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Today, modern pirates operate both in ports and on the open sea and use state-of-the-art equipment. Their crimes range from simple robbery to murder and hijacking of entire ships for ransom demand. It is the purpose of this paper to investigate the modern piracy trends and the effect of preventive actions taken by the crew of the attacked vessels. By analysing the available statistical material from the International Maritime Organization’s (IMO) monthly piracy reports during the period 2000–2009, it is shown that the attack rates on specific vessel segments and the recorded incidents for each geographical area develop their own trends. Incidents off and around the African continent have resulted to fewer deaths as compared to those in South China Sea and Malacca strait indicating that this area is dominated by more violent attacks against seafarers. However, the African attacks have bigger threatening potential in terms of the weapons used, whereas the inclusion of light weaponry in Asian attacks characterises them ancestors of historical piracy. Over the 10-year investigation period, a shift is observed from acts of robbery to acts of hostage taking and hijacking particularly around and off the East African coast. Estimates of the probability of an attack are provided through logistic regression modelling indicating that the success rate decreases with vessel size. It is also shown that the attacks are emphasised on specific vessel types for example chemical and oil tankers. The importance of a heightened vigilant crew in reducing the probability of a successful attack is pointed out by the analysis’ results. It is found that pirates are aiming at successful attacks regardless of their tactics and the success rate becomes higher as the pirates’ capability is improved. Additionally, the success probability of an attack is decreased as the act’s difficulty is increased, i.e. less success for hijacking rather than robbery.

A woman with tetra-X is presented together with a survey of the physical signs and the mental retardation in the 26 cases previously published.

Deletion of short arm 9 was found in a 61-year-old, mentally retarded male with few of the previously described signs typical of deletion of short arm 9 in children. A survey is given of the nine previously described cases of deletion of short arm 9.

Introduction: Non-shockable rhythm (NSR) is the most prevalent heart rhythm for both in- and out-of-hospital cardiac arrest (OHCA). While survival from OHCA patients with a shockable rhythm (SR) has increased over time, survival following NSR remains low. Thus, identification of risk factors for NSR is important to reduce mortality. We hypothesize that patients with NSR and SR are two disparate groups where patients with NSR are characterized by a high non-cardiac disease burden when compared to patients with SR. Methods: Using data from the nationwide Danish Cardiac Arrest Registry (2001–2012), we identified 33,617 OHCA patients ≥18 years old. The Danish National Registry of Patients was used to identify comorbidities while the National Prescription Registry was used to identify drug prescriptions (within 180 days). A multivariable logistic regression model was used to estimate odds ratios for risk factors associated with NSR. Results: Patients with NSR were characterized by a higher median age 71 years (IQR 60-81) vs. 67 years (IQR 58-77), higher proportion of women (38% vs. 21%), lower proportion of witnessed collapse (50% vs. 79%) and bystander CPR (27% vs. 50%) than patients with SR. A higher proportion of NSR occurred in private homes (77% vs. 58%) and time from recognition of OHCA to first rhythm analysis was longer: 13 min (IQR 7-22) vs. 9 min (IQR 6-14). In a fully adjusted model (patient-related and cardiac arrest-related characteristics included) a higher degree of comorbidity, psychiatric disease, chronic obstructive lung disease and the use of antidepressants, antipsychotics, anxiolytics, analgesics, corticosteroids, and antibiotics (within 14 days) where associated with NSR (Table). In contrast, the use of cardiovascular specific drugs and history of cardiovascular disease was associated with a lower risk of NSR. Conclusion: A history of non-cardiac disease and non-cardiac drug use are risk factors of NSR when compared to patients with SR.

Monogenean parasite infestations are common in captive marine teleosts, and are generally found on the skin and gills. This report describes an unusual pathological presentation of exuberant granulation tissue of the gills, suspected to be related to Neobenedenia infestation in two cobia housed together at a North Carolina aquarium.

Reactions between α-MoO3 or MoO3·0.43H2O and 65–95 wt% H2SO4 were studied from room temperature up to the boiling point of the acid. Four new compounds, MoO2(SO4), (modifications I, II and III) and MoO2(SO4)· H2SO4·H2O, have been isolated depending on the H2SO4 concentration, reaction temperature, reaction time and molybdenum source. The characterization of these phases was performed with powder X-ray diffraction, thermogravimetric analysis, differential thermal analysis, chemical analysis and density measurements. Both starting materials react with sulfuric acid and form MoO2(SO4) II at temperatures above ca. 75 °C. This compound is unstable in the reaction mixture and converts into MoO2(SO4) I or III depending on time and temperature. The three modifications of MoO2(SO4) are hygroscopic and decomposition in moist air is studied for the I and II modifications. On heating, all modifications of MoO2(SO4) decompose into α-MoO3 or a mixture of α-MoO3 and β-MoO3 depending on heating rate and sample size. The three-dimensional, open-framework structures of I and II, have been determined from single-crystal X-ray diffraction data. I crystallizes in the monoclinic space group C2/c and II in the orthorhombic space group Pna21. Both structures are made up of MoO6 octahedra and SO4 tetrahedra and contain layers of eight- and four-membered rings of alternating, corner-sharing octahedra and tetrahedra. These layers are linked (also via Mo–S bridges) to form a three-dimensional framework. The MoO6 octahedra are rather distorted, as demonstrated by large variations in the bonding Mo–O interatomic distances, which reflect the double-bond character of the binding between molybdenum and terminal oxygen atoms pointing into the eight-membered rings. The SO4 tetrahedra are quite regular. The structural relation to MoO2(SO4) III is briefly considered.

This study investigated whether the moderate observer agreement rate for lung scintigraphy, when using the PIOPED criteria, reflects significant variations in accuracy. In a prospective study, 170 patients were investigated with lung scintigraphy and pulmonary angiography. The lung scintigrams were read according to the PIOPED criteria by three skilled observers from different hospitals who had no experience of consensus interpretation. The scintigrams were reinterpreted 6 months later. The inter-observer agreement rates were moderate and fair, with kappa values of 0.49 (0.44-0.54) for the first reading and 0.36 (0.31-0.41) for the second reading. The intra-observer agreement rates were good and moderate, with kappa values of 0.62 (0.51-0.73), 0.52 (0.42-0.62) and 0.54 (0.44-0.64). There were no significant differences between the observers in the areas under the ROC curves. However, one observer showed a significant difference between his first and second reading (P = 0.02). All three observers showed good accuracy. Although there were substantial variations in the inter- and intra-observer agreeement rates, this was only reflected to a minor degree in the accuracy.

Spatiotemporally chaotic dynamics of a Kuramoto-Sivashinsky system is described by means of an infinite hierarchy of its unstable spatiotemporally periodic solutions. An intrinsic parametrization of the corresponding invariant set serves as accurate guide to the high-dimensional dynamics, and the periodic orbit theory yields several global averages characterizing the chaotic dynamics.

The population is aging. We examined changes in the proportion of elderly (≥ 80 years) intensive care unit (ICU) patients during 2005-2011 and the association between age and mortality controlling for preexisting morbidity.Through the Danish National Patient Registry, we identified a cohort of 49,938 ICU admissions (47,596 patients) in Northern Denmark from 2005 to 2011. Patients were subdivided in age groups (15-49, 50-64, 65-79 and ≥ 80 years) and calendar year. We estimated 30-day and 31-365-day mortality and mortality rate ratios (MRRs), stratified by admission type (medical and elective/acute surgical patients). Mortality was compared between age groups adjusting for sex and preexisting morbidity using 50-64-year-olds as reference.The proportion of elderly patients increased from 11.7% of all ICU patients in 2005 to 13.8% in 2011. Among the elderly, the 30-day mortality was 43.7% in medical, 39.6% in acute surgical, and 11.6% in elective surgical ICU patients. The corresponding adjusted 30-day MRRs compared with the 50-64-year-olds were 2.7 [95% confidence interval (CI) 2.5-3.0] in medical, 2.7 (95% CI 2.4-3.0) in acute surgical, and 5.2 (95% CI 4.1-6.6) in elective surgical ICU patients. The 31-365-day mortality among elderly patients was 25.4% in medical, 26.9% in acute, and 11.9% in elective surgical ICU patients, corresponding to adjusted MRRs of 2.5 (95% CI 2.1-2.9), 2.2 (95% CI 1.9-2.5), and 1.9 (95% CI 1.6-2.3), respectively.During 2005-2011, there was an 18% increase in the proportion of elderly ICU patients. Advancing age is associated with increased mortality even after controlling for preexisting morbidity.

Diurnal vertical movements of Cancer pagurus L. have been studied by skin-diving surveys on an exposed rocky islet on the Norwegian Skagerrak coast. The site studied was bounded in depth by the upp...

Purpose: The PIOPED criteria in their original and revised forms are today's standards in the interpretation of ventilation-perfusion scintigraphy. When the PIOPED criteria are used by experienced raters with training in consensus interpretation, the agreement rates have been demonstrated to be excellent. Our purpose was to investigate the rates of agreement between 2 experienced raters from different hospitals who had no training in consensus interpretation. Material and Methods: The 2 raters investigated a population of 195 patients. This group included 72 patients from a previous study who had an intermediate probability of pulmonary embolism and who had also been examined by pulmonary angiography. Results: The results demonstrated moderate agreement rates with a kappa value of 0.54 (0.45–0.63 in a 95% confidence interval), which is similar to the kappa value of the PIOPED study but significantly lower than the kappa values of agreement rates among consensus-trained raters. There was a low consistency in the intermediate probability category, with a proportional agreement rate of 0.39 between the experienced raters. Conclusion: The moderate agreement rates between raters from different hospitals make it difficult to compare study populations of a certain scintigraphic category in different hospitals. Further investigations are mandatory for accurate diagnosis when the scintigrams are in the category of intermediate probability of pulmonary embolism.

For diagnosis of pulmonary embolism (PE), ventilation/perfusion lung scintigraphy is routinely used; approximately one-third of the patients will have the diagnosis “intermediate probability of PE” (inconclusive). In this group only about 33% are found to have pulmonary emboli if examined with pulmonary angiography. To evaluate the diagnostic, therapeutic, and economic consequences of ultrasound of the legs as a complementary diagnostic investigation to “intermediate probability”, 72 consecutive patients were investigated with bilateral ultrasound of the proximal deep veins of the legs and pulmonary angiography in a prospective study. Ten patients had PE, of whom 7 had deep venous thrombosis, and 62 had no PE, of whom 2 had deep venous thrombosis. The negative predictive value of ultrasound was 0.95. In view of the importance of adequate treatment and rational use of public health care expenditure, complementary diagnostics should be performed, and ultrasound is an adequate complementary investigation.

Chronic diseases are common among intensive care unit (ICU) patients and may worsen their prognosis. We examined the prevalence and impact of pre-admission/index morbidity among ICU patients compared with a general population cohort.Our study encompassed all 28,172 adult patients admitted to ICUs in northern Denmark in 2005-2007 and 281,671 age- and sex-matched individuals from the general population. We used a nationwide hospital registry to obtain a 5-year history of 19 chronic diseases and computed Charlson Comorbidity Index (CCI) for each study participant and grouped them into low (CCI=0), moderate (CCI=1-2), and high (CCI=3+) morbidity levels. We computed mortality and mortality rate ratios (MRRs) adjusted for confounders, and compared the mortality between ICU patients and the general population cohort.Low, moderate, and high pre-admission morbidity levels were present in 51.5%, 34.1%, and 14.4% of ICU patients, respectively. In these groups, 30-day mortality was 10.8%, 18.4%, and 26.7%, respectively. Three-year mortality was 21.3%, 43.1%, and 63.2%, respectively. The adjusted 30-day MRR was 1.30 [95% confidence intervals (CI): 1.21-1.39] and 1.86 (95% CI: 1.71-2.01) for ICU patients with moderate and high morbidity levels, both compared with a low morbidity level. The general population had a lower morbidity level and mortality at all morbidity levels throughout the study period. Interaction between ICU admission and high morbidity level added 5.1% to the mortality during the second and third year of follow-up.A high pre-admission morbidity level was frequent among ICU patients and associated with a worsened prognosis. Morbidity had more impact on mortality among ICU patients compared with a general population cohort.

Nephrogenic systemic fibrosis (NSF) is a new and probably iatrogenic disorder. It was first described time in 2000 and associated with the use of gadolinium containing MR contrast media in patients with impaired renal function in 2006.We describe a case of NSF identified at Haukeland University Hospital and give a brief overview of the disease, based on literature retrieved from a non-systematic search.NSF is a serious systemic disorder with active inflammation and fibrosis, particularly in skin, but also in other tissue such as skeletal muscle, heart and oesophagus. The condition is very difficult to treat. Awareness of the illness has led to changes in guidelines and clinical practice regarding use of gadolinium-containing contrast media in patients with renal impairment.

Purpose: Using the PIOPED criteria in the interpretation of lung scintigraphy, perfect agreement between experienced raters with training in consensus interpretation has been demonstrated. In a previous paper we found a kappa value of 0.54 (0.45–0.63) between experienced raters with no experience of interpretation in consensus; this is significantly lower than the perfect agreement described between consensus-trained raters. The purpose of this study was to reinvestigate the same study population with the same raters, but this time after they had undergone consensus training. Material and Methods: Lung scintigrams of 192 patients were reviewed and categorized according to the PIOPED criteria by 2 raters after consensus training. The 2 raters reviewed a training material of 59 cases, which was not part of the study population, in order to reach a full consensus interpretation. Results: After consensus training the kappa value was 0.57 (0.48–0.66). Three cases had a discrepancy of 2 categories (1.6%), and the remaining discrepancies were of one category. Conclusion: Consensus training did not significantly improve the agreement rate between experienced raters from different hospitals. A substantial improvement in agreement rates between hospitals may make heavy demands on resources.

The aim of this study was to determine whether a common diabetic haplotype, including human leukocyte antigen (HLA)-B8 and HLA-DR3, in Northern India is the same haplotype as the European HLA-B8-DR3 haplotype. DNA samples from Northern Indian subjects selected on the basis of HLA-B8 and HLA-DR3 were tested for microsatellite and single nucleotide polymorphism alleles throughout the major histocompatibility complex (MHC). It was found that the Indian samples represent a conserved haplotype in which all alleles were shared by Indian subjects with HLA-B8 and HLA-DR3, but were different to those that are characteristic of the European 8.1 ancestral haplotype. The Indian and European haplotypes share HLA-B*0801, HLA-DRB1*0301 and HLA-DQB1*02 but differ for subtypes of HLA-Cw*07 and HLA-DRB3 and all central MHC alleles tested. In contrast, Indian subjects selected on the basis of HLA-B58 ( 1-17) and HLA-DR3 shared the same alleles at other MHC loci as have been described in the common Chinese haplotype with HLA-B58/17 and HLA-DR3. A third haplotype, HLA-B50/21 and HLA-DR3, was also found to be highly conserved but shares little in common with the other two HLA-DR3-containing Indian haplotypes.

The HLA-DRB1 sequencing based typing strategies reported to date require separate amplifications of each sample with a series of group-specific primers followed by sequencing of any resulting polymerase chain reaction (PCR) products. Whilst this results in high resolution typing in the majority of cases, a number of unnecessary amplifications are performed. We report here a novel approach where amplification of the second exon of HLA-DRB1 is performed in a single tube for all alleles. Retrospective analysis of 642 consecutive Western Australian unrelated bone marrow registry donors has shown that this approach results in unambiguous typings in 71.1% of cases. Ambiguities can be readily resolved if necessary with a single additional sequencing reaction on the original PCR product.

The World Marrow Donor Association has formulated guidelines for establishing the extent and quality of histocompatibility testing for unrelated donor registries, umbilical cord blood banks, and transplant centers involved in international exchange of hematopoietic stem cells for allogeneic transplantation. The ability to identify unrelated stem cell donors in one country for patients in another country requires cooperation and standardization in many areas. The adoption of guidelines for histocompatibility testing, such as those summarized in this report, will facilitate these opportunities and rapidly provide accurately typed donors for patients in need.

Clinical diagnosis of pulmonary embolism is difficult and often dependent on radiological methods. In Sweden scintigraphy has hitherto been the method most commonly used, though all too often it leaves the diagnosis in doubt. Spiral computed tomography, performed during continuous infusion of contrast medium, clearly depicts the pulmonaries arteries, emboli appearing as filling defects. The examination takes less than one minute. Although the method has yet to be fully evaluated, it is already available at most Swedish hospitals. Results presented so far suggest that the technique has great potential, and may become the method of choice in the diagnosis of pulmonary embolism.

The World Marrow Donor Association has formulated guidelines for establishing the extent and quality of histocompatibility testing for unrelated donor registries, umbilical cord blood banks, and transplant centers involved in international exchange of hematopoietic stem cells for allogeneic transplantation. Registry and cord blood bank guidelines suggest that, at a minimum, initial HLA typing should be performed for three HLA loci, HLA-A, -B, and -DR, at low resolution/split antigen level. DNA-based testing methods should be utilized for HLA-DR typing. DNA-based testing for HLA-A and -B should replace serologic testing of new volunteer donors and cord blood units as robust protocols and reagents become available to the laboratories. Transplant center guidelines for typing of patient, family and to confirm the HLA types of potential unrelated donors should include, at the minimum, typing HLA-A, B, and -DR loci using primarily DNA-based testing methods at allele level resolution for DRB1 and low resolution/split antigen level for HLA-A and -B. It is strongly recommended that the typing of a patient and the selected donor be performed using the same set of reagents, methodology, and interpretation criteria with fresh tissue samples to ensure HLA identity. Guidelines for laboratory accreditation, approaches to quality assurance and quality control for HLA testing, and suggestions for the format of the HLA database of donor types are also outlined.

The purpose of the study is to investigate the number and the character of deaths during stays in prisons, county goals etc. During the study period from 1992-1996 with approx. 38,000 imprisonments per year there were 74 deaths, 71 males and three females. The average age was 32.4 years. Approximately 16% had foreign citizenship. Twenty had leave, legal or illegal when death occurred. There were 34 suicides, 22 accidents, 3 homicides and 15 cases of natural death. Several deaths took place relatively shortly after the arrival at the institution, one third within a week. The most frequently used suicidal method was hanging. The accidents were dominated by poisoning deaths, often with morphines, possibly in combination with alcohol or other drugs. Two of the three homicides took place during leave. Among natural deaths, heart death was the most frequent cause of death with six of 10 unexpected deaths. Among expected deaths in prison there were three AIDS patients. Fourteen of the fifteen natural deaths had a substantial alcohol consumption and/or drug abuse. There ought to be a central registration of deaths in prisons and similar institutions. The autopsy frequency should be high, and forensic chemical investigation should be used more often. Drug dependent inmates should be informed about reduced tolerance to drugs in relation to release and leave.

Akutes Nierenversagen gehort zu den haufigsten Organkomplikationen, wenn Patienten auf einer Intensivstation behandelt werden. Haufig muss zur Uberbruckung ein maschinelles Nierenersatzverfahren verwendet werden: Bei etwa 4–6 % aller Intensivpatienten wird das notwendig. Meist erholt sich die Nierenfunktion (zunachst) wieder, aber wie verhalt sie sich bei diesen Patienten im Langzeitverlauf? Eine danische Gruppe hat das nun systematisch uberpruft.

Purpose: Reporting a lung scintigraphy diagnosis as a PIOPED categorical probability of pulmonary embolism offers the clinician a wide range of interpretation. Therefore the purpose of this study was to analyze the impact on lung scintigraphy reporting of adding a visual linear scale (VLS) probability assessment to the ordinary PIOPED categorical probability. Material and Methods: the study material was a re-evaluation of lung scintigrams from a prospective study of 170 patients. All patients had been examined by lung scintigraphy and pulmonary angiography. the scintigrams were re-evaluated by 3 raters, and the probability of pulmonary embolism was estimated by the PIOPED categorization and by a VLS probability. the test was repeated after 6 months. Results: There was no significant difference (p>0.05) in the area under the ROC curve between the PIOPED categorization and the VLS for any of the 3 raters. Analysis of agreement among raters and for repeatability demonstrated low agreement in the mid-range of probabilities. Conclusion: A VLS probability estimate did not significantly improve the overall accuracy of the diagnosis compared to the categorical PIOPED probability assessment alone. from the data of our present study we cannot recommend the addition of a VLS score to the PIOPED categorization.

The common strategy of combining clinical information, lung scintigraphy and pulmonary angiography in the diagnosis of acute pulmonary embolism (PE), has many limitations in clinical use. The major causes are that pulmonary angiography and lung scintigraphy are not universally available, and that pulmonary angiography is very expensive. The purpose of this thesis was to analyse different aspects of validity in regard to lung scintigraphy, pulmonary angiography, spiral CT, and ultrasound of the legs, with the subsequent intention of discussing new diagnostic strategies. Observer variations in lung scintigraphy interpretation when applying the PIOPED criteria were tested in 2 studies with 2 and 3 observers respectively and expressed as kappa values. The ability to improve agreement in lung scintigraphy interpretation was tested by training 2 observers from different hospitals. The impact of 3 observers' variations in lung scintigraphy interpretation when compared to pulmonary angiography, was tested by comparing the ROC areas of the observers. The value of combining subjectively derived numerical probabilities and the PIOPED categorical probabilities in lung scintigraphy reporting was compared to using the PIOPED categorization only, and this was tested by comparing ROC areas. The sensitivity and specificity of detecting an embolic source in the deep veins of the legs by ultrasound as a sign of PE when lung scintigraphy is inconclusive, was tested by comparison with pulmonary angiography. The sensitivity and specificity of spiral CT, compared to pulmonary angiography, was tested by comparison to pulmonary angiography. The inter- and intra-observer kappa values were in the range of moderate and fair. It was not possible to achieve better kappa values after training. Although observer variations were substantial, the accuracy did not differ significantly between the 3 observers. Incoorporating subjectively derived probabilities into lung scan reporting could not reduce the number of inconclusive investigations. Sensitivity and specificity of ultrasound in detecting PE was 0.70 and 0.97, respectively. However, 2 patients (of 9) had deep venous thrombosis and no pulmonary emboli at angiography. The sensitivity and specificity of spiral CT was 0.90 and 0.96, respectively. The observer variations at lung scintigraphy are substantial and may be difficult to improve between hospitals, even though the accuracy of observers in general is good. Although subjectively derived interpretation criteria did not show to be useful when added to categorical interpretation criteria, they may be useful when substituting established criteria. Despite recent progress in refining interpretation criteria, a substantial fraction of the patients still need pulmonary angiography to be performed. However, in many patients pulmonary angiography is not performed as prescribed. Spiral CT and ultrasound of the legs is a new favourable diagnostic strategy with a high validity in detecting venous thromboembolic disease, and a good availability and cost-effectiveness.

Gonadectomy of pet lizards may be necessary to treat various medical conditions, and prophylactic surgery may prevent life-threatening reproductive-associated conditions. This study provides information relevant to the pre-surgical evaluation of bearded dragons (Pogona vitticeps). Blood samples collected from seven male and seven female inland bearded dragons prior to elective gonadectomy surgery, and again 12 days following surgery, were analyzed using a point-of-care blood gas analyzer (iStat) and a semiportable chemistry analyzer (Abaxis VetScan) to obtain plasma biochemistry and electrolyte concentrations. Statistically significant differences were seen for packed cell volume and protein, calcium, and potassium concentrations when pre-surgical values were compared with post-surgical values. Four female lizards in the cohort died in the immediate post-operative period, and three of these animals had large, well-developed ovarian follicles. The ovaries of all surviving female lizards were chara...

In 1972 Yellow Springs Instrument Co., Inc. (YSI) introduced the first commercial instrument which could measure glucose in diluted whole blood by use of an enzyme-based biosensor. Until 1986 YSI had a monopoly of this technology for clinical chemistry. Since 1986 another ten companies have commercialized the technology. Enzyme-based biosensors for clinical chemistry are now available for glucose, lactate, and urea. Until 1975 the annual number of papers on enzyme-based biosensors is sparse, but from then there is a significant increase in the number of publications. The commercial interest in glucose is reflected in the number of patents covering this analyte: close to fifty per cent of the patents cover this type of sensor while less than ten per cent of the scientific papers are on glucose sensors. The major problems in developing enzyme-based biosensors for clinical chemistry have been achievement of the necessary linear range and elimination of interferences from the blood. The slow penetration of enzyme-based biosensors into clinical chemistry analysis is due to the fact that it is difficult to develop sensors which meet the high accuracy and reliability requirements, are manufacturable, and have an acceptable shelf life. The number of commercial products utilizing enzyme-based biosensors will probably remain limited in the future due to the limited number of analytes for which a suitable enzyme exists, and for which the use of an enzyme-based biosensor offers the advantages that can justify the costs of development.

The substance concentration of ionized calcium (cCa 2+) in blood, plasma, or serum preanalytically may be affected by pH changes of the sample, calcium binding by heparin, and dilution by the anticoagulant solution. pH changes in whole blood can be minimized by anaerobic sampling to avoid loss of CO 2, by measuring as soon as possible, or by storing the sample in iced water to avoid lactic acid formation. cCa 2+ and pH should be determined simultaneously. Plasma or serum: If centrifuged in a closed tube and measured immediately, the pH of the sample will be close to the original value. If there has been a delay between centrifugation and measurement, causing substantial loss of CO 2, equilibration of the sample with a gas mixture corresponding to pCO 2 = 5.3 kPa prior to the measurement is recommended. Conversion of the measured values to cCa 2+ (7.4) is only valid if the pH is in the range 7.2-7.6. Ca 2+ binding by heparin can be minimized by using either of the following: 1) a final concentration of sodium or lithium heparinate of 15 IU/mL blood or less; or 2) calcium-titrated heparin with a final concentration of less than 50 IU/mL blood. Dilution effect can be avoided by use of dry heparin in capillaries or syringes.(ABSTRACT TRUNCATED AT 250 WORDS)

The substance concentration of ionized calcium (cCa2+) in blood, plasma or serum preanalytically may be affected by pH changes of the sample, calcium binding by heparin, and dilution by the anticoagulant solution. pH changes in whole blood can be minimized by anaerobic sampling to avoid loss of CO2, by measuring as soon as possible or by storing the sample in iced water to avoid lactic acid formation. cCa2+ and pH should be determined simultaneously.

The substance concentration of ionized calcium (cCa2+) in blood, plasma or serum preanalytically may be affected by pH changes of the sample, calcium binding by heparin, and dilution by the anticoagulant solution.pH changes in whole blood can be minimized by anaerobic sampling to avoid loss ofCo2, by measuring as soon as possible, or by storing the sample in iced water to avoid lactic acid formation.cCa2+and pH should be determined simultaneously.Plasma or serum: If centrifuged in a closed tube, and measured immediately, the pH of the sample will be close to the original value. If a delay has occurred between centrifugation and the measurement, causing substantial loss ofCo2, equilibration of the sample with a gas mixture corresponding to pCO2= 5.3 kPa prior to the measurement is recommended. Conversion of the measured values tocCa2+(7.4) is only valid if the pH is in the range 7.2-7.6.Ca2+binding by heparin can be minimized by using either of the following:(1) A final concentration of sodium or lithium heparinate of 15 IU/ml blood or less(2) Calcium titrated heparin with a final concentration of less than 50 IU/ml blood.Dilution effect can be avoided by use of dry heparin in capillaries or syringes. When heparin solutions are used, errors due to dilution or calcium binding can be reduced by using syringes with a heparin solution containing free calcium ions corresponding to the mean concentration of ionized calcium in normal plasma.Conditions for blood collection, storage, and transport to avoid preanalytical errors are described in this paper.