Maria Stella Graziani

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Bruna Lo Sasso
Giampaolo Merlini
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Paola Pezzati
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Matteo Vidali

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Sergio Bernardini Italy
Marcello Ciaccio Italy
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BC: Articoli scritti da S. Bernardini

Siero o plasma? Un quesito non nuovo che attende risposte nuove
Serum or plasma? An old question awaiting for new answers.
<p>There is a continual debate on what type of sample a clinical laboratory should use. While serum is still considered the gold standard and remains the required sample matrix for some assays, laboratories must consider turn-around time, which is an important metric for laboratory performance and, more importantly, plays a critical role in patient care. In addition, a body of evidence emphasize the choice of plasma samples in order to prevent modifications of some measurands due to the coagulation process and related interferences. Advantages and disadvantages of serum and plasma are discussed on the basis of current literature and evidence. In addition, data are provided on the current utilization of the matrix (serum or plasma) in Italy and in other Countries. Finally, a rational for a possible shift from serum to plasma is provided.</p>
Biochimica Clinica ; 43(2) 178-186
Documenti - Documents
Glycated albumin is correlated to insulin resistance and β-cell secretory function in subjects at risk of developing diabetes
<p>Insulin resistance and &beta;-cell secretory function represent two main issues in the pathogenesis of type 2 diabetes mellitus (T2DM). Conflicting results have been obtained about the association between glycated albumin (GA) and body mass index (BMI), insulin resistance and &beta;-cell function in diabetic patients. Actually, the relationship (if any) between GA and the markers of glucose homeostasis and insulin resistance in subjects at risk of developing diabetes, has not been completely elucidated yet. Two hundred and one patients undergoing to oral glucose tolerance test (OGTT) were enrolled in the study. Routine laboratory tests, including fasting insulin, were performed at enrollment. GA was measured on plasma-EDTA by quantILab<sup>&reg;</sup> Glycated Albumin (Instrumentation Laboratory, A Werfen Company) on ILab Taurus analyzer. According to the plasma glucose concentration measured after 2 hours of glucose intake (2h- PG), 13 subjects (6.4%) were classified as impaired glucose tolerance (IGT). GA weakly correlated with fasting plasma glucose (FPG) (r=0.21; P=0.002), with HbA1c (r=0.16; P=0.024) but not with 2h-PG (P=0.7). GA, but not HbA1c, was negatively correlated to HOmeostasis Model Assessment for &beta; cell fuction (HOMA-&beta;) (r<sup>2</sup>=0.23; P&lt;0.001), to HOMA for insulin resistence (HOMA-IR) (r<sup>2</sup>=0.15; P&lt;0.0001) and to BMI (r<sup>2</sup>=0.05; P=0.001). In a stepwise multivariate regression analysis including HbA1c, HOMA-&beta;, plasma albumin, BMI, eGFR, age, FPG, and HOMA-IR as predictors of GA, only HbA1c (&beta;-coefficient: 0.04; P=0.038) and HOMA-&beta; (&beta;-coefficient: -0.01; P&lt;0.0001) were able to predict GA levels (r<sup>2</sup>=0.26; P&lt;0.001 for the model). Our results demonstrated that GA was associated to HOMA-&beta; and, to a lesser extent, to HOMA-IR and BMI. The increase of GA values can be explained by the reduction of &beta;-cell secretory function in subjects with no significant increase of FPG and 2h-PG.</p>
Biochimica Clinica ; 42(3) 234-239
Contributi Scientifici - Scientific papers
L’uso dei biomarcatori del liquido cerebrospinale nella diagnosi della malattia di Alzheimer: un’indagine tra i laboratori italiani
The clinical use of cerebrospinal fluid biomarkers for Alzheimer’s disease diagnosis: an Italian survey
<p>The use of cerebrospinal fluid (CSF) biomarkers amyloid <span style="font-family:symbol; font-size:12.0pt">b</span><sub>1-42</sub> (A<span style="font-family:symbol; font-size:12.0pt">b</span><sub>42</sub>), tau (T-tau), and phosphorylated tau (p-tau<sub>181</sub>) for the diagnosis of Alzheimer&rsquo;s Disease is limited to a restricted number of neurological centers. By a survey, we aimed to do a &ldquo;selfie&rdquo; of the use and diffusion of CSF biomarkers of dementia in Italy, the standardization of pre-analytical procedures, the harmonization of ranges, and the participation to Quality Control programs. The members of SIBioC and of the Piattaforma Italiana per le Malattie Neurodegenerative della Societ&agrave; Italiana di Neurologia per le Demenze (SINdem-ITALPLANED) together with other neurological clinics all over Italy have received an online questionnaire. Forty neurological centers require CSF analyses while 7/20 regions (35%) lack CSF laboratories. Standardization of pre-analytical procedures is present in 62.02% of laboratories and only 56% participate to International Quality Control Programs. There is no harmonization of the reported cut-offs. A cost-benefit analysis, with a program for standardization and harmonization should be promoted by Scientific Societies and National Health Services.</p>
Biochimica Clinica ; 42(1) 39-43
Contributi scientifici - Scientific papers
Esami di laboratorio in Pronto Soccorso: una proposta di consenso SIBioC - Medicina di Laboratorio e Academy of Emergency Medicine and Care
Laboratory tests in the Emergency Department: a consensus document by SIBioC-Medicina di Laboratorio and the Academy of Emergency Medicine and Care
<p>Laboratory diagnostics in the emergency setting encompasses the identification of appropriate testing according to specific acute conditions. Since the pathway of ordering tests in the Italian Emergency Departments (EDs) is rather heterogeneous, SIBioC-Medicina di Laboratorio and the Academy of Emergency Medicine and Care designed a survey aimed to generate consensus pertaining to appropriate laboratory tests in most frequent acute conditions. A questionnaire including a panel of laboratory tests was administered to 8 representative members of each of the two societies, who were asked to provide a score between 1 and 3 for the various tests, where a score of 1 entailed &ldquo;highly recommended&rdquo;, 2 &ldquo;recommended in specific conditions&rdquo; and 3 identified &ldquo;highly discouraged&rdquo; tests. The results of the questionnaire are shown as mean (&plusmn;SD) of individual responses, thus allowing to define a scale of priority comprised between &ldquo;highly recommended&rdquo; and &ldquo;highly discouraged&rdquo;. Overall, 24 tests were classified as &ldquo;highly recommended&rdquo;, whereas 6 were &ldquo;highly discouraged&rdquo;. The remaining 16 tests were classified as &ldquo;somehow recommended&rdquo; or &ldquo;somehow discouraged&rdquo;. In the expectations of the two societies, this document may represent a first step towards harmonizing the laboratory test ordering in Italian EDs.</p>
Biochimica Clinica ; 41(2) 183-188
Documenti SIBioC - SIBioC Documents
Ferritina e siderofagi liquorali nella diagnosi di siderosi cerebrale superficiale
Cerebrospinal fluid ferritin and siderophages in the diagnosis of superficial cerebral siderosis
<p>We observed&nbsp;a case of superficial siderosis (SS) of the central nervous system caused by an hemorrhagic trauma forty years&nbsp;before. We questioned whether SS was the stabilized effect of a remote bleeding or an evolutionary process&nbsp;indirectly related to the trauma. Moreover, we aimed to evaluate whether an iron chelator can affect the level of iron&nbsp;deposition. Magnetic Resonance (MRI) demonstrated iron accumulation mainly on the surface of the cerebellum and&nbsp;brain stem. Cerebrospinal fluid (CSF) microscopic analysis revealed few siderophages; CSF ferritin level was 76&nbsp;ng/mL (reference value &lt;12). After treatment with an iron chelator (deferiprone) for three months, MRI was&nbsp;unchanged, but the CSF ferritin was about 20% less. The presence of few siderophages supported the hypothesis of&nbsp;a persistent subarachnoid microbleeding. CSF ferritin, as an iron deposition index, allowed a diagnosis of SS and a<br />more sensitive evaluation of the efficacy of the treatment than the MRI.</p>
Biochimica Clinica ; 39(6) e19-e21
Casi clinici - Case report
Monitoring and improvement of intralaboratory turnaround time at the university hospital Campus Bio-Medico in Rome
<p>The aim of the present study was to evaluate the intralaboratory turnaround time (TAT) of the emergency samples at&nbsp;the laboratory of the university hospital Campus Bio-Medico. TAT for urgent tests was recorded during 7 months after&nbsp;the introduction of a system allowing TAT monitoring in real-time, from January to July 2012. TAT analysis was&nbsp;performed through five consecutive phases. At the end of each phase, TAT was evaluated and a corrective strategy,&nbsp;if needed, was introduced. The TAT evaluation at the end of phase I (January-March 2012) showed that all urgent&nbsp;tests were in extra-time. From the phase II (April 2012) to the phase IV (June 2012), three different consecutive&nbsp;corrective strategies, related to preanalytical and analytical phases were implemented. Each corrective action&nbsp;determined TAT improvement. In the last phase of the study (July 2012), no further corrective strategies were added,&nbsp;but a pure observation activity was decided to give time to the laboratory staff to adapt to changes introduced before.&nbsp;The intralaboratory TAT can improve through the introduction of TAT monitoring systems, gradual and step-by-step&nbsp;changes in sample management and staff adhesion to and awareness of the project.</p>
Biochimica Clinica ; 38(2) 115-120
Contributi scientifici - Scientific papers