Laboratory Diagnosis

In clinical practice, e.g., for the planning of operations, diagnosis of congenital F XI deficiency is usually established by APTT-based assays, whereas molecular techniques are mostly restricted to scientific studies. However, there are conditions, such as consumption reactions or the presence of a high titer of lupus anticoagulant, where APTT-based tests may not be suitable and molecular methods are needed to identify a congenital deficiency state. For mutation analysis, genomic DNA is extracted and usually amplified by PCR with primers covering all 15 exons and the intron-exon boundaries. Frequently, primers are designed in such a way that a section of DNA encompassing a number of exons in close proximity to each other is amplified.[31,32] PCR may be directly followed by determination of nucleotide sequences of all PCR products, but frequently a mutation-screening technique such as single-stranded conformation polymorphism (SSCP) analysis is subsequently applied to avoid unnecessary sequencing.[17,33] Restriction fragment-length polymorphism (RFLP)[32] analysis and dideoxyfinger-printing (ddF)[15] have also been used for this purpose. The disadvantage of all of these methods is that the mutation-detection rate may be incomplete. For example, with Fluorescent-SSCP, the detection rate is 80-85% in routine use.[34] Recently, considerable improvement with denaturing high-performance liquid chromatography (dHPLC) has been reported. In one study, the detection

rate using this technique was 100%.

Getting Started With Dumbbells

Getting Started With Dumbbells

The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.

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