ACB News...4•ACB News Issue 513 •January 2006 General News General News General News General...

ACBNewsACBNewsThe Association for Clinical Biochemistry • Issue 513 • 20th January 2006

Where are the

Agenda for

Change Pay

Bands!

What is Wrong

with Reference

Intervals?

Science and

More in

Llandudno

Focus on the

Future in

Brighton

Where are the

Agenda for

Change Pay

Bands!

What is Wrong

with Reference

Intervals?

Science and

More in

Llandudno

Focus on the

Future in

Brighton

January 2006 • ACB News Issue 513 • 3

About ACB News

The monthly magazine

for Clinical Science

The Editor is responsible for the finalcontent. Views expressed are not necessarily those of the ACB. EditorDr Jonathan BergDepartment of Clinical BiochemistryCity HospitalDudley RoadBirmingham B18 7QHTel: 07973-379050/0121-507-5353Fax: 0121-765-4224Email: [email protected]

Associate EditorsMiss Sophie BarnesDepartment of Chemical PathologySt Thomas’ HospitalLondon SE1 7EHEmail: [email protected]

Mrs Louise TilbrookDepartment of Clinical BiochemistryBroomfield HospitalChelmsfordEssex CM1 5ETEmail: [email protected]

Mr Ian HanningDepartment of Clinical BiochemistryHull Royal InfirmaryAnlaby RoadHull HU3 2JZEmail: [email protected]

Situations Vacant AdvertisingPlease contact the ACB Office:Tel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]

Display Advertising & InsertsPRC AssociatesThe Annexe, Fitznells ManorChessington RoadEwell VillageSurrey KT17 1TFTel: 0208-786-7376 Fax: 0208-786-7262Email: [email protected]

ACB Administrative OfficeAssociation for Clinical Biochemistry130-132 Tooley StreetLondon SE1 2TUTel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]

ACB ChairmanMiss Janet SmithDepartment of Clinical BiochemistryUniversity Hospital Birmingham NHS TrustBirmingham B29 6JDTel: 0121-627-8449 Fax: 0121-414-0078Email: [email protected]

ACB Home Pagehttp://www.ACB.org.uk

Printed by Piggott Black Bear, CambridgeISSN 1461 0337© Association for Clinical Biochemistry 2006

ACBNewsNumber 513 • January 2006

General News 4

Disposable Laboratory Tips 8

MRCPath Short Questions 9

Federation of Clinical Scientists 10

Council Matters 11

Meeting Reports 13

Focus 2006 News 19

ACB News Crossword 23

Obituary 24

Situations Vacant 26

Front cover: Mark Weaver and Kelly Parham on Llandudno beach with the Bayer Award

4 • ACB News Issue 513 • January 2006

General News General News General News General News General News

November Sudoku Solution

Mark Weaver presents Kelly Parham with then ACB Wales Regional BayerMembers’ Award for the best presentation at the Llandudno meeting lastNovember

MRCPath Exam -

Proposed Changes

Proposed changes to the MRCPath exam have beentabled and are out for discussion. The proposal is tounify the exam with a simplified form of the examwith the Part 1 testing knowledge and Part 2 skills. For many specialities that has already happened. Inpractice it would mean that the practical would be inthe Part 2. ■

New SAS AssaysThe hormone and tumour marker group of theSupraregional assay service seeks to increase itsrepertoire of specialist endocrine tests. Laboratories ableto provide assays for ADH (antidiuretic hormone),plasma catecholamines and steroids by massspectrometry are invited to tender submissions. Forinformal contact and further details please contactJulian Barth, Chair, Hormone and Tumour MarkerSubgroup Email: [email protected] or Tel: 0113-392-3416. ■

All Smiles in Llandudno

January Sudoku

Chairs at Council

There is much going on in the Education Committeeand ACB Council are very pleased that David Cassidy hasagreed to take on the role of Chair of the Committee fora second term of three years. It has also beenannounced that Denis O’Reilly will be taking on theChair of the Scientific Committee. ■

GFR Calculator

For those taking forward guidelines on estimated GFRthe website www.renal.org will be of interest. The site includes a calculator for eGFR ■



Nominations are invited for the three awards to bepresented at Focus 2007 in Manchester.

ACB Foundation AwardThe ACB Foundation Award is to acknowledge anoutstanding contribution to clinical biochemistry by anAssociation member, who is normally resident in theBritish Isles. The recipient will deliver the FoundationAward Lecture, which will be of a specific nature,reflecting the state of the art in one area of clinicalbiochemistry.

Nominations may be made by any three members ofthe Association (excluding elected members of theCouncil) and should be submitted via a RegionalSecretary.

Dade Behring Award The Dade Behring Award is given to honour a clinicalscientist whose work has been of major importance toclinical biochemistry in practice, research or education,leading to improved international co-operation betweenworkers in the speciality, particularly those within

Europe. The Dade Behring Award comprises finance forthe Dade Behring Lecture to be delivered at the NationalMeeting, and is usually awarded to a practising clinicalbiochemist from outside the UK.

Three members of the Association but excludingcertain ACB Officers should make nominations.

Roche Diagnostics AwardThe Roche Diagnostics Award is used to finance thevisit of an international lecturer to give the RocheDiagnostics Award Lecture at the National Meeting.Any three members of the Association may makenominations.

Full details of the nominations procedure for each ofthe three awards will be found in the current ACBMembers’ Handbook.

Nominations should be sent, before 28th February2006, to: Mr Gilbert Wieringa, National MeetingsSecretary, Department of Biochemistry, Christie Hospital NHS Trust, Wilmslow Road,Manchester M20 4BX. ■

Nominations for Association Awards for 2007

Intensive Course on

Screening for Down’s Syndrome15th-18th May 2006

Wolfson Institute of Preventive Medicine

Barts & The London, Queen Mary’s School of Medicine & Dentistry

• Comprehensive Coverage of Theoretical and Practical Aspects of Screeningfor Down’s Syndrome

• New Information on Advances in First and Second Trimester Biochemicaland Ultrasound Screening

Further details are available from the Wolfson Institute website:http://www.wolfson.qmul.ac.uk/epm/screening/

or from Cecily Cromby, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ

Tel: +44 (0)20 7882 6258. Fax: +44 (0)20 7882 6290 E-mail: [email protected]



ACB South West & Wessex Region Scientific Meeting

Pharmacogenetics Update

for the Clinical Biochemist Postgraduate Centre

Royal Devon and Exeter Hospital, Exeter

Tuesday 7th March 2006

10.00 Registration and Coffee

10.30 WelcomeDr John O’Connor, RDEH

10.35 Pharmacogenomics, Setting the SceneMr Mike Hallworth, Shrewsbury

11.15 Establishing and Maintaining a National TPMT Screening ServiceDr Jonathan Berg, Birmingham

11.55 TPMT Genotyping and its Role as Part of a Routine ServiceDr Loretta Ford, Birmingham

12.40 Lunch/Trade Exhibition

13.40 The Sugar Pills Work Now DoctorDr Sian Ellard Exeter

14.20 Polygenic Diabetes, New PerspectivesDr Tim Frayling, Exeter

15.00 Tea/Trade Exhibition

15.30 UGT-1A1: More than just Gilbert’s?Ms Roberta Goodall, Bristol

16.05 New Chips on the BlockMr Ewan Wilkinson, Roche Diagnostics

16.40 A Curious Case of HypokalaemiaDr Marion Croft, Exeter

17.15 AGM

Registration cost is just £20 for ACB and IBMS members. Free for Grade A trainees, £25 to othersClosing date: 24th February 2006

For further details and to register please visit www.acbsww.org.uk or contact: Dr Roy Fisher, Department of Clinical Chemistry, Royal Cornwall Hospital, Truro, TR1 3LJ.

Tel: 01872-252546. Email: [email protected]

Disposable Laboratory Tips Disposable Laboratory Tips Disposable


Questions MRCPath Short Questions MRCPath Short Questions


Question 59Stating any assumptions you make, estimate the maximum rise in plasma glucose (in mmol/L) which would be possible if an adult male was given a glucose load of 75g.

(Question suggested by John Morton of Poole General Hospital)

Deacon’s ChallengeNo. 58 Answer

*** Christmas Special Answer ***The sales manager of a diagnostics company gives an area rep a crate containing 24 bottles ofwine to distribute to his customers on Christmas Eve. The rep, being an enterprising fellow,decides to distribute the wine according to the number of orders placed by each lab. He decides togive a bottle of wine for each 100 packs of reagents purchased over the preceding year. He giveslab B twice as many bottles as lab A, lab C one less than lab B, lab D the same number as lab Band lab E twice as many as lab C. When he gets to lab F he decides to keep two bottles forhimself and give this lab one bottle less than they are due. How many packs of reagent did hesell over the year?

The total number of bottles of wine he should have distributed to hiscustomers was 23 (since he had 24 altogether, kept 2 for himself, gave out22 and he should have given lab F one more).

Each bottle is a reward for purchasing 100 packs of reagent.

Total number of packs sold = 23 x 100 = 2300 packs

Exam tip: Examiners sometimes give superfluous information in a question in orderto confuse.

Federation of Clinical Scientists Federation of Clinical Scientists


Advertising ClinicalScientist PostsBy Alan Penny

The FCS Executive is dismayed that, at the time of writing, onlytwo Clinical Scientist posts have been advertised with an Agendafor Change (AfC) pay band and/or pay scale (plus any advertised

this month). We are surprised that Trust HR Departments are stillpermitting it. The start date was 1st October 2004 and all Trusts, at leastin England, should have assimilated all staff by 31st December 2005.

Whitley Scales should no longer be used. Where a vacancy has arisenthe post should have been matched or evaluated prior to advertisement.The job may or may not be identical to the one of the previous postholder, but it is the job which must be assessed and not the person.

By continuing to use Whitley Scales in adverts, even with a rider thatthe post is subject to AfC banding, it leaves potential applicants in a veryconfusing and uncertain situation. Good candidates may be discouragedfrom applying. The limited number of reported matches so far received,indicates that there is certainly no straight read across as many memberswere naively expecting, despite our repeated advice. To accept a post onthe expectation of a particular AfC banding is a high risk strategy bothfor candidate and employer. For example, the salary ceiling for a “Grade C, Consultant Scientist” matched to the generic profile may be£59395, £71494 or £86240. To accept on the basis of “AfC bandpending” candidates would need to be prepared to accept the lowestand employers prepared to pay the highest of these.

Posts at top of Grade B have been matched from Band 7 to 8c andGrade C from 8a to 9. In these circumstances we would advise allmembers considering applying for a vacancy to wait until the outcomeof banding is certain. You may find that the new post is banded lowerthan the one you have left.

Heads of Department must work closely with AfC leads in their Trustto have posts robustly banded prior to advertisement. The process neednot be time consuming nor delay advertising posts and the certaintymay avoid lots of problems later through unmet expectations.

AfC is now the structure of our profession and we must learn to thinkof Band 7 posts after registration, advancing though 8A and 8B toconsultant and department head posts at 8C, D & 9. Triplets are gone.Nine point and six point scales with KSF Gateways are in.

Members are also reminded that if considering applying for a bandingreview they should seek advice from the FCS as soon as possible. ■

Council Matters Council Matters Council Matters Council Matters


The ACB Council often starts with a “Topic for the Day” and at theOctober meeting Dr Julian Barth was invited to make apresentation to Council on reference intervals. Julian talked about

complex patient pathways, who will be using laboratory reports and thedifferent perspectives of those involved. “Am I normal?” asks thepatient. “Is my diagnosis correct?” asks the physician. Julian hadattended a recent meeting of the IFCC Committee on Reference Intervalsand Decision Limits, a committee with the acronym RIDL. Followinghis presentation, Council clearly appreciated the problems, and agreedthat the whole subject was obviously in need of some futher study. ProfIan Young, Chair of the ACB Scientific Committee, suggested that anACB working group be set up to tackle some specific problems. Councilhas asked Dr Barth to initiate this in liaison with the ScientificCommittee.

Pathology ReviewMs Janet Smith announced that the review is to be led by Lord Carter ofColes, with Professor Price (as an independent expert on lab medicine)and Marcus Robinson (Accenture Government Services) to sit on theReview Team. The ACB is satisfied that there are no preconceptions inthis Review Team and, as an Association, we should support it. Dr IanWatson will lead a taskforce which will seek the views of ACB Membersand work with the ACB Corporate Members, under BIVDA, to produce aresponse to the Review Team. Lord Carter will be invited to meet withACB Executive.

Association AwardsAs mentioned in the last Council report, the National Members, Dr Ceridwen Coulson, Dr Ian Godber and Dr Brian Senior, were asked tolook at the feasibility and/or desirability of Regional Awards. Theyreported to Council that they felt the creation of a new “RegionalAward” would not work effectively. Their favoured option was toincorporate the Regional Award into the Fellowship Award. Councilagreed to accept the proposals. From 2006, new guidelines will applyand will appear in the next Handbook. The criteria are:

Fellow

Nominations can be put forward for individuals who have retired overthe past 3 years, or are known to be retiring in the next 12 months.These nominated individuals must have achieved one or more of thefollowing:

• Continually led and instigated changes to meet the needs of clinical

What’s Wrong WithReference Intervals?Reported by Steve Goodall, Assistant Secretary

ACB Counciltook place on

10th November

Council Matters Council Matters Council Matters Council Matters


biochemistry services on behalf of a region or nationally• Developed exceptional educational and/or training facilities for the profession• Led in setting up and developing over a considerable period of time, a well-respected and valued

specialised service that had a major impact either within a region or nationally• Raised the profile of the profession over many years, within the lay community, either regionally or

nationally

Honorary Member

Distinguished, international contribution to Clinical Biochemistry.

Emeritus Member

Exceptional contribution to objects of the ACB.

Government Officer

Whenever there are changes in the Department of Health regarding, inter alia, pathology services, the ACBis not always consulted, and it is often difficult to obtain relevant information. Such problems could beovercome by the creation of an ACB Government Officer post, the incumbent of which would activelyundertake PR and information gathering. Council agreed in principle with the proposal that such a postshould be established. Further work in setting up the post needs to be performed.

Pink Application Forms Must GoThere is still much concern with the Northgate electronic application system for Trainee Clinical Scientists.Dr David Cassidy, Chair of the Education Committee, has written to Thames Valley SHA, the holders of thecontract with Northgate, questioning on what basis Thames Valley could give a vote of confidence inNorthgate. He has not yet had a reply. He will be pursuing the matter further with Professor Sue Hill, theChief Scientific Officer.

Still with trainees there has been concern that so few men applying for a career in clinical biochemistry.Dr Stephanie Barber, Chair of the Trainees’ Committee, said the Committee had been looking at this andsuggested that chemistry graduates and careers promotions should be targeted in an effort to redress theimbalance. The South West & Wessex Region had looked into this in great detail. There is no doubt intheir minds that the reason for the overwhelming preponderance of female applications to Grade “A” postsis the pink application form!

Succession PlanningThe Chairs of the Scientific Committee and Education Committee are due to demit office soon. Dr DavidCassidy has agreed to continue for a further term as Chair of the Education Committee. The next Chair ofthe Scientific Committee will be Dr Denis O’Reilly. Janet Smith thanked Professor Ian Young for all hiswork on the Scientific Committee.

Workforce Advisory CommitteeMr John Kane, Chair of the Workforce Advisory Committee, tabled a graph showing the bimodal agedistribution of Clinical Biochemists. There is a distinct “dip in the middle” i.e. a lack of numbers in postin the age range 35-45. Over the next few years there will be a large number of the more “senior”Members retiring. Who will take their posts? It is, however, encouraging to see the numbers of youngerMembers in post.

Other ItemsA number of other items were discussed, including the ACB Code of Conduct complaints procedure, SfH,NOS, KSF, HPC, FCS (including AfC), CPS, FHCS, ACS and the RCPath. Translations and furtherinformation will follow later! ■

Meeting Reports Meeting Reports Meeting Reports Meeting Reports


Science and More in LlandudnoReported by Gareth Davies, Wrexham

One hundred and twenty-two delegates registered for the meetingand, despite lashing rain and an over-enthusiastic traffic warden,started on time on the Tuesday morning.

Peter Maddison is Professor of Bone and Joint Studies at theUniversity of Wales Bangor, and Consultant Rheumatologist at YsbytyGwynedd. His opening talk on “A Rheumatologist’s View ofAutoimmunity outlined the working of his fast-track autoimmunityclinic at Bangor and was illustrated with a number of case studies fromboth adult and neonatal practice. These included neonatal lupus,catastrophic antiphospholipid syndrome and the role of anti cyclic-citrulline peptides in the diagnosis of rheumatoid arthritis.

Continuing the immunology theme, Professor Paul Morgan fromCardiff discussed the laboratory investigations of complement disorders.Prof Morgan began by reviewing the classical, alternative and lectinpathways of complement activation and the function of the complementsystem as a whole in the protection of the body against bacterial andviral infections. Under normal circumstances, the complement systeminitiates/enhances inflammation, enhances phagocytosis, solubilisesimmune complexes and contributes to the induction of immuneprotein production. When inappropriately activated, it can causeinflammation and cell damage, the clinical manifestations of whichdepend upon which complement component is deficient. An overviewof the laboratory investigation covered the appropriate use of assays ofthe individual complement proteins and their activation products. Thistalk also concluded with case presentations including C6 and CH50deficiencies, SLE and the haemolytic uraemic syndrome.

Shocking News from SheffieldDr Graham Wild of the Sheffield Protein Reference Unit reviewed thehistory of anaphylaxis from the first recorded case in 3000BC, throughthe early work of Portier and Ricket in 1902 involving jelly fish venom,to the current understanding of the role of the immune system in thesensitisation of individuals to specific allergens. Worryingly, it isestimated that about 30% of the population have some form of allergy,although few of these will progress to anaphylaxis. Type 1hypersensitivity is mediated by the binding of IgE to mast cells, causingactivation and subsequent release of histamine and tryptophan. In a caseof suspected anaphylaxis, measurement of b-tryptase may indicate mastcell activation. Symptoms include a cutaneous rash, bronchospasm andcardiac arrest and may be treated by chromoglycates to prevent calciumion influx, theophylline to block phosphodiesterase activity, andadrenaline.

The WalesRegion returnedto the Imperial

Hotel inLlandudno fortheir Autumn

ScientificMeeting held onthe 8th and 9th

of Novemberthis year

CLINICAL CHEMISTRY � IMMUNOCHEMISTRY � BLOOD GROUPING � AUTOMATION � MICROSCOPY � E

DDOO YYOOUU IINNTTEERRRRUUPPTT TTHHEE FFLLOOWW AANNDD SSLLOOWW TTHHEE RROOUUTTIINNEE ??

DDOO TTHHEEYY JJOOIINN TTHHEE QQUUEEUUEE AANNDD WWAAIITT TTHHEEIIRR TTUURRNN ??

WWHHYY CCOOMMPPRROOMMIISSEE ??

TTHHEE WWAAIITTIINNGG IISS AALLMMOOSSTT OOVVEERR..

Oncology

Thyroid

Anaemia

Cardiac

HCG Fertility

ENDOSCOPY � DIGITAL IMAGING � PATIENT SAFETY

URGENT TESTS REQUIRED



To round off the session on immunology, Dr Paul Williams fromCardiff looked forward to the possible developments in immunologythat could be expected over the next ten years. He emphasised that aclinical immunology service was a clinical and a laboratory disciplinewhich deals with the study and management of these diseases. His ownpractice in south east Wales is mainly concerned with children andyoung adults and currently comprises 2 Consultant ClinicalImmunologists, 2 Nurse Practitioners and 1 SpR. There is a need forexpansion of the service to include 1 Clinical Immunologist in northWales, 1 in south west Wales and 3 in south east Wales for which thereis support in principle, but details are still being worked on and willinevitably depend on funding, personnel and an IT system that works.The service from Cardiff has an active commitment to undergraduateteaching and research. Limits to further development of the servicedepend on advances in knowledge and technology.

Pharmacogenomics and AzathioprineAfter lunch, Mike Hallworth provided an overview of the rapidlyexpanding field of pharmacogenomics. A knowledge ofpharmacogenomics can aid drug development, individualised therapiesand the prediction of adverse drug reactions (the 4th most commoncause of death in the USA in 1998). It can also play a part in definingsusceptibility, identifying possible addiction and defining pathogensusceptibility. Overall, such knowledge can ultimately reduce the cost ofhealthcare and this drive for information has resulted in an exponentialincrease in publications on the subject in the last 10 years. There is stillsome way to go, for example in explaining the differences betweengenotype and phenotype that are observed. There are also ethical, legaland social issues that are yet to be resolved.

The practical application of pharmacogenomics was illustrated by Dr Andy McFarlane of Bangor using azathioprine as an example thateveryone has experience of. Azathioprine was introduced in the mid1960s as a steroid-sparing agent, and is closely related to 6-mercaptopurine. It has well known side-effects includinghepatotoxicity, nausea, opportunistic infections and, critically, bonemarrow suppression. Polymorphism of the gene encoding thiopurinemethyl transferase was discovered in the 1980s and it in known that0.3% of the population will be homozygous for the underactive form ofTPMT and will be at risk of bone marrow suppression. Similarly, agroup showing intermediate activity of the enzyme may be prone totoxicity at higher doses of azathioprine and checking TPMT activityprior to commencing treatment is recommended by the BritishAssociation of Dermatologists, the British Society of Gastroenterologyand the British Society for Rheumatology.

Setting up a service for the assay of TPMT was the subject of the lastpresentation of this session, given by Dr Jonathan Berg of the CityHospital, Birmingham. Mindful of a local resistance to send work out toother laboratories, and the small workload generated locally, the onlyway to establish a viable TPMT assay in his laboratory was to offer it as asupra-regional service, available to all UK laboratories. In assessing the



potential workload, it was noted that about 15,000 samples per year arecurrently being processed by 2 UK laboratories and that about 25% of patientsstarting azathioprine therapy were tested before commencing treatment. Thetechnical problems of developing the assay were discussed, along with thelogistical issues of providing a service that depended on the postal services, andgetting the assay CE marked. Turnaround time is of particular importance forpatients waiting to commence treatment. Establishing the assay has requiredentry into the market-place with an emphasis on advertising and quality ofservice requiring constant monitoring of commercial risk from changingprescribing patterns, other laboratories entering the market and thedevelopment of new technologies, e.g. PoCT. The service is designed to be costeffective for users with guaranteed turnaround times, good qualitymanagement, CPA accreditation and CE marking of the assay.

Following tea, there were four presentations for the annual Bayer Award. DrSharman Harris (Bangor) presented “Using six-sigma methodology forimproving quality of HbA1c requesting in diabetic care”, Dr Kelly Parham(Cardiff) presented “The molecular analysis of complement C6 deficientpatients and assay development for the detection of mutations”. Two casepresentations were given, Dr Gail Curtis (Bodelwyddan) presented “A case ofunwell adult – 23 weeks pregnant” and Mr Gareth Davies (Wrexham)presented “An IgG kappa paraprotein in a 36 year old woman”. The Award wasmade to Kelly Parham and presented at the conference dinner that evening.

The conference dinner allowed the delegates and representatives of thesponsors to mix in more relaxed surroundings and although comparatively fewventured onto the dance-floor, the bar staff were kept busy until the earlyhours. Dr Keith Griffiths, Wales Region Chairman, took the opportunity tothank everyone for attending, and for the generous support of commercialcolleagues, without whom, such meetings would not be possible to organise.

Paul Wright talks with KeithGriffiths in the exhibition



Renal Function Testing

The first session on the following morning, Dr Mahdi Jibani, anephrologist from Bangor, outlined the contents of the Welsh NSF forRenal Services. The document has not yet been published but is in finaldraft form. Like the English documents, its objective is to set standardsof care, an implementation programme and a means of audit andassessment of its impact. End stage renal disease is seen as the tip of apotentially very large iceberg with many stages leading to it. The NSFaims to minimise the incidence of renal failure through early diagnosisand to slow down the progression to ESRD whilst integrating thetreatment measures available. One of the drivers of this strategy is thehigh mortality observed in chronic kidney disease in patients beforethey need renal replacement therapy. The introduction of the estimatedGFR has been advocated as a screening test for early kidney disease. Thisnew “test” needs clear guidelines to be issued, particularly to PrimaryCare, to avoid an avalanche of referrals to specialist services.

Dr Tony Avades from the University Hospital of Wales developed DrJibani’s clinical discussions with a review of the laboratory impact of theNSF. Referring to the ESRD iceberg, he suggested that implementationof the eGFR would find many previously unknown cases at a stagewhere intervention would be effective in reducing the progression toESRD and the need for renal replacement therapy. Estimations of theGFR based on the serum creatinine value are not new. As many as 25formulae exist, the most commonly used until recently being theCockroft and Gault formula developed in 1976. More recently, the 6-value MDRD formula has been advocated, although the easier to use4-value MDRD equation using creatinine, age, gender and ethnicity isrecommended in the NSF document. The good news for laboratories isthe recommendation to stop determining creatinine clearance. On thedown-side, the eGFR is not perfect, 90% of people will have an eGFRwithin 30% of a directly measured GFR and 98% will be within 50%.The calculation is very dependent on the accuracy and precision of thecreatinine method in use and not all ethnic groups have been adequatelyinvestigated. The MDRD calculation is not suitable in the under 18s anddoesn’t take weight or body mass into account. It was emphasised thatthe eGFR should not be taken alone as an indicator of renal diseasewithout other factors such as proteinuria being present.

The established practice within the Wales Region is to hold a meetingof the All Wales Clinical Biochemistry Audit group at the end of itsSpring and Autumn scientific meetings. This meeting saw presentationsof a survey of methods of deriving adjusted calcium values (TonyAvades, Cardiff), final draft standards for the investigation of suspectedphaeochromocytoma (Gareth Davies, Wrexham), draft standards for5’HIAA testing (Sharman Harris, Bangor) and final draft standards forperforming Short Synacthen tests (Martin Giles, Bodelwyddan). Detailsof AWCBAG activity can be found on the ACB Wales websitehttp://www.acbwales.org.uk/audit ■

News Focus 2006 News Focus 2006 News Focus 2006 News


Focus on the future is the theme for Focus 2006 and theScientific Committee has assembled a number of internationallyrenowned speakers to give us a glimpse of the future. Below are

brief bio-sketches of three of them. More to follow…

Lawrence ChanProfessor Lawrence Chan is the Betty Rutherford Chair for DiabetesResearch, the Director of the Center for Molecular Medicine at Baylor,and Professor in the Departments of Medicine and Molecular andCellular Biology. He will be delivering the Roche Plenary Lecture. Inthe field of molecular therapy, his laboratory has been developinggene therapy regimens that not only inhibit atherosclerosisdevelopment, but also remodel atheromatous plaques, changing themfrom vulnerable to stable-looking lesions. In collaboration with theDepartment of Molecular and Human Genetics, Dr Chan has been atthe forefront of adenoviral vector application and development.Metabolic syndrome is a predictor of Type 2 diabetes, and obesity is adominant pathological factor in the process. Professor Chan andcolleagues have used a fat vasculature homing peptide to deliver apro-apoptotic gene, leading to targeted ablation of adipose tissue andreversal of obesity and diabetes in mice. The laboratory isinvestigating the use of this as a possible approach to the treatment ofobesity in non-human primates.

Nader RifaiNader Rifai is Professor of Pathology at Harvard Medical School andDirector of the Clinical Chemistry Laboratory at Children’s Hospital inBoston. Dr Rifai’s major research interests have focused on thebiochemical risk markers of coronary heart disease. He has publishedover 200 peer-reviewed scientific publications and co-edited fivebooks. He is the recipient of several scientific awards and has been anactive member of several national and international professionalsocieties. He serves on the Boards of Editors of several scientificjournals in laboratory medicine. He will be delivering the AACC/ACBTransatlantic Lecture, and it will be of great interest to hear about hislatest work in this area, and possible recommendations on whatbiochemical markers we should be using to assess coronary risk.

Chris LoweProfessor Chris Lowe is Head of Cambridge University’s Institute ofBiotechnology and member of the University’s Nanoscience Centre.He will be giving the Dade Behring Lecture. His research has focused

Focus on the Futurein BrightonBy Gordon Fearns

Focus 2006 News Focus 2006 News Focus 2006 News Focus 2006


on the directed immobilization and orientation of biomolecules for useas sensors, arrays and the construction of 3-dimensional architectures.Over the past twenty years Chris has been involved in researchcollaborations with companies, large and small, based in Europe, NorthAmerica and the Far East. He is also co-founder of two spinouts -Affinity Chromatography Ltd (now Prometic Biosciences Inc), a proteinseparations and biopharmaceuticals company, and Cambridge SensorsLtd, a point-of-care diagnostics company. He sits on the Executive Boardof Cambridge’s University Challenge Fund. ■

News Focus 2006 News Focus 2006 News Focus 2006 News


The Local Organising Committee has been working hard to ensure a widerange of social events for Focus 2006. We look forward to welcomingyou to Brighton and hope that the social program will give you a flavour

of this lively city.

Champagne & Chips . . .The Corporate Members Night on Monday 15th May will be held on Brighton’sfamous pier. Following a champagne Civic Reception there will be free passes tothe funfair, dancing, and a fish and chips supper. A karaoke competitionbetween ACB and ACB Corporate Members has been threatened, and there willbe a bar extension until 1.00 am.

Choices for the social events on Tuesday 16th May are:

Brighton Museum and Art GalleryHired exclusively for the evening, the gallery has an extensive collection offashion and style, 20th century art and design and world art. Following thevisit there will be a meal at “ Al Duomo”, a local restaurant.

South Downs WalkA guided 5 mile walk from Ditchling Beacon to Lewes along the South Downswith a pub restaurant meal afterwards. Numbers will be limited to 30 partici-pants.

Greyhound RacingThe first drink and first bet are included for this night at the races. Food anddrink will be served in the restaurant, which has a panoramic view of the racetrack.

Harvey’s BreweryFor real ale enthusiasts! A visit to this local brewery in Lewes with an opportu-nity to taste the products. This will be followed by a meal in a local pub restau-rant. Numbers will be limited to 50 participants.

Golf TournamentSponsored by Olympus, golfers are invited for a round of golf at Singing HillsGolf Club, followed by a meal in the clubhouse.

Late evening Jam SessionNight owls will be able to enjoy a late evening music session organised by ourACB musicians and friends at a local venue.

Focus 2006 SocialEvents Finalised

Focus 2006 News Focus 2006 News Focus 2006 News Focus 2006


Dinner will be provided in the Hilton Metropole for those who do not take part in the otherTuesday social events.

Banquet Wednesday . . .Retired Members Day

Participating retired members will meet in the exhibition before departing for lunch in arestaurant close to the Brighton Marina. There will be time for a stroll round the Marina andMarina Village before returning to the Metropole Hotel.

Conference Banquet (7 pm - midnight)

This will have a tropical theme. Cocktails will be served in the Oxford Gallery to the relaxing sound of a steel band. A Salsa dance band and a disco will provide the after dinnerentertainment. ■

ACB Southern Region Spring Scientific Meeting

‘Vascular Disease in the 21st Century’

Friday March 31st 2006

Lecture Theatre F

St George’s Hospital, London

09.30-10.15 Coffee and Registration10.10-10.15 Welcome 10.15-11.00 Beyond cholesterol – Novel Risk Markers11.00-11.45 Homocysteine – Vascular Risk Assessment 11.45-12.30 Neuroimaging12.30-13.30 Lunch13.30-14.15 Cardiac Imaging – The End of Biomarkers?14.15-15.00 Cardiac Troponins – More than MI15.00-15.30 Tea15.30-16.15 Biomarkers of Cardiac Cisease16.15-17.00 Biomarkers in Stroke17.30-18.30 ACB Southern Region AGM 18.30-20.00 Reception

Cost of meeting: £15.00 (Grade A trainees/temporarily retired members/retired members are required to submit a £15 deposit which will be returned at the meeting) £25 for non members

Closing date for registration: 17th March.For further information please contact: Dr Frances Boa, Department of Chemical Pathology,

2nd Floor Jenner Wing, St George’s Hospital, Blackshaw Road, London SW17 0QTEmail: [email protected] Website: www.acbsouth.org.uk

ACB News Crossword ACB News Crossword ACB News Crossword


ACB News Crossword

Crossword set by RugosaAcross1/9 Tory quit on-call over maintenance of standards (7,7)5 Memory of sound money (5)9 See 110 Female cooked rumen membrane (6)13 Prefer to a limited extent (6)15 Upset washerwomen who lost garments (8)17 We hear point sentry is in charge of regulations used for

1/9 (8,5)19 Beginner enjoys evening dance, missing none of

well-known 1/9 chart titles (5-8)22 Lope around middle of March in England like a hare (8)23 Member of Inuit seen in ladies kimono (6)27 Psychoactive food of mentally disturbed person having

magnetoencephalography (6)28 Imino acid drug left 22 confused (7)29 Race that has two separate circuits (5)30 Account of equivocation about cancelled quota (7)

Down 2 Vessel initially used by orientals as teapot (1-4)3 Measure of lithium treatment starting (5)4 Very small measure for you? (4)6 Spray chocolate colloidal suspension (7)7 Persistent followers of hothead annoy offspring (7-2)8 Rascal cries about radical lack of consistency (11)11 Set limits on update of 19 display? (4,3,4)12 Orders that may not be final or absolute (7)14 Very good but wanted by the police (3)16 Boast about Chinese feminine principle, laughing

harshly (7)18 Explosive fertiliser (9)20 Flower-pot man in rave about plant (7)21 Gall inactivated reductase kinase: initial isolation (3)24 Burst of sound like gunfire coming from a quaquaversal

volcano (5)25 Sort of capital Greek dialect (5)26 Bargain hunting for odd items used to make bread and

muffins (4)

Answers to Last Month’s CrosswordAcross: 9 Acted, 10 Phosphate, 12 Euro, 13 Ma, 15/11/1 Parathyroid hormone-related peptide, 17 Ash, 18 Was, 19 Side effects, 21 It, 22 Inca, 24 In vitro, 27 Etymology, 28 Venue, 29 Protein-binding Down: 2 Enterprise, 3 Audio, 4 Probe, 5 Papered, 6 Imam, 7 Eye-wash,8 Mayhap, 10 Pie-eyed, 14 Calcitonin, 16 Obesity, 18 Write-up, 19 Syncope, 20 Sloven, 23 Adorn, 25 Vivid, 26 Typo

Congratulations to Jahm Persaud who sent the only winning entry in lastmonth and is now the proud owner of a

Calcium CD-ROM

Keep sane at coffee time with the ACB News Crossword. Always relating to the science and practice ofClinical Chemistry, you will never cease to be astounded by the convoluted mind of the ACB NewsCrossword compiler.

Prizes for your department: The first five correct solutions to appear on the ACB News fax machine(Fax: 0121-765-4224) will receive a copy of the new educational Calcium Cases CD-ROM by AubreyBlumsohn, Christina Gray, Neil McConnell, John O’Connor, Anne Pollock & Roy Sherwood and whichretails at over £50. Please state clearly the name and address of the Department that is entering the competition.

Remember that ACB News appears first as a PDF on www.ACB.org.uk around the 7th of each month.

Obituary Obituary Obituary Obituary Obituary Obituary Obituary


Fishing in theStream of LifeProfessor Nick Hales

Professor Nick Hales, who died on 15th September 2005 aged 70,was Head of the Department of Clinical Biochemistry at theUniversity of Cambridge and Addenbrooke’s Hospital for 25

years. Before that he was Head of the Department of MedicalBiochemistry at the Welsh National School of Medicine and UniversityHospital of Wales in Cardiff. During a very productive research career inthe field of diabetes, Nick made many important contributionsincluding major developments in immunoassay methods for measuringinsulin and other polypeptide hormones. He also established the role ofnutrition during early life as a key factor in the development of diabetes.

Nick Hales was born in Stafford in 1935. He was educated at KingEdward VI Grammar School, Stafford, and then Trinity College,Cambridge where he read Medicine. After clinical training at UniversityCollege Hospital, London, he returned to Cambridge in 1960 to studyfor a PhD in the Department of Biochemistry under the supervision ofPhilip Randle. At that time the department, headed by Professor SirFrank Young, had a strong interest in the control of metabolism.Although it was 40 years after the discovery of insulin by Banting andcolleagues in Toronto and its successful use in the treatment of diabetes,the biochemical mechanisms underlying insulin production and actionremained largely a mystery. This was in no small part due to a lack ofanalytical methods for measuring the fluctuating concentrations ofinsulin in the blood. The description by Yalow and Berson in 1960 ofan immunoassay method employing radioactively labelled insulin andan insulin antibody was a major step forward that Nick was very quickto appreciate. He developed a modification of the immunoassay methodthat greatly facilitated its application. His first major scientific paper,describing this new method and published in the Biochemical Journalin 1963, remains the most highly cited of over 300 publications. Theimmediate impact of this work, and a series of papers that soonfollowed describing levels of circulating insulin under differentphysiological conditions, established his reputation. In 1964, soon aftercompleting his PhD, he was appointed University Lecturer inBiochemistry in Cambridge. There then followed a period of activeresearch, undergraduate teaching and also seeing diabetic patients at aweekly clinic at Addenbrooke’s Hospital. In the laboratory Nickdeveloped the novel immunoradiometric assay using radioactivelylabelled antibodies to measure insulin and other polypeptide hormoneswith greater sensitivity and specificity than earlier immunoassays. ANature paper written by Nick in 1968 envisaged the use of enzymes or

Obituary Obituary Obituary Obituary Obituary Obituary Obituary


viruses as alternative labels capable of providing even greater assay sensitivity.Diagnostic methods based on labelled antibodies are nowadays a worldwide,multi-billion dollar industry.

In 1970 Nick was appointed Head of Department at the Welsh National Schoolof Medicine and Honorary Consultant in Chemical Pathology, where he continuedto refine immunoassay methods. In 1977, Nick returned to the University ofCambridge as Head of the Department of Clinical Biochemistry and HonoraryConsultant at Addenbrooke’s Hospital. He found himself working across the roadfrom Cesar Milstein, and was quick to enlist his advice in setting up a laboratoryto produce monoclonal antibodies. Nick himself continued to evolve and refinemethods for measuring insulin, and its precursor pro-insulin, and showed that incombination these assays could provide an early indication of the development ofdiabetes. Nick’s constant search for new insights into insulin secretion led to asabbatical year in Seattle in 1984. He discovered, with Dan Cook, an ATP-sensitivepotassium channel in the β cells of the islets of Langerhans that helped resolve thelong-standing problem of how glucose instructs the pancreas to secrete insulin. In1988, a conversation with Professor David Barker from Southampton was to havea significant influence on Nick’s subsequent research. David told him of hisobservations establishing a link between birth weight and death fromcardiovascular disease, suggesting that environmental influences during fetal lifeplay a major role in this association. Nick recognised that since the majority ofpancreatic β cells are laid down during fetal life, these could be very vulnerable ifthey were exposed to poor nutrition during this critical period. In collaboration,Nick demonstrated that low birth weight greatly increased the risk of diabetes inlater life. This discovery formed the basis of the Thrifty Phenotype Hypothesis putforward by Nick in his Banting Award Lecture in 1991. Over the next decade hewent on to dissect the underlying molecular mechanisms linking fetal growth tolong-term health.

Nick was a strong advocate of the importance of combining university andhospital departments of Clinical Biochemistry, bringing together those involved inresearch, diagnosis and treatment. He also believed that new ideas should receivethe speediest and fullest dissemination if they were to deliver maximum benefit toscientific colleagues and most importantly to patients. Nick was an outstandingmentor who encouraged younger scientists to tackle difficult problems andachieve independence. He presided over two happy and very successfuldepartments and his style of encouraging people to continue scientific debate inthe convivial atmosphere of a pub or social club undoubtedly played its part inthis. Nick was elected FRS in 1992 and received many major awards, includingthe ACB Foundation Award in 1991, the Kone Award in 1999 and theInternational Federation of Clinical Chemistry’s Distinguished Clinical ChemistAward in 2002. “Fishing in the stream of diabetes”, the title he gave to an awardlecture delivered in 1995 and the title used for his retirement symposium in2002, reflected the diversity of his research and was also a reference to hisfavourite hobby.

Nick’s intellectual leadership at the interface of basic and clinical science will besorely missed, but he will be remembered very fondly by many friends andcolleagues. He is survived by his wife Margaret, his younger son Tim and hisdaughter Kate who is a medical student.

P.L.

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