The invention relates to an apparatus and a method for examining a liquid sample, in particular a urine sample, for determining the risk of urinary lithiasis.
The risk of becoming ill with urinary lithiasis is 5 to 15% on average in industrialised countries: peak values of approximately 20% are reached in the Gulf States. Epidemiological data show an increasing tendency in the incidence and in the prevalence of calculosis. 75% of calculi formed in the industrial countries consist of calcium oxalate.
A patient who has already suffered from a calculus once without therapy or with unsuitable therapy should expect a probability of recidivism of 75-100%. The need for a suitable method for determining the risk of uroliths may be derived from this. This is particularly important for determining the risk of recidivism in patients who are already ill.
A method developed at the urological clinic of Bonn University and based on a calculation of what is known as the Bonn risk index (BRI) has proven suitable for determining a urolith risk indicator. To calculate the BRI, a 40-millimolar ammonium oxalate solution is added to a urine sample by a standard method until calcium oxalate crystallisation commences. The millimolar concentration of oxalate (Ox2−) added to the urine sample at this moment is determined and related to a sample volume of 200 ml. In specialist medical circles, the concentration of oxalate (Ox2−) based on a sample volume of 200 ml is described as the added amount of oxalate (Ox2−). In addition, the initial concentration of free calcium ions in the urine sample [Ca2+] is determined: the concentration is given in mmol/l. The BRI is then calculated as
BRI=[Ca2+]/(Ox2−).
A BRI of 1/L is considered to be the risk limit for calcium oxalate lithiasis. All problems are allocated one of eight risk categories, I-VIII. BRI 1/L falls between risk categories IV and V. In a variation of the measurement method, the risk of calcium phosphate lithiasis can also be determined, a phosphate solution, rather than the ammonium oxalate solution, being presented to the urine sample until it crystallises and the ratio of free calcium ions and phosphate solution being determined as the risk indicator.
The object of the invention is to provide an apparatus and a method for examining liquid samples with which, in particular, the above-described method of examination of a urine sample for determining the Bonn risk index may be carried out cost-effectively and reliably in a medical practice or in a hospital. The apparatus should enable the method to be carried out in a standard, substantially automated manner and at low cost.
The inventors have found that a titration system may be used in conjunction with optical transition measurement to determine the crystallisation point of a liquid sample. However, the measuring arrangement for transmission measurement could not, in turn, necessitate the exclusive use of sample vessels for the liquid sample, in particular for a urine sample, of high optical quality. The inventors have concluded from this that although a portion of the liquid sample is to be investigated thoroughly with a light ray for transmission measurement, it is, on the other hand, disadvantageous to pass rays through the sample vessel itself.
According to the invention, therefore, the apparatus comprises a measuring head which comprises an optical fibre and may be immersed into a liquid sample to be measured. A first end of the optical fibre is allocated to a light source. A light sensor is arranged in a defined manner relative to the light path, predetermined by the optical fibre, of the light emitted from the light source. In the immersed region of the measuring head there is further provided a recess which further interrupts the optical fibre in such a way that at least a portion of the light guided by the optical fibre thoroughly examines the liquid sample over a defined distance. Clouding of the liquid to be examined, which is due to the initiation of crystallisation during the defined addition of a titration liquid to the liquid sample by a titration system of the measuring apparatus may then be detected by the light sensor on the basis of the increasing losses of transmission.
Preferably, a ray-form light source is used as the light source and may be produced, for example, by means of an orifice structure in an expansive light source or by the use of a laser, for example a laser diode. Furthermore, the notion of the light source in the present application is not restricted to the visible wavelength range, as a source of electromagnetic radiation outside the range which is perceptible to the human eye may also be used, for example an infrared source. Visible light, in particular in the red range of the spectrum, preferably of approximately 650 nm is preferred.
A detector system which is suitable for the light source is used as the light sensor and may be, for example, a photo transistor, a photo diode or a photo resistor. It is also conceivable to construct the photo sensor as a sensor matrix so the influence of faults may be reduced by adjusting the sensor arrangement.
According to the invention the measuring head is accordingly configured in such a way that, with the ends of the optical fibre, it is allocated to the light source and the light sensor, but may be separated therefrom. It is particularly preferable to use a measuring head which is only used for one respective urine sample in the context of a disposable measuring head. This procedure affords the advantage, in particular, that the measuring head coming into contact with the liquid sample does not have to be cleaned in a complex manner after taking a measurement. In addition, as a disposable part, it does not have to be formed so as to be suitable for a large number of measuring and cleaning steps.
With respect to geometric configuration, the measuring head is so constructed that it is immersed into a urine sample, at least until a recess in the measuring head, which is traversed by the light ray, is filled with the liquid to be measured, in particular the urine. In addition, it is preferable to arrange the light source and the light sensor in such a way that they do not come in to contact with the liquid sample, i.e. only the measuring head which touches the liquid sample becomes contaminated, although this is immaterial as it is a part which will be exchanged after one measurement in any case.
A possible configuration of the measuring head comprises an optical fibre with at least one ray-deflecting device. This enables the light source, as well as the light sensor to be positioned above the liquid level of the urine to be examined. Two ray deflectors which are at an angle of 45° to the horizontal and an angle of 90° to one another, so that a ray portion leading substantially vertically downwards, followed by a substantially horizontal ray portion and a ray portion which is directed substantially vertically upwards, is constructed in the measuring head, have proven particularly advantageous. Said recess in the measuring head is located in at least one of these ray portions, so that the ray penetrates through the liquid sample substantially freely in a specific portion and detects changes in transmission over this known path.
With an apparatus according to an invention of this type it is accordingly possible to determine, in conjunction with a metering system for the crystal formers, the amount of crystal former which leads to the initiation of crystallisation. A solution which contains a lithogenic component of the type of crystal of which the risk or crystallisation is to be determined is used as the preferred crystal former for a sample. An oxalate or phosphate solution is preferred as the crystal former for a urine sample.
For measuring the amount of crystal former required in proportion to the volume of the liquid sample, it is necessary to determine the existing amount of liquid in the urine to be examined. With a known weight of the sample vessel, this can be determined using a weighing apparatus.
Alternatively, the geodesic height of the liquid level in the sample vessel may be measured in the case of a known form of sample vessel in order to determine the volume of the measured liquid. Various apparatuses are conceivable for this purpose, for example, moisture sensors which have an open pair of electrodes between which contact is produced by the liquid to be measured, which in turn may be detected by resistance measurement. A device for determining the geodesic height of the liquid level, connected to the measuring head for transmission measurement is particularly preferred. Preferably, the measuring head is then, in turn, connected to a height adjusting apparatus which enables the measuring head to travel into the sample vessel from above and therefore to be immersed into the urine. If the height adjusting apparatus is so constructed that measurement is carried out from a known reference height from the distance covered in a vertical direction, the geodesic height of the liquid level and therefore the volume of liquid in the sampling container may be determined if the position of the liquid sensor is known.
In a particularly preferred configuration of the invention, the recess in the measuring head is used to determine the position of the liquid level of the urine sample. The initially free measuring head, i.e. there is no liquid in the recess provided by transition measurement, is moved vertically downward in the direction of the liquid level until the liquid to be examined penetrates into the recess and changes the transmission. The position of the liquid level may then be determined from the known position of the recess and the light ray travelling therein as well as the distance covered.
The measured value of the free calcium ions [Ca2+], required for BRI calculation, is determined in a preferred development of the apparatus for examining a urine sample by means of a suitable sensor system. In a possible configuration, a specific amount of the untreated urine sample is removed from the sample vessel for this purpose and presented to a sensor of a Ca2+ ions by means of a fluidics system. This may be, for example, an ion-selective field-effect transistor which comprises an ion-selective membrane. The fluidics system preferably also comprises an apparatus for introducing rinsing liquids for cleaning purposes. For calibrating the sensors, it is additionally preferred to present a calibrating solution thereto. The construction of the pumps, containers, and receivers required for this purpose and of the associated fluidic control are within the ability of a person skilled in the art.
For controlling the apparatus according to the invention, the apparatus according to the invention may comprise internal or external control units in the form either of microcontrollers or externally connected PCs, by means of which an interface for the user in the form of input units and displays may also be produced.
The measuring head preferably has a holding device for holding it on a mount of the apparatus, the holding device comprising a holding means, in particular an integrally connected component with a set breaking point, which is so constructed that the holding device may only be used once. This means that the measuring head can only be used once.
Accidental repeated use of a measuring head, which can lead to distorted results owing to impurities, is thus avoided. Repeated use of the measuring head is precluded particularly reliably if the holding means is made unserviceable as a holding means after the first use of the holding device.
In a variation, the measuring head is so constructed that it conveys the light received from the light source to the light sensor. A change in the transmission of the liquid sample to be examined may be determined in this way.
Alternatively, the measuring head may be constructed in such a way that it conveys the light received from the light source along a light path, adjacent to which the sensor is arranged, but in which the sensor is not directly arranged. A measuring head configuration of this type may be used to measure scattered light provided by the liquid sample.
The apparatus can comprise a drive device for moving the measuring head relative to the sample vessel, at least a portion of a determining device for determining the liquid level of the liquid sample being provided on the measuring head. To simplify the exchange of the sample vessel, it is advantageous in any case if the measuring head is movable relative to the sample vessel. In the above-described development, this movement may at the same time conveniently be used to determine the liquid level.
If the recess in the measuring head is a part of the determining device, the light source and the light sensor may be used for liquid level determination, together with this recess as the light intensity of the light emitted by the light source and conveyed through the measuring head changes on entering the recess into the liquid sample to be examined.
A fluid duct of the fluid system may be constructed in the measuring head. A portion of the liquid sample may then be aspirated via the measuring head for determining a parameter of the liquid sample to be examined via the fluid duct. This aspiration fluid duct is then also exchanged when the measuring head is exchanged and this makes it easier to keep the measuring apparatus clean.
The fluid duct is preferably closed by a sealing stopper which, in the measuring position of the measuring head, is penetrated by a line portion of the fluid system on the measuring head receiving side. A sealing stopper of this type allows the fluid duct to be sealed cleanly against the line portion.
In a preferred development, a fluid duct of the titration system is constructed in the measuring head. A separate titration feed pipe into the sample vessel can then be dispensed with.
Preferably, a stirrer is provided for stirring the liquid sample, the measuring head comprising at least one flow component, in particular at least one flow blade, for cooperating with the liquid sample. This allows defined mixing of the liquid sample during stirring and therefore a reproducible examination of the liquid sample.
In a variation of the measuring apparatus, the measuring system comprises a spectrometer for determining the concentration. This allows reliable, substance-selective determination of concentration.
With regard to the method, the object of the invention is achieved on the one hand, by a method for examining a liquid sample by titration, which employs the above-described measuring apparatus according to the invention. This object is achieved, on the other hand, by a method for examining a liquid sample by titration, comprising the following steps: preparation of the liquid sample, measurement of the liquid level of the liquid sample by introduction of a measuring head from above into the liquid sample, determination of the concentration of at least one type of ions in the liquid sample, feeding of a crystal former into the liquid sample and measurement of the transparency of the liquid sample after introduction. Defined, reproducible determination of the liquid parameters is thus possible.
Preferably, a new disposable measuring head is used prior to feeding. This ensures particularly readily reproducible processing conditions with regard to the measuring head. Cleaning of a used measuring head is unnecessary.
Preferably, a concentration determining sensor is cleaned and/or calibrated prior to determination of concentration. This provides defined conditions during determination of the concentration, so concentration-determining sensors which have a long-term drift tendency may also be used.
The liquid sample may be stirred before determining the concentration. This ensures defined measuring conditions, as a homogeneously distributed liquid sample is measured.
Preferably, a sample parameter is calculated from the measured values of concentration and transparency. This allows a concentration-dependent crystallisation point to be determined by a simple numerical value.
Preferably, the pH of the liquid sample is additionally determined. This provides additional information about the constitution of the liquid sample.
In addition, the temperature of the liquid sample may be determined. This may be used, in particular, to correct the determined concentration. Additional liquid parameters may also be measured using the measuring apparatus. In an advantageous development, the measuring apparatus may be constructed as a mobile laboratory for determining a large number of liquid parameters.
Liquid parameters of this type may be: the specific gravity, the content of or the presence of Na, K, Mg, NH4, Cl, PO4, SO4, creatin, uric acid, leucocytes, nitride, albumin, proteins, glucose, ketone, urobilin, billirubin, urobillinrubin, erythrocytes, haemoglobin. The separation of serum proteins such as albumin, transferrin, globulins, immunoglobulins and immunoglobulin fragments.
The invention will be described in more detail with reference to the following figures which show embodiments.
It is preferable to introduce a substantially ray-shaped light ray into the measuring head. If this then consists of a material which is transparent to the employed wave length of the illuminating light, for example, PMMA (polymethylmethacrylate) or Makrolon (polycarbonate), which are 70-81% transparent to visible light. Any plastics materials which may be produced by injection-moulding or by machining processes may generally be used. Alternatively, the optical fibre may also consist of glass. In most cases, the influence of scattered light may be ignored for the measuring head and merely the external regions in which ray deflection occurs are then advantageously reflected. Alternative configurations of the measuring head include glass fibres or optical fibres based on polymers for ray positioning. It is also conceivable to separate regions of opposing ray positioning from one another by the geometric configuration of the measuring head. This may be effected, for example, by a recess which separates a first portion of the measuring head with downwardly directed ray positioning from a second part in which ray positioning is directed upwards. Owing to the formation of an interface from the material of the measuring head to the open region in the recess, crosstalk between the individual regions of ray positioning in the measuring head, which reduces the accuracy of measurement, is avoided. A free region of this type is sketched in
For taking transmission measurements, it is necessary to interrupt the optical fibre over a specific irradiation distance. According to
The measuring head 1 for transmission measurement is located above the sample vessel 8 in the sample-receiving region 7. It is fixed on a measuring head carrier 11 and can preferably be exchanged by mere manual interventions in the sense of a disposable article. The light source 2 which remains permanently on the measuring system and the light sensor 3 are preferably arranged in the measuring head 11. In a preferred configuration, moreover, the measuring head carrier is allocated a marking and/or detection system by means of which an already used measuring head 1 may be detected or which marks a measuring head as used when it is attached or is immersed into the liquid sample. In a possible configuration, two plastic pins which may be broken off and which actuate a switch when inserted into the measuring head carrier are arranged on the measuring head. The pins break off so that the switches cannot be triggered again if they are re-used. The switch transmits two signals to the electronics. The first signal has a short duration and the second signal is applied throughout the measuring process and at the same time serves to check the position of the measuring head.
For positioning the measuring head 1, the measuring head carrier 11 is connected to a positioning system 12, which substantially allows a vertical movement for immersing the measuring head 1 into the liquid sample.
For carrying out the investigation, it is necessary to determine the liquid volume of the liquid sample in the sample vessel 8. This may be effected in various ways. On the one hand, it is possible to derive the volume by determining the weight of the filled sample vessel 8. For this purpose, the sample plate 9 can be allocated a weighing unit. Alternatively, if the shape of the sample vessel is known, the volume may be measured by determining the geodesic height of the liquid level of the liquid sample in the sample vessel 8. A configuration in which a liquid detection system 14 is connected to the measuring head, and the positioning system 12 for the measuring head is allocated a position measuring system 13 is particularly preferred. Starting from a specific reference point, the vertical distance covered by the measuring head 1 until it reaches the liquid level may be used to determine the volume of the liquid sample in the sample vessel 8. In a possible configuration, the position measuring system 13 comprises contact switches for the reference position. These may be formed, for example, as Hall-effect sensors.
In addition, the distance covered by the measuring head during positioning may be determined by a suitable sensor, for example a rotational speed sensor or a linear scale. If a stepping motor is selected as the drive, it is unnecessary to use additional sensors to determine the movement.
Ion-selection field-transistors (ISFET) of which the ion selectivity is brought about by the choice of a suitable membrane, are preferably used in the sensor block 24. A pH sensor and a temperature sensor may additionally also be used as the sensors.
In addition to use of the apparatus according to the invention for examining human urine, in particular for determining the BRI, it is possible to examine a large number of different liquids, in which the transmission properties are changed by the addition of a substance and for which quantities change in transmission is to be determined quantitatively.
The measuring apparatus is switched on in a preparatory step 32. Starting parameters, for example, an identification code of the patient, are then input in an input step 33 via an alphanumeric keyboard. The user can control the input parameters via an LCD display of the measuring apparatus. After the parameters have been input, the measuring head 1 is inserted into a corresponding measuring head socket of the measuring apparatus in an assembly step 34. The measuring head 1 comprises a contact pin (not shown) which cooperates with a corresponding contact in the socket of the measuring apparatus. If the measuring head is incorrectly positioned in the socket, the measuring apparatus automatically emits an error message on the LCD display. The sample vessel 8 is then placed on the sample plate 9 with the liquid sample and the door element 30 is subsequently closed in a readiness step 35. The closed position of the door element 30 is checked by the measuring apparatus via corresponding contacting. If the door element 30 is not correctly closed, the measuring program emits an error message. Measurement is subsequently started automatically. The liquid level of the liquid sample is subsequently measured in a level measuring step 36. For this purpose, the measuring head I is driven from a defined zero position by means of the positioning system 12, which comprises a threaded spindle from above into the sample vessel with the liquid sample. Using the position measuring system 13, the distance covered is measured via the number of revolutions of the threaded spindle. As soon as the recess 5 is wetted by the liquid sample, in other words, as soon as the lower edge of the recess 5 is at the height of the liquid level, the intensity of the ray falling onto the light sensor 3 changes as, on the one hand, the refractive indices at the interfaces of the recess 5 change and, on the other hand, the light ray through the liquid is at least partially attenuated. The change in intensity caused by the attainment of the liquid level is detected by the light sensor 3. As soon as a defined change has occurred, for example as soon as the measured intensity attains less than 98% of the starting intensity, the instantaneous position of the threaded spindle is detected by the position measuring system 13. In this way, the liquid level of the liquid sample in the sample vessel 8 can be determined exactly and conclusions can be drawn about the amount of sample from the height of the liquid level and the then known liquid volume in the sample vessel 8.
A cleaning step 37 now takes place in preparation for concentration determination. For this purpose, the cleaning solution 25 is temporarily guided past the sensor block 24. The cleaning solution 25 then remains for a short time in the fluidics system, so bacteria can be destroyed. This passing and standing of the cleaning solution 25 is repeated a plurality of times during the cleaning step 37. If the measuring apparatus is not used for a prolonged period, it may also be necessary to clean further line regions of the fluidics system and not just the sensor block 24.
The sensor block 24 is calibrated in a subsequent calibration step 38. For this purpose, a Ca ion sensor and the pH sensor of the sensor block 24 are brought into contact with the first calibration solution 27. The first calibration solution 27 is drawn past the sensors of the sensor block 24 for a short time. As soon as the measured values of the sensor are stable, as detected by the measuring program by means of a slight variation in successive measured values, the measured values are stored. This process is subsequently repeated with the second calibration solution 26 within the calibration step 38. The measurement program determines the necessary calibration parameters for Ca-concentration determination and pH determination from the measured values of the sensor determined in this way, from the two different calibration liquids. The subsequently collected measured values are collected using the calibration parameters contained.
The liquid sample in the sample vessel 8 is subsequently stirred in a stirring step 39. For this purpose, the sample plate 9 with the sample vessel 8 is set into uniform rotation about the vertical axis of the sample vessel 8. The measuring head 1 is lowered further into the liquid sample and therefore acts as a stirrer during the stirring step 39.
In a subsequent concentration-determining step 40, a portion of the liquid sample from the sample vessel 8 is aspirated via a supply line 41 (CF.
A further cleaning step 42 for the sensor block 24 now takes place. The cleaning step 32 corresponds to the cleaning step 37.
In a crystallisation measuring step 43, the sample vessel 8 is initially rotated uniformly by means of the motor 10 of the sample plate 9 in a preparatory manner, so that a thoroughly mixed liquid sample is obtained. The light source 2 is then switched on and the intensity of the light arriving at the light sensor 3 from the light source 2 is measured. At specific time intervals, for example at respective intervals of one minute or also at intervals of a few seconds, a specific amount of ammonium oxalate is injected or titrated from the resource container 17 via the metering system 15. The measurement program calculates the total injected amount of ammonium oxalate from the previously known concentration of the ammonium oxalate solution. Titration is continued during the crystallisation measuring step 43 until calcium oxalate crystallisation occurs. The crystallisation point can be detected by clouding of the liquid sample and an associated lower light intensity at the light sensor 3. The instant of titration, for example, at which the measured light intensity at the light sensor 3 is 98% of the light intensity at the beginning of titration can be determined as the crystallisation point. During the crystallisation measuring step 43, the amount of added ammonium oxalate required for achieving the crystallisation point can be measured in this way with an accuracy of, for example, ±0.2 ml at a titration rate of 40 mmol/l via the reduction in the light intensity measured at the light sensor 3.
The BRI index is subsequently calculated in a calculation step 44. For this purpose, the amount of oxalate is initially calculated from the amount of liquid in the liquid sample and the amount of ammonium oxalate added up to the crystallisation point. The BRI index is obtained in the manner mentioned at the beginning of the description as the quotient of the Ca2+-concentration determined in the concentration-determining step 40 divided by the amount of oxalate. In medical circles, the amount of oxalate is understood to be the concentration of oxalate (Ox2−) based on a sample volume of 200 ml.
In a subsequent storage step 45, the following values in particular, are then stored: the patient's identity code, the date, the time, the measured temperature, the measured Ca2+-concentration, the measured pH, the BRI index calculated form the measured data, the respective individual values measured by the sensors of the sensor block 24 and any error messages that have appeared. A compact flash card, in particular, is used as the storage medium. For maintenance or monitoring purposes, the storage medium can be transferred to a maintenance or monitoring computer via a read-out interface.
The desired data of the measured, calculated or stored values are printed out in a final printing step 46. For this purpose, the stored information can be transferred to a computer, for example via an USB-interface. The data can be further processed there.
A measuring head which is an alternative to the measuring head 1 shown in
A fluid duct 51 which communicates fluidically with the supply line 41 of the fluidics system in the assembled alternative measuring head 1 is constructed in the alternative measuring head 1. The fluid duct 51 extends in a first duct portion 52 from an upper limiting wall, which is horizontal in
Before the alternative measuring head 1 is inserted, the fluid duct 51 is closed by a sealing stopper (not shown) which is inserted tightly into the enlargement 54. In the measuring position of the alternative measuring head 1, in which the measuring head 1 is received in the socket of the measuring apparatus, the sealing stopper is penetrated by a line portion of the supply line 41 of the fluid system on the measuring head receiving side. This line portion is formed by a conventional commercial injection needle. Once the sealing stopper with the line portion has been pierced, the sealing stopper seals the line portion against the internal wall of the enlargement 54, producing a fluid connection between the fluid duct 51 and the supply line 41 that is sealed from the exterior.
In a deflection portion 56 in the lower region, in
During insertion of the alternative measuring head 1 into the measuring position, the holding pin 50 latches into the associated opening in the socket of the measuring apparatus 1. The opening is configured in such a way that, as the measuring head is removed after measurement, the holding pin 50 breaks away from the holding portion 57 at a set breaking point. As the holding pin 50 has a holding function, the alternative measuring head cannot be re-used after it has broken away.
In the alternative measuring head 1, the recess 5 is used to determine the liquid level of the liquid sample, as described herein before in conjunction with the flow chart in
The two variations of the measuring head shown on the one hand, in
In a further variation of the measuring head (not shown), a fluid duct of the metering or titration system 15 is constructed with the nozzle 16 in the measuring head.
In a further variation of the measuring head, a spectrometer is used to determine the Ca2+-concentration in the concentration-determining step 40, rather than the sensor block 24. For this purpose, the portion of the liquid sample, of which the Ca2+-concentration is to be determined, is permeated with light of different wavelengths, conclusions about the presence of Ca-ions in a corresponding concentration being drawn form the absorption of the liquid at specific wavelengths.
Number | Date | Country | Kind |
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10 2004 045816.2 | Sep 2004 | DE | national |
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/EP04/13084 | 11/18/2004 | WO | 5/19/2006 |
Number | Date | Country | |
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60523488 | Nov 2003 | US |