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Chronic kidney disease (CKD) is common, particularly in those of advanced age.

Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile.

The role of alcohol in the development of subclinical cardiovascular disease is unclear. We examined the association between alcohol consumption and markers of subclinical cardiac damage and wall stress.

The substantial technological advancements in next-generation sequencing (NGS), combined with dropping costs, have allowed for a swift diffusion of NGS applications in clinical settings.

This is the November2016 issue of Clinical Chemistry, Volume 62, Issue 11.

Measurement of serum cancer antigen 125 (CA125) is the standard approach for epithelial ovarian cancer (EOC) diagnostics and follow-up. However, the clinical specificity is not optimal because increased values are also detected in healthy controls and in benign diseases.

Electrophoretic separation of serum and urine proteins has played a central role in diagnosing and monitoring plasma cell disorders. Despite limitations in resolution and analytical sensitivity, plus the necessity for adjunct methods, protein gel electrophoresis and immunofixation electrophoresis (IFE) remain front-line tests.

Circulating tumor DNA (ctDNA) has emerged as a good candidate for tracking tumor dynamics in different cancer types, potentially avoiding repeated tumor biopsies. Many different genes can be mutated within a tumor, complicating procedures for tumor monitoring, even with highly sensitive next-generation sequencing (NGS) strategies.

Most people perceive pilots who don't fly for the commercial airlines as daredevils who always "fall out of the sky." My acquaintances are genuinely surprised to learn that I, a medical doctor and a clinical chemist, am one of those presumed reckless individuals.

Cardiac troponin is integral in the investigation of acute coronary syndromes. Modern high-sensitivity versions of troponin assays are able to detect very low concentrations and potentially identify disease sooner.

This is the September2016 issue of Clinical Chemistry, Volume 62, Issue 9.

The Ebola outbreak in the fall of 2015 led to emergent responses by hospitals to prepare for potential patients. This included preparedness efforts by laboratories, which was challenging as they was evolving and at times contradicting information about how samples from patients under investigation for Ebola should be handled.

Initial detection and reporting by clinical microbiology laboratories is a sentinel marker for foodborne outbreak surveillance systems. Initiation of a public health investigation is reliant on the rapid initial identification of pathogens of interest. Diagnostics for Escherichia coli have evolved to reduce identification turnaround time, incorporating technologies for rapid identification (MALDI-TOF MS) and serogrouping (O157 antiserum or latex agglutination). Reporting of these isolates to a public health agency may initiate further laboratory investigations, such as pulsed-field gel electrophoresis, for confirmation that isolates may be related to a common source (clonal population).

It is no secret that laboratory tests are overordered in the clinical environment; a recent metaanalysis demonstrated that tests are overused by 20.6% on average. The ordering of unnecessary tests on such a massive scale may impact not only direct healthcare costs, but also patient safety, and may lead to unnecessary follow-up investigation and iatrogenic blood loss due to excess phlebotomy. Unfortunately, in large hospitals with high patient volumes, it would be impractical for laboratory directors to evaluate every test individually for appropriateness, and even more difficult to convince providers to change ordering practices. Meeting other evidence-based quality objectives in laboratory ordering is similarly labor-intensive.

Next generation sequencing is increasingly available in clinical laboratories, enabling the sequencing of more genes for relatively lower costs.