maurizio Ferrari, presently setting the condi- Dr. Mabel Charles-Davies tions for multiplex PCR. Chemistry of Nigeria (ACCN). On the social side, hospitality and I am very grateful to the IFCC for courtesy are part of the ltalian culture. granting me the PSEP. It was finanI found everyone friendly and ready to cially very stressful before this aid, help, even not convenient. My enrolbecause of the relative cost of transment in an Italian school for foreigners portation and accommodation bet2 hours a week greatly enhanced my ween Nigeria and the EU. interaction with others, particularly I must extent my wholehearted outside the laboratory where English thanks to Prof. Maurizio Ferrari, who language, my mode of communicagenerously opened his doors, and tion, is scarcely understood. offered his staff and facilities in the This Professional Scientific Exdevelopment of my career. I am particchange Program was the beginning ularly grateful to Dr. Paola Carrera (in of a true collaboration between my charge of my training) and Dr. Mascia institution, the University of Ibadan Di Marzio (who supervised my hands(Nigeria), and the Vita-Salute San on experience in 21β-hydroxylase Raffaele University, in Milan (Italy). enzyme work, including interpretation), I recommend the continuation of and the whole laboratory staff of the the IFCC PSEP program in settings Department of Molecular Biology and with advanced technologies, in particCytogenetics for their assistance and ular for individuals from developing friendliness. I am also grateful to Ms. countries. This will, beyond courses Denise Bottoni (Prof. Ferrari's organized by the IFCC both within and Secretary) and Dr. Monica Zanusi for outside their countries, build capacity their availability that made my stay and increase confidence in the use of socially comforting. I cannot thank advanced technologies in their laborathem enough. I also wish to thank Prof. tories. The additional knowledge and E.O Agbedan, my Department Head at experience I have gained in Milan will the College of Medicine, University of impact on my colleagues and stuIbadan, for his support and advice. dents, and the Association of Clinical by Dr. Mabel A. Charles-Davies, Immediate Past IFCC National Representative (Nigeria), Department of Chemical Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria. he purpose of spending my sabbatical period in Prof. Maurizio Ferrari's laboratory was to improve my capacity of applying advanced technologies, particularly molecular biology, in the of diagnosis of diseases, and in research in the field of reproductive endocrinology. My exposure to the “state of the art” molecular biology techniques in Prof. Ferrari's Laboratory has allowed me to fulfill my dreams and aspiration. My attendance at the International Federation of Clinical Chemistry and T Laboratory Medicine (IFCC) course in Molecular Biology in Milan (Italy) in 2006 was intended to achieve the above objective but time was short, and facilities were then unavailable in our laboratory to continue with what was learnt. In the last few months, I have been through various aspects of molecular diagnosis of 21β-hydroxylase enzyme deficiencies. 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Standard: 500 x 320 mm • • 100% Silicone Size: 2400 x 1000 mm (3 mm thick) VICOTEX S.A. Place de la Gare 1 • 1009 Pully • Switzerland Tel: (41) 21-728-4286 • Fax: (41) 21-729-6741 E-Mail: contact@vicotex.com www.vicotex.com LINKXPRESS COM LMI-04-12 134 itself cannot guarantee the quality under insufficient quality of healthcare policy where there are numerous distortions in the field of laboratory diagnostics. Distortion of professional attitude is repeatedly noticed in the case were competing laboratories, being under pressure from investors, try to gather as many samples as possible, often forgetting that the service they offer is done for the patient and not for the sheer profit of the investor. Distortion of laboratory services and decreasing quality is also caused by the attitude of the health insurance companies, which often “reimburse” money according to very questionable policy that frequently ruins any possible and essential progress in clinical laboratory diagnostics. This distortion of the common sense comes from the utterly underestimated role of the laboratory diagnostics in healthcare by the government and politicians. • Distortion of fair competition in laboratory diagnostics resulting from the potential conflicts of interests is another problem of clinical laboratory diagnostics in Slovakia, which delegates of the conference perceive as an unacceptable situation. Although clinical laboratory diagnostics is essential field for medicine, and is recognized by EPMA in the concept of predictive, preventive and personalized medicine, with help and political backing from other experts and international organizations, clinical laboratory professionals must exert substantially more effort to change the unsustainable situation in Slovak clinical laboratory diagnostics in order to increase the quality to the level that can be appreciated by the patient. LabMedica International April/2012 34 LINKXPRESS .COM LINKXPRESS .COM LMI-04-12 172 LINKXPRESS COM LMI-04-12 135 LMI-04-12 173 NEWS News from the World of the International Federation of Clinical Chemistry and Laboratory Medicine Visit www.ifcc.org for more information IFCC Task Force for Young Scientists Holds Educational Workshop in India Contributed by Pradeep Kumar Dabla, IFCC-TF YS Member & National Representative s part of the efforts of IFCC-Task Force Young Scientists (IFCC-TF YS) to promote networking between young scientists, to involve them in activities of laboratory medicine, and to promote the future of laboratory medicine, the IFCC-TF YS in collaboration with the Association of Clinical Biochemists of India (ACBI) held an Educational Workshop on December 3, 2011. The program was well attended by more than 100 candidates from various streams all over India. The event was hosted by the ACBI Conference (ACBICON) 2011 Organizing Committee under supervision of Dr. Neelima Singh (Organizing Secretary), and held at the ITM University, Gwalior (Madhya Pradesh, India). IFCC has identified the need for young scientists to participate in Task Force activities and to understand the latest practices in laboratory healthcare sector. Therefore, various Educational workshops have been organized during IFCC and Member Societies Congresses under the roof of IFCC-TF YS. The concept of these activities is to encourage interactions between young scientists to face challenges, and to brighten the future prospects of self and laboratory medicine. A In keeping with these objectives, the Task Force organized Educational Workshop themed “Think The Unthinkable.” For the first time, this workshop, second in continuation of the one-day workshop organized during the 37th Conference of the Association of Clinical Biochemists of India in December 2010, brought the laboratory medicine and Industry together, stressing on Various Job Opportunities present in Industry and other sectors related to Laboratory Medicine. This was an important step since it sought to share experiences, scope, and a common platform for both the laboratory personnel and the industry, which will lead to well-thought solutions to bridge the gap. The workshop was organized with close cooperation with IFCC and ACBI. Addressing the conclave, Mr. J. Lopez (EB-IFCC & Past-President APFCB) praised the Task Force initiative and stressed upon the need to share experiences and challenges around the world. He explained the need of live sessions to demonstrate the laboratory management to build the future leadership. Then, Dr. Sucheta Dandekar (President ACBI) addressed and summarized the ACBI initiatives for the young biochemists. Dr. Pradeep Kumar Dabla, convener, Photo: (Left) Dr. Pradeep Kumar Dabla, Head of the Department of Biochemistry, Chacha Nehru Bal Chikitsalya Pediatric Superspecialty Hospital, New Delhi receiving a memento from Mr. Joseph Lopez, IFCC Executive Board Member, representing the President Dr. Graham Beastall. and National Representative IFCC-TF YS discussed the Task Force objectives and commitment of focused trainings to strengthen the future prospects of young laboratorians in absence of Damien Gruson, Chair IFCC-TF YS. The all senior members and EB-ACBI were present to support the cause. Dr. Dabla stressed, “With a robust general economy and with extraordinary advances being made in biotechnology and biopharmaceuticals, excellent positions are available in a wide variety of fields for current and future college graduates.” While discussing various fields he emphasized on making a decision about what type of career and exactly what field will be best for you and the importance of dual proficiency of management training. Dr. Elizabeth Frank (Chair of the Clinical Lab Management Committee of the IFCC & elected Secretary APFCB) explained the work strategies related to jobs vs. careers. Then she discussed about Entrepreneurship and how to start and managing your own business. Dr. Gurumukh Advani (Sales President Transasia) gave the view on how India is emerging as leading player in business and economy. He pointed out, “Healthcare delivery is growing as a largest service sector with excellent 15% growth per annum in India,” and explained the role of biochemists in lab industry. In this blend of excellent professionals, Mr. Shankar Haveri, (Head Healthcare Learning Academy, Siemens Healthcare) discussed the learning academy programs and opportunities in various less known areas of IVD Industry. In row, Dr. Rajesh Bendre (Consultant Pathologist & HOD Immunochemistry, Metropolis Healthcare) explained the concept of Clinical Reference laboratories, the role of laboratory professionals and the job profiles and career opportunities. He emphasized on the need of multitasking behaviour and flexibility. Dr. Dabla, ended by giving Dr. Gruson's view about the young scientists and laboratory medicine. To summarize, the workshop has provided tangible results for the young laboratory professionals to select the right path after completing their studies. It has provided the vision about the various techniques and essentials to reach the right destination. LabMedica International April/2012 36 News from the World of the International Federation of Clinical Chemistry and Laboratory Medicine Visit www.ifcc.org for more information NEWS AACB News: Looking Back to Look Ahead Contributed by Sandra Klingberg, Chair AACB Media and Communications Committee; Editor, Clinical Biochemist Newsletter he year 2011 has been a year of milestones for The Australasian Association of Clinical Biochemists (AACB), the most notable of these being the celebration of 50 years since the formation of the AACB in May 1961. Our Golden Jubilee was celebrated throughout the year with special events held in each of the Branches including the Roman Lecture tour featuring one of our founding fathers, Prof. Geoffrey Kellerman. The Golden Jubilee was also the key focus of our annual scientific meeting in October celebrating “Laboratory Medicine - Past, Present & Future.” Other significant milestones for the AACB include the induction of a new President Dr. Andrew St John and a new Chief Executive Officer (CEO), Mr. Peter Graham. Prof. Leslie Burnett vacated the office of president at the annual general meeting of the Association in October with Dr. Andrew St John taking the helm. In articles recently pub- T lished in the Clinical Biochemists Newsletter, both Prof. Burnett and Dr. St John reflected on things past, present, and future. Key issues and highlights noted in these two reports included: • Development of international collaborations and cooperation with sister Associations such as the APFCB, IFCC, AACC, and ACB • Forging new links with the EFCC and emerging Associations in South-East Asia • Progression of workforce issues through the reactivation of Pathology Associations Council • Initiation and participation in a number of major new scientific initiatives, including the introduction of reporting of the eGFR, international standardization and dual reporting of HbA1c, standardization of pathology and terminology, and most recently, pathology harmonization • Relocation of the AACB Head Office from Perth to Sydney with Photo: Celebrating the AACB's 50th Birthday: Prof Geoffrey Kellerman (2nd from the left), 2011 AACB Roman Lecturer, with the Victorian AACB Branch Committee. co-location and strategic alliance with the Human Genetics Society of Australia (HGSA) to better position the AACB for the genomic revolution The relocation of the Office has also brought about another of the significant changes to the “face” of the AACB in 2011 with the recent retirement of our CEO, Mr. Tony Prior. The AACB is indebted to Tony's dedicated service over the last ten years, which was recognized with the presentation of an outstanding service medallion at the annual scientific meeting. The good news is that we have a new CEO in Mr. Peter Graham who brings a wealth of laboratory and management experience with him. The AACB looks forward to long and productive working relationship with Peter as we move forward into our next 50 years! IFCC Welcomes New Corporate Members Mindray www.mindray.com Mindray, founded in 1991 with the goal of delivering high quality, competitively priced medical devices to make healthcare more accessible and affordable around the world was listed on the New York Stock Exchange in 2006. The company has three wellestablished business segments: Patient Monitoring and Life Support Products, In Vitro Diagnostic Products, and Medical Imaging Systems. Health care facilities equipped with Mindray's products can be found in over 190 countries and regions. IVD Mindray has a global R&D network with research centers in Shenzhen (China), Beijing (China), Nanjing (China), Seattle (USA), New Jersey (USA), and Stockholm (Sweden). Merck Millipore - Millipore SAS www.millipore.com/labwater Merck Millipore is the Life Science division of Merck KGaA of Germany and offers a broad range of innovative, performance products, services, and business relationships that IFCC OFFICE Via Carlo Farini 81, 20159 Milan, ITALY Tel: (39) 02-6680-9912 • Fax: (39) 02-6078-1846 E-mail: ifcc@ifcc.org • Web: www.ifcc.org Office Hours: 9.00-13.00 and 14.00-18.00 Staff Members: Paola Bramati, Silvia Cattaneo, Silvia Colli-Lanzi 37 LabMedica International April/2012 enable our customers' success in research, development, and production of biotech and pharmaceutical drug therapies. Through dedicated collaboration on new scientific and engineering insights, and as one of the top three R&D investors in the Life Science Tools industry, Merck Millipore serves as a strategic partner to customers and helps advance the promise of life science. Nova Biomedical www.novabiomedical.com Nova Biomedical's clinical laboratory business comprises point of care IVD test systems used in hospital and primary care settings. These include innovative new hand-held point of care sensors as well as an array of blood gas and critical care analyzers offering a wide menu range. Immunodiagnostic Systems (IDS) www.idsplc.com Immunodiagnostic Systems (IDS) is dedicated to the development and provision of innovative Immunoassays and automated immunoanalyzer technologies for use in clinical and research laboratories worldwide. The company enjoys a dominant position in the provision of immunoassay kits for the determination of Vitamin D (both 25-Hydroxy Vitamin D, and 1,25Dihydroxy Vitamin D. LINKXPRESS COM LMI-04-12 137 EFLM CORNER European Federation of Clinical Chemistry and Laboratory Medicine Edited by Dr. Bernard Gouget European Funding: A Financial Windfall to Seize for Innovative Projects by Dr. Bernard Gouget SFBC-EFLM Representative; IFCC Treasure; Secretary General, International Francophone Federation of Clinical Biology and Laboratory Medicine (FIFBCML) ublic health, research, and continuing education are fields in which the European Commission awards financial aid. This community funding exists to implement projects or activities related to European Union policy. This funding can be awarded to companies, associations, and healthcare facilities, in the form of subsidies or investment grants. European policies are divided into thematic programs such as the 2007-2013 health program (the one for 2014-2019 is being negotiated) or the Program of the European Community for research, technological development, and demonstration activities. Next, these programs are subdivided into projects and then funding means. Brussels regularly issues calls for projects, open to all interested candidates. To respond, candidates must submit proposals with a European dimension and involving, in principle, at least three Member States. Beyond this requirement, the conditions to fulfill for participation vary. The list of calls for proposals is available on the Commission Website (http://ec.europa.eu/ index_en.htm under the section “Public Contracts and Funding,” subsection "Grants"). An innovative e-learning experience was led by Prof. Corberand, hematology, at the Rangueil Toulouse University Hospital, which coordinated the e-HEMATimage interactive multilingual project as part of the Leonardo da Vinci Program in the field of education and continuing training. The goal was to create online continuing-education programs on the topic of hematology. The programs are available in eight languages and accessible to medical biology professionals. In 2009, this successful operation generated a second, e-MEDICINimage (www. e-hematimage.eu/index.jsp?Langue=en&Pays=GB), with the goal of improving knowledge and knowhow, in the fields of hematology, mycology, and parasitology for all medical biology laboratory profes- P LINKXPRESS COM LMI-04-12 140 sionals (doctors, scientists and technicians) concerned with performing and interpreting hematological, mycological, and parasitological exams. The site offers real cases taken from laboratory experience, with access in the user’s native language, records validated by scientific societies, supervision by recognized specialists, and from of personal projects. The European Commission also funded research on the genome, cancer, and even Alzheimer's disease. If they are not the leader of a European project, health facilities and laboratories or services can work with a private company, a medical research unit, such as INSERM in France, or a research center that received an EU grant. Between 2003 and 2009, for example, the European Commission supported 50% of the cost of the MyHeart project for developing intelligent systems for preventing and detecting cardiovascular disease. This equaled sixteen million euros. Among the forty partners and beneficiaries of the project are the San Carlos Hospital of Madrid (Spain), and the Coimbra (Portugal) and Aix-la-Chapelle (Germany) University Hospitals. The Commission never funds a project in its entirety; however, the sums paid can be substantial. Most often, the allocated budgets are managed by a public authority, with its partners to be clearly identified before its project is designed. Setting up projects is difficult, but European associations such as the European Hospital and Healthcare Federation (HOPE) can provide valuable and effective assistance. The e-MEDICINimage project is a good example of the generalization of e-learning in our education and training systems. Connectivity and equipment are no longer central questions, and the focus is now on problems of pedagogy, content, and quality assurance and standards, training of teachers and LINKXPRESS COM trainers, and of continuous development, organizational change and transformation processes of education and training. E-learning has entered adulthood and we are in the process of evolving from preparation to practice and from pilot e-learning projects to lasting education and training programs. The European Federation has demonstrated its clear understanding by establishing a WG on distance learning. Moreover, its newly named “European Federation of Clinical Chemistry and Laboratory Medicine” will undoubtedly factor in creativity in e-learning on many subjects! New Acronym for EFCC he Executive Board of the European Federation of Clinical Chemistry and Laboratory Medicine has become aware that the abbreviation EFCC is often misidentified as IFCC by other international organizations, National Societies and other stakeholders as well as by individuals from the profession. In the past, this has caused confusion and sometimes has undermined the identity of the Federation. After consultation with National Representatives and Presidents of our Member Societies, he Executive Board has agreed to adopt EFLM to replace EFCC as the acronym to describe our Federation. The full name of the Federation remains unchanged: European Federation of Clinical Chemistry and Laboratory Medicine. We take this occasion to thank all our National Society Members for supporting the Executive Board in this important decision for the future “branding” of our Federation Yours sincerely, Ian Watson, EFLM President T LMI-04-12 139 LabMedica International April/2012 38 European Federation of Clinical Chemistry and Laboratory Medicine EFLM CORNER 14th Berkes Annual Scientific Conference Held in Belgrade by Dr. Snezana Jovicic, Member of the IFCC eNews Working Group he 2011 Annual Scientific Conference “Professor Ivan Berkes” was held on December 1, at Military Medical Academy in Belgrade (Serbia). As it is customary, the lecturers were clinical laboratory professionals who have defended their doctoral thesis in the course of the past year at the Faculty of Pharmacy and Faculty of Medicine. This year, they were Dr. Janko Pejovic (Military Medical Academy, Belgrade), Dr. Marijana Dajak (Faculty of Pharmacy, University of Belgrade), Dr. Jasenka Lalos-Miljus (Faculty of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina) and Dr. Jelena Popovic (Faculty of Medicine, University of Nis, Serbia). This Annual Scientific Conference and Fund “Professor Ivan Berkes“ was established to honor life and work of Prof. Ivan Berkes, one of the founders of medical biochemistry in former Yugoslavia. He taught medical biochemistry at Universities in Zagreb, T Skopje, and Belgrade. His work at the Faculty of Pharmacy of the University of Belgrade was in great part directed towards the definition and foundation of the specialist studies program. In addition, Prof. Berkes introduced Clinical Enzymology as an independent discipline. With over 200 publications, mentoring of 150 specialists in medical biochemistry and several tens of doctoral candidates, Prof. Berkes left an indelible mark in clinical laboratory profession in Serbia. After his death in 1997, the Society of Medical Biochemists of Yugoslavia and the Faculty of Pharmacy of the University of Belgrade founded the Scientific Fund and Annual Scientific Conference named after him, as a sign of appreciation and respect for this remarkable teacher and eminent expert. Awards from the Scientific Fund “Professor Ivan Berkes” are given yearly to the two best graduate students from the Faculty of Pharmacy of the University of Belgrade, one gradu- 2nd EFCC-UEMS European Joint Congress: Laboratory Medicine at the Clinical Interface e take this opportunity to inform you that the Scientific Program of the 2nd EFCC-UEMS European Joint Congress has been finalized and is now available at www.dubrovnik2012.com. The Scientific Committee has done a great job in gathering the recognized international experts in the field who will be presenting the latest news and findings in their field. The Scientific Program will encompass 3 plenary sessions, 15 scientific symposia, 4 highly interactive pro- and contra- sessions, as well as a series of specialized industry sponsored workshops. We would like to draw your particular attention to the S10 Session (Friday, October 12, 2012, 14:0015:30) on Education of Specialists in Laboratory Medicine in Europe within which most recent advances in the W 39 LabMedica International April/2012 Photo: (From left to right) Awarded students with the Dean and Professors of Faculty of Pharmacy; Milena Andelkovic, Prof. Nada Majkic-Singh, Prof. Nada Kovacevic, Sanela Dordevic, Ana Milojevic, Prof. Svetlana Ignjatovic ate in pharmacy, and the other in medical biochemistry. However, 2011 called for a special event as the first students graduated according to the new syllabus harmonized with the Bologna declaration. Hence, this year the Fund gave four diplomas and monetary awards; two to students graduated according to previous school system - Mladen Milovic (pharmacy graduate) and Milena Andelkovic (pharmacy-medical biochemistry graduate), and two to “Bologna graduates” - Sanela Dordevic (Master of Pharmacy) and Ana Milojevic (Master of Pharmacy-medical biochemistry). After the traditional welcoming address of Colonel Prof. Marijan Novakovic, Head of Military Medical Academy, and of Prof. Nada Kovacevic, Dean of Faculty of Pharmacy, and Chair of the event, Prof. MajkicSingh, presented awards. With this successful conference, we remembered once again, the legacy of Prof. Ivan Berkes, whose students represent the core of science of medical biochemistry and clinical laboratory practice in Serbia today. recognition of the profession at the European level will be presented and discussed. Abstract Submission is also now available at the Congress web site. Best posters will be awarded with Poster awards. Dates to remember: • Abstract Submission Deadline: May 15, 2012 • Early Registration Deadline: May 1, 2012 We proudly announce that EFLM (formerly EFCC) Travel grants are available for Young Congress participants. For more details, please visit: www.efcclm.eu. We look forward to see you in Dubrovnik! LINKXPRESS COM LMI-04-12 138 EFLM CORNER European Federation of Clinical Chemistry and Laboratory Medicine EFLM Reaches Collaboration Agreement with the European Society for Pharmacogenomics and Theranostics (ESPT) Memorandum of Understanding has been prepared to define a collaborative working relationship between EFLM and ESPT, the European Society for Pharmacogenomics and Theranostics, to foster the cooperation and to advance Clinical Laboratory Medicine. The European Society of Pharmacogenomics and Theranostics (ESPT) is a nonprofit organization, whose aims are to promote the education and research in pharmacogenomics and theranostics, to ensure the high standards in their application to clinical practice for improving the delivery of medicines, to provide a scientific basis for official recommendations and to provide education materials for patients, clinicians and all health workers. For further information, the document is downloadable at the following link: http://efcclm.eu/downloads/ (section: Agreement) A EFLM Presence at National Society Meetings The Executive Board appreciates the support it receives from National Societies and individual members of these societies in the various past and current EFLM activities. To foster this relationship, EFLM officers' attendance, and their active participation as invited speakers has been arranged during the following National Congresses: • 11th Baltic Congress of Laboratory Medicine - Vilnius (LT), May 10-12, 2012 • Congress of the Slovak Society of Clinical Biochemistry (NC SSCB) Banska Bystrica (SK), May 27-29, 2012 • XXXIII Nordic Congress in Clinical Chemistry - Reykjavik (IS), June 12-15, 2012 • National Days for Russian Laboratory Medicine - InterLabDiagnostika 2012 - Moscow (RU), October 2-4, 2012 • 7th Conference of the Romanian Association of Medical Laboratories (RAML) with International Participation - Sinaia, Romania (RO), June 20-23, 2012 New Type of Membership: Young Membership The EFLM Executive Board to strengthen the role of Young Scientists inside its Working Groups invited National Societies to send nominations. The number of Full Members' positions inside each EFLM Working Group has been enlarged to enable Young Scientists to take part in the WG activities. A large number of nominations was received and the selected candidates are as follows: Cardiac Markers (WG-CM): Christopher DUFF (UK); Biological Variation (WG-BV): Federica Braga (IT); Guidelines (WG-G): Shivani Misra (UK); Test Evaluation (WG-TE): Philip Monoghan (UK); Preanalytical Phase (WG-PA): Michael Cornes (UK); Congresses and Postgraduate Education (WG-CPE): Andjelo Beletic (SRB); Distance Education and eLearning (WG-DE): Darya Kisilichina (RU); Accreditation and ISO/CEN (WG-A/ISO): Kanella Konstantinakou (GR) Working Group: Preanalytical Phase (WG-PA) The pre- and post-analytical phases of the laboratory testing process are now widely recognized as the major source of laboratory errors. Preanalytical errors are the most common and account for up to 2/3 of the total number of errors. The risk for errors in the laboratory testing process quite is underestimated in the everyday clinical practice. To reduce the error risk, important steps are to increase the awareness of the importance of the preanalytical phase in the total testing process and recommend guidelines for the best preanalytical practices. Efficient indicators and educational tools should be provided in order to implement the best preanalytical practices. For this reason, a new EFLM WG was created under the Chairmanship of Prof. Ana-Maria Simundic (Croatia). This WG will focus their work on the following: 1) To promote the importance of the quality of the preanalytical phase of laboratory medicine; 2) To define the best practices and provide recommendations for some critical activities in the preanalytical phase; 3) To design and validate questionnaires for assessing the current practices related to some pre-analytical variables; 4) To conduct surveys using validated questionnaires with the aim to assess the current pre-analytical practices; 5) Organize symposia, workshops, webinars, or training courses on preanalytical phase issues. One of the main future activities of this WG will be to organize the 2nd EFLM-BD Conference on pre-analytical phase, during March 1-2, 2013, in Zagreb, Croatia. EFLM-AACB Agreement on the Joint Task-and-Finish Working Group on Critical Values (TFG-CV) EFLM and AACB (Australasian Association of Clinical Biochemists) recognize the added value of working together to foster cooperation and to advance Laboratory Medicine. To formalize this cooperation a joint Taskand-Finish Working Group on Critical Values (TFG-CV) has been established for a 2-year period. Action points that are of mutual interest to both parties are: 1) To expand the recent Australasian survey on critical values management to Europe. 2) To publish results of the European survey of critical value management jointly with AACB 3) Develop joint recommendations on best laboratory practice for communicating critical results. News from the Belgian Society by Prof. J.P. Chapelle, Centre Hospitalier Universitaire de Liège, Head of Medical Chemistry Service uring the year 2011, the Royal Belgian Society of Clinical Chemistry (RBSCC) organized a National Symposium (Brussels, April 7, 2011) on the topic “New and sensitive testing: improving healthcare?” and, in collaboration with the Belgian Society of Clinical Biology, a national meeting (Liège, October 15, 2011) dealing with “The added value of clinical-laboratory interaction and The future of Clinical Biology”. Education is also a main objective of the RSBCC. During the RRBSCC National Symposium (April 7, 2011), two trainees in Laboratory Medicine received the Young Investigators Award in Clinical Chemistry 2010-2011 for an outstanding publication in the field of applied clinical chemistry and in the field of fundamental research. During the D BSCB/RBSCC joint National Symposium (October 15, 2011), three prizes were awarded to young investigators for a recently published article relating to clinical biology. In 2012, the National Symposium of our society will be devoted to “Medical quality beyond operational quality in the lab: the role of Clinical Biologist.” The meeting will be held in Groot-Bijgaarden (Brussels) on May 3, 2012. (Information: joris.penders@zol.be). The joint National Symposium of the Belgian Society of Clinical Biology will be organized in Ghent on October 20, 2012. On the international level, preliminary contacts have been made with the organizers of the 2015 EFCC EuroMedLab Congress to be held in Paris (France), in order to organize a satellite meeting in Brussels. LabMedica International April/2012 40 INDUSTRY NEWS OGT in Licensing Agreement for 12 Colorectal Cancer Biomarkers xford Gene Technology (OGT; Oxford, United Kingdom; www. ogt.co.uk), provider of clinical genetics and diagnostic solutions, has entered into an exclusive licensing agreement with Inven2 (Oslo, Norway; www.inven2.com), the technology transfer office at Oslo University Hospital (OUS; Oslo, Norway; www. ous-research.no) and University of Oslo (UiO; Oslo, Norway; www. uio.no/english), for 12 promising colorectal cancer tissue biomarkers. The DNA methylation biomarkers were developed in the laboratory of Prof. Ragnhild A. Lothe, in the department of Cancer Prevention, the Norwegian Radium Hospital, part of the Oslo University Hospital. As a result of the agreement OGT will be able to O commercialize any test developed using these biomarkers and to sublicense the markers to other parties. The results obtained in Prof. Lothe’s laboratory were validated by OGT, and demonstrated a sensitivity of 93% and specificity of 90% when using tissue biopsies. The efficacy of the biomarkers in blood and fecal samples is still being studied. A robust preventive strategy for colorectal cancer that can stratify patients into appropriate screening or surveillance programs is lacking for early detection of cancer. Internationally, the chosen modality of colorectal cancer screening varies, with cost and availability of diagnostic resources likely to be the leading factors effecting program design. Report Predicts High Growth in Personalized Medicine Testing ersonalized medicine, or matching an individual patient to an individual treatment, has long been part of diagnostic testing. Matching a drug’s effectiveness with a patient’s genetics has been considered since the 1950s. Blood testing, transplant tissue testing, microbial identification, and antibiotic susceptibility (AST susceptibility) are examples of individualized testing that have been part of medicine for many years. According to healthcare market research publisher Kalorama Information (Rockville, MD, USA; www. kaloramaInformation.com), new vali- P 41 LabMedica International April/2012 dated biomarkers, and the need to improve target cancer therapy, increased personalized medicine testing to a USD 28 billion market in 2011. A new report by Kalorama acknowledges that the current interest in in-vitro diagnostics (IVD), and that a share of the growth in this market, is coming from new molecular tests and the profiling of solid cancer tumors. These are creating an entirely new paradigm for diagnosing and choosing treatment options. The new tests are driving the market to betterthan-average growth rates compared to other segments of the IVD market. BD Diagnostics Acquisition Expands Microbiology Portfolio D Diagnostics (Franklin Lakes, NJ, USA; www.bd.com) has acquired Kiestra (Drachtan, the Netherlands; www.kiestra.nl), expanding the company microbiology portfolio to include new automated instrumentation technologies, which will enable it to offer total lab automation solutions to hospitals and laboratories worldwide. Kiestra Lab Automation BV, which designs, develops, manufactures, markets, and sells lab automation solutions for the microbiology lab, complements BD’s microbiology portfolio of instruments, reagents, and supplies. Kiestra offers two lines of automated solutions: Total Lab Automation (TLA) and Work Cell Automation (WCA). Total Lab Automation is designed to significantly increase overall microbiology lab productivity, streamline workflow, and shorten the time to results. Kiestra’s Work Cell solutions will offer customers a modular and scalable approach to automate their lab within current space and budget constraints. “We look forward to joining the BD team to expand automation B LINKXPRESS COM across the entire microbiology and infectious disease testing process,” said Jetze Botma, vice president, microbiology laboratory automation, who served until the acquisition as CEO, KIESTRA Lab Automation. “Together with BD, we now have the opportunity to integrate automation across microbiology informatics, instruments, and consumables for maximum workflow efficiency, and have access to the global arena.” Kiestra Lab Automation BV, which designs, develops, manufactures, markets, and sells lab automation solutions for the microbiology lab, complements BD’s microbiology portfolio of instruments, reagents, and supplies. Kiestra offers two lines of automated solutions: Total Lab Automation (TLA) and Work Cell Automation (WCA). Total Lab Automation is designed to significantly increase overall microbiology lab productivity, streamline workflow, and shorten the time to results. Kiestra’s Work Cell solutions will offer customers a modular and scalable approach to automate their lab within current space and budget constraints. LMI-04-12 141 INTERNATIONAL CALENDAR For a free listing of your event, or a paid advertisement in this section, contact: International Calendar • LabMedica P.O.Box 800806, Miami FL 33280-2410, USA Fax: 1-954-893-0038 E-mail: info@globetech.net Yellow-highlighted listings are available at US$ 300 for a one-year period. Please mail check with your event’s details to above address. APRIL 2012 Focus on Microscopy 2012. Apr 1-4; Singapore; Web: www.focusonmicroscopy.org CBBS 2012 - 57th Annual Meeting of the California Blood Bank Society. Apr 3-6; San Francisco, CA, USA; Web: www.cbbsweb.org A-TESTex Analitika 2012. Apr 10-13; Moscow, Russia; Web: analitikaexpo.com ANALYTICA 2012. 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