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PubMed1990

[Early and late prognosis in acute myocardial infarct. A retrospective study in patients admitted to the coronary care unit in the past 10 years].

The prognostic evaluation of the patient with an acute myocardial infarction is one of the most interesting unanswered problems. This is both because of its complexity and its implications in terms of secondary prevention. Several clinical studies have emphasized the reliability of the prognostic evaluation based on data collected during the first 24 hours. We therefore evaluated the prognostic relevance of 26 variables measured in the coronary care unit in 1914 patients admitted to our Unit as a result of acute myocardial infarction during the past 10 years. Twenty-four patients were lost to follow-up so that the evaluation refers to 1,890 patients, 1,506 of whom are males aged between 22 and 99 years (mean 58.1) and 384 are females aged between 29 and 88 years (mean 67.1); thus there is a greater prevalence of males. The sex-related difference in the age distribution is statistically significant. In-hospital mortality was analyzed using univariate and multivariate statistical methods (chi-squared test, multiple logistic regression analysis). The prognostic relevance of the considered variables in relation to the survival was analysed using the logrank test and using Cox's model. The variables associated with a greater risk of in-hospital death were found to be: age, presence of diabetes, anterior location of the infarct, arterial hypotension at admission, Killip class III and IV and the presence of ventricular tachyarrhithmias. In contrast, smokers had a lower in-hospital death risk. As to mortality during the follow-up, there was an association with age, female sex, pre-existent coronary disease, presence of high heart rate on admission, low peripheral tissue perfusion, x-ray documented pulmonary congestion, supraventricular tachiarrhythmias and intraventricular block. In contrast, the presence of obesity was associated with a reduced death risk during the follow-up. During the follow-up the most frequent cause of death was re-infarction, followed by sudden death, death from non-cardiac causes and heart failure.

Adult↗

PubMed1999

Association between the Epworth sleepiness scale and the multiple sleep latency test in a clinical population.

BACKGROUND: Excessive daytime sleepiness can be evaluated with both subjective and objective tests. OBJECTIVE: To examine the association between Epworth Sleepiness Scale scores and sleep latency on the multiple sleep latency test. DESIGN: Case series. SETTING: Referral sleep disorders center. PATIENTS: 102 consecutive patients evaluated for excessive daytime sleepiness. MEASUREMENTS: Epworth Sleepiness Scale scores and mean sleep latency on the multiple sleep latency test. RESULTS: No significant association was seen between Epworth scores and mean sleep latency (Pearson correlation, -0.17 [95% CI, -0.35 to 0.03]; P = 0.09) (analysis of variance, P = 0.13). The mean Epworth score did not differ in three groups of patients who were defined by mean sleep latency as having normal sleep latency (>10 minutes), moderate sleep latency (5 to 10 minutes), or severe sleep latency (<5 minutes) (analysis of variance, P = 0.13). CONCLUSIONS: No statistically or clinically significant association was seen between Epworth scores and mean sleep latency. The subjective Epworth Sleepiness Scale and the objective multiple sleep latency test may evaluate different, complementary aspects of sleepiness.

Humans↗

PubMed1997

Positional vs nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data.

STUDY OBJECTIVES: To compare anthropomorphic, nocturnal polysomnographic (PSG), and multiple sleep latency test (MSLT) data between positional (PP) and nonpositional (NPP) obstructive sleep apnea (OSA) patients. DESIGN: This is a retrospective analysis of anthropomorphic, PSG, and MSLT data of a large group of OSA patients who underwent a complete PSG evaluation in our sleep disorders unit. The patients were divided in two groups: the PP group, those patients who had a supine respiratory disturbance index (RDI) that was at least two times higher than the lateral RDI, and the NPP group, those patients in whom the RDI in the supine position was less than twice that in the lateral position. SUBJECTS: From a group of 666 consecutive OSA patients whose conditions were diagnosed in our unit from September 1990 to February 1995, 574 patients met the following criteria and were included in the study: RDI > 10; age > 20 years, and body mass index (BMI) > 20. RESULTS: Of all 574 patients, 55.9% were found to be positional. No differences in height were observed but weight and BMI were significantly higher in the NPP group, these patients being on the average 6.5 kg heavier than those in the PP group. The PP group was, on average, 2 years younger than the NPP group. Nocturnal sleep quality was better preserved in the PP group. In this group, sleep efficiency and the percentages of deep sleep (stages 3 and 4) were significantly higher while the percentages of light sleep (stages 1 and 2) were significantly lower than in the NPP group. No differences for rapid eye movement (REM) sleep were found. In addition, wakefulness after sleep onset and the number of short arousals (< 15 s) were significantly lower in the PP group. Apnea index and total RDI were significantly higher and the minimal arterial oxygen saturation in REM and non-REM sleep was significantly lower in the NPP. No differences in periodic limb movements data were found between the two groups. The average MSLT was significantly shorter in the NPP group. Univariate and multivariate stepwise logistic regression analysis showed that the most dominant variable that correlates with positional dependency in OSA patients is RDI, followed by BMI which also adds a significant contribution to the prediction of positional dependency. Age, although significant, adds only a minor improvement to the prediction of this positional dependency phenomenon. A severe, obese, and older OSA patient is significantly less likely to be positional than a mild-moderate, thin, and young OSA patient. In four obese OSA patients who lost weight, a much more pronounced reduction was seen in the lateral RDI than in the supine RDI, and three of these cases who were previously NPP became PP. CONCLUSIONS: In a large population of OSA patients, most were found to have at least twice as many apneas/hypopneas in the supine than in the lateral position. These so-called "positional patients" are on the average thinner and younger than "nonpositional patients." They had fewer and less severe breathing abnormalities than the NPP group. Consequently their nocturnal sleep quality was better preserved and, according to MSLT data, they were less sleepy during daytime hours. RDI was the most dominant factor that could predict the positional dependency followed by BMI and age. RDI showed a threshold effect, the prevalence of PP in those with severe RDI (RDI > or = 40) was significantly lower than in those OSA patients with mild-moderate RDI. BMI showed a major significant inverse relationship with positional dependency, while age had only a minor although significant inverse relationship with it. Body position during sleep has a profound effect on the frequency and severity of breathing abnormalities in OSA patients.

Adult↗

PubMed1997

Value of the multiple sleep latency test (MSLT) for the diagnosis of narcolepsy.

Since its introduction, the multiple sleep latency test (MSLT) has played a major role in the diagnosis of narcolepsy. We assessed its diagnostic value in a series of 2,083 subjects of whom 170 (8.2%) were diagnosed with narcolepsy. The sensitivity of the combination of two or more sleep onset rapid eye movement (REM) periods (SOREMPs) with a mean sleep latency of < 5 minutes on an initial MSLT was 70% with a specificity of 97%, but 30% of all subjects with this combination of findings did not have narcolepsy. In some narcoleptics who had more than one MSLT, the proportion of naps with SOREMPs varied substantially from the initial MSLT to the follow-up test. The highest specificity (99.2%) and positive predictive value (PPV) (87%) for MSLT findings was obtained with the criteria of three or more SOREMPs combined with a mean sleep latency of < 5 minutes, but the sensitivity of this combination was only 46%. The combination of a SOREMP with a sleep latency < 10 minutes on polysomnography yielded a specificity (98.9%) and PPV (73%) almost equal to those obtained from combinations of MSLT findings, but the sensitivity was much lower. Our results suggest that the MSLT cannot be used in isolation to confirm or exclude narcolepsy, is indicated only in selected patients with excessive daytime sleepiness, and is most valuable when interpreted in conjunction with clinical findings.

Adolescent↗

PubMed2000

Amniotic fluid index values after preterm premature rupture of the membranes and subsequent perinatal infection.

OBJECTIVE: Our purpose was to determine whether an amniotic fluid index (AFI) <5 cm after preterm premature rupture of the membranes is associated with an increased risk of perinatal infection. STUDY DESIGN: We performed a nonconcurrent prospective analysis of 225 singleton pregnancies complicated by preterm premature rupture of the membranes, with delivery between 24 and 32 weeks' gestation. All included patients received 2 doses of betamethasone antenatally, in the first 24 hours after admission, and broad-spectrum antibiotic prophylaxis. Patients were categorized into 2 groups on the basis of a 4-quadrant AFI <5 cm (n = 131) or > or =5 cm (n = 94). Perinatal outcomes analyzed included latency until delivery, mode of delivery, and frequencies of clinical chorioamnionitis, postpartum endometritis, and culture-proved early neonatal sepsis. Continuous data were evaluated for normal distribution and tested for significance with the Student t test. Categoric data were tested with the chi(2) and Fisher exact tests. Multiple logistic regression analyses were performed with chorioamnionitis, endometritis, and early-onset neonatal sepsis each as the dependent variable in separate analyses. All 2-sided P values <.05 were considered significant. RESULTS: Both groups were similar with respect to selected demographics, gestational age at rupture of the membranes, birth weight, and maternal group B streptococcal colonization. Patients with an AFI <5 cm demonstrated a shorter mean latency until delivery (5.5 +/- 4.0 vs 14.1 +/- 5.2) (mean +/- SD) days (P =.02), greater frequency of amnioinfusion therapy (23.6% vs 5.3%) (P <.001), and cesarean delivery for nonreassuring fetal testing (18.3% vs 4. 3%) (P =.01). Multiple logistic regression analysis showed that an AFI <5 cm was the only significant risk factor independently associated with early-onset neonatal sepsis (P =.004) and chorioamnionitis (P =.024). CONCLUSIONS: An AFI <5 cm after preterm premature rupture of the membranes between 24 and 32 weeks' gestation is associated with an increased risk of perinatal infection and a shorter latency preceding delivery.

Adult↗

PubMed2005

Multiple drug hypersensitivity--proof of multiple drug hypersensitivity by patch and lymphocyte transformation tests.

BACKGROUND: Multiple drug hypersensitivity (MDH) was first described in 1989 by Sullivan et al. as drug allergies to two or more chemically different drugs. So far, the diagnosis of MDH was associated almost exclusively with antibiotics and was defined based on history alone. AIMS OF THE STUDY: The objective of this study was to prove MDH by two independent tests, namely patch (PT) and lymphocyte transformation (LTT) tests. METHODS: Here we present 7 patients matching the definition of a MDH which were documented by positive LTT as well as PT to different drugs. RESULTS: Three of the 7 patients developed sensitization to the different compounds during the same treatment period and had one longer-lasting allergic reaction. For another 4 patients sensitization to the different drugs occurred at distinct time points. CONCLUSIONS: Our data support the concept of a MDH syndrome. The multiple sensitizations can be proven by skin and in vitro tests. We propose two subtypes of MDH: MDH, which develops against different drugs given simultaneously, and a second subtype, where the sensitizations develop sequentially. Antibiotics are often involved, but we also found sensitization to antiepileptics, hypnotics, antidepressants, local anesthetics, corticosteroids and other drug classes.

Adult↗

PubMed1982

Mitochondrial and nuclear mutagenicity of ellipticine and derivatives in the yeast Saccharomyces cerevisiae.

Haploid strains of the yeast Saccharomyces cerevisiae were tested for their sensitivity to ellipticine and nine derivatives; some of them exhibiting antitumor properties. Different mutagenic properties of ellipticines are described. Charged ellipticines, which were ineffective in Ames' bacterial assay, were found to be potent inducers of the mitochondrial p- mutation: induction proceeded even in the absence of growth. Uncharged ellipticines increased mitochondrial antibiotic resistance mutations, whereas charged derivatives decreased them. Ellipticine derivatives enhanced, reduced, or did not change the reversion frequencies of nuclear auxotrophic markers. The result depended on the strain being tested: no structure-effect relationship existed. As some ellipticine derivatives were mutagenic in Saccharomyces cerevisiae despite being ineffective in Ames' assay, multiple tests should be used to check that chemotherapeutic drugs are devoid of mutagenic properties.

Alkaloids↗

PubMed1994

Multiple viral infections in the immunocompromised host: recognition and interpretation.

BACKGROUND: During the past decade, diagnostic virology has become an integral part of patient management. Concurrent infection with multiple viruses occurs in both the healthy and immunocompromised host. Many common viruses result in latent infection with the potential for reactivation throughout the life of the host. Superimposed on this are transient infections with yet other viruses. OBJECTIVES: To review multiple viral infections in immunocompromised hosts, focusing on laboratory recognition and interpretation of results. STUDY DESIGN: A review of the literature, with case examples from the author's laboratory. RESULTS: Viral infections are more likely to cause morbidity and mortality in immunodeficient hosts, and early recognition and treatment may be lifesaving. To detect two or more viruses shed concurrently from the same body site requires the use of multiple test modalities, which are now available in many clinical laboratories. Establishing the significance of a virus isolate is a complex process. Knowledge of the specimen source, virus quantitation and characteristics of the patient are helpful. Careful evaluation of the patient's clinical findings together with other laboratory test results, including histopathology, X-rays and the detection of other microorganisms, is also essential. CONCLUSIONS: The recognition and interpretation of multiple virus infections requires heightened awareness as well as close cooperation and communication between the professionals in the laboratory and physicians at the bedside.

Journal Article↗

PubMed2006

G protein-coupled receptor 154 gene polymorphism is associated with airway hyperresponsiveness to methacholine in a Chinese population.

BACKGROUND: A new asthma susceptibility gene, the G protein-coupled receptor for asthma susceptibility (GPRA, GPR154), has recently been identified and the association was replicated in 2 white populations, but not in a Korean population. OBJECTIVE: To test the association between GPR154 gene polymorphisms and airway responsiveness to methacholine in a Chinese population. METHODS: Eight single nucleotide polymorphisms (SNPs) in the GPR154 gene were genotyped in 451 cases and 232 controls in stage I. The association of 1 SNP, rs324981, was tested in an additional 264 case and 241 control subjects in stage II. Both single marker and haplotype associations were tested. RESULTS: In stage I, we found that airway hyperresponsiveness to methacholine was associated with 2 single SNPs, rs324981 and rs324987, but not with the haplotypes of GPR154. The minor allele homozygotes of rs324981 (AA) and rs324987 (TT) were at a significantly lower risk of hyperresponsiveness to methacholine with odds ratios of 0.59 (P=.02) and 0.56 (P=.01), respectively. In stage II, we found a similar trend of association between rs324981 and airway hyperresponsiveness (P=.09). In the pooled analysis, the odds ratio of the AA homozygote of rs324981 was 0.61 (P=.004). The permutation test resulted in a study-wide empirical P value of .023, which meant that the association remained significant after adjustment for multiple tests. CONCLUSIONS: Our study supports a role of the GPR154 gene in asthma susceptibility and suggests that the AA homozygote of rs324981 is a protective factor for airway hyperresponsiveness to methacholine in a Chinese population. CLINICAL IMPLICATIONS: Our findings confirmed a role of GPR154 in the genetic susceptibility of asthma and suggest that GPR154 polymorphism should be taken into consideration to improve the assessment of an individual's risk of asthma.

Adolescent↗

PubMed1978

[The Bayesian theorem in clinical differential diagnosis (author's transl)].

New (a posteriori) probablities of medical diagnosis can be calculated by the Bayesian formula from a priori probabilities of the diagnosis or diagnoses under consideration and from the probabilities of a given test result occurring with each disease. Using sequential iteration, the Bayesian formula is applicable to the calculation of a posteriori probabilities after multiple tests have been performed. When this iterative process has been programmed for a pocket calculator it can easily be used in clinical practice. As a consequence, medical knowledge can be applied more rationally. Many inconsistent data can be more easily interpreted as a result. Furthermore, results of diagnostic tests can be used more extensively and normal test results given their full weight.

Adult↗

PubMed1987

Density and frequency dependence of resistance in early airway obstruction.

The forced oscillation technique is a noninvasive and effort-independent test used to characterize the mechanical impedance of the respiratory system. The aim of this study was to assess the sensitivity of this method in detecting early airway abnormalities caused by smoking or occupational hazards. Respiratory mechanical parameters by the forced oscillation technique and maximal expiratory flow volume (MEFV) curves were obtained in a group of 82 workers from a gas manufacturing plant. In addition, the variations in the frequency dependence of total respiratory resistance between air breathing and a mixture of helium-oxygen (He-O2) were measured. All parameters were normalized for age, height, and weight. In order to compare the 2 types of testing, multiple linear regressions were performed with smoking or exposure as independent variables on one hand and parameters of the 2 types of testing on the other hand. This statistical procedure showed that 2 parameters of the forced oscillation technique constantly reached higher levels of significance than those of the MEFV parameters in the regression equations describing smoking history and occupational exposure: these were the frequency dependence of resistance and the change in frequency dependence between air and He-O2 breathing. When nonsmokers, ex-smokers, and smokers were considered separately, the degree of frequency dependence of resistance and the change in frequency dependence between air and He-O2 breathing were the only parameters that were significantly different between these 3 groups (one-way analysis of variance).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2003

[Complementary tests in respiratory allergy].

Several complementary tests are currently available for the diagnosis and evaluation of allergic respiratory disease. Besides the classic skin prick tests which have been standardized, a number of assay methods have been developed for specific IgEs and different mediators as well as multiple tests for allergy screening. In the near future, several techniques for measuring allergens in the environment should become available for physicians and patients. The purpose of this review is to present the different complementary tests useful in respiratory allergy defining the contribution of each test in the management of patients with allergic disease.

Allergens↗

PubMedDate not supplied

[Myocardial perfusion scintigraphy with Tc-99m MIBI in patients with left bundle branch block: Visual quantification of the anteroseptal perfusion imaging for the diagnosis of left anterior descending artery stenosis].

INTRODUCTION: The non-invasive detection of myocardial ischaemia in patients with left bundle branch block (LBBB) remains a challenge. It is often associated with coronary artery disease or hypertension, but frequently there is no indication of cardiovascular pathology at presentation. Exercise-induced electrocardiographic ST segment changes are non-diagnostic. Confirming coronary artery disease has obvious implications for management. Several studies have shown greater cardiac mortality in the presence of LBBB. Generally, a good prognosis has been found in patients with LBBB and normal or near-normal myocardial perfusion scintigraphy (MPS). Various investigators report frequent anteroseptal defects with MPS in patients with LBBB in the absence of significant left anterior descending (LAD) coronary artery disease. Several mechanisms have been proposed to explain this false-positive phenomenon. Various interpretative methods and stress techniques have been evaluated in an attempt to improve the specificity of noninvasive studies for detecting LAD disease. A number of software packages for quantifying myocardial perfusion are commercially available. Quantification is recommended to improve diagnostic accuracy and intra- and inter-observer reproducibility.41 METHODS: Patients with LBBB on ECG, who were referred to our institution (February 2002 to September 2003) for myocardial perfusion scintigraphy, were included in the study. Patients with previous myocardial infarction were excluded, unless the location was confirmed to be not anteroseptal before the onset of LBBB. Patients who did not undergo coronary angiography within six months were also excluded, unless a LAD lesion of > or = 50% was diagnosed more than six months prior to MPS without subsequent intervention, or angiography more than six months later showed a LAD lesion of < or = 50%. Treadmill exercise, dipyridamole or dobutamine infusion were used according to standard protocols and imaging commenced 15-60 minutes later. QPS quantitative software, used to reconstruct the images and quantify perfusion, is described in detail elsewhere. Three experienced nuclear physicians interpreted the studies. Stress and rest perfusion, as well as reversibility, to the anteroseptal wall (excluding the apex), anteroseptal wall and apex, and apex only, were graded on a scale of 0 (normal) to 4 (absent perfusion), where 1 represents mild, 2 moderate, and 3 severe impairment of perfusion. A final decision was made by consensus. Using QPS, summed stress, rest and difference scores were obtained for the same regions. Angiographic correlation was obtained by reviewing the patients' records. Stenosis of the LAD or graft vessel to the LAD of > or =50% was regarded as significant. The Kruskal-Wallace non-parametric test was used to compare the groups with and without significant LAD stenosis. A Bonferroni correction was applied to make provision for multiple testing. Receiver operating characteristic (ROC) analysis was utilised to determine the optimal threshold of the significant measurements to distinguish between the two groups; for this threshold, the sensitivity and specificity were calculated. RESULTS: Nine men and nine women (42-78 years) satisfied the inclusion criteria and were included in the study. Dipyridamole was used in nine patients, exercise in seven, dobutamine in one, and one patient was injected during a period of typical chest pain. Ten patients had a LAD stenosis of < 50% and eight > or = 50%. The only measurement that yielded a significant difference between the groups was visual improvement in perfusion to the anteroseptal wall and apex between the stress and rest study (p < 0.0096). Even after applying a Bonferroni correction, the value tended towards significance (p = 0.16). A ROC curve was calculated and an optimal threshold of 0.5 determined, which in turn had a sensitivity of 88% and specificity of 67%. DISCUSSION: Our findings suggest that visual reversibility in the anteroseptal wall and apex gives an indication of significant LAD stenosis in patients with LBBB. This finding agrees with that of Mairesse et al. Wackers argues that cardiomyopathic changes cause anteroseptal perfusion defects in LBBB. It is possible that irreversible perfusion defects in the anteroseptal wall and apex are caused by a constant, stress-independent mechanism, whereas reversible defects indicate underlying ischaemia. Interestingly, quantitative analysis was not helpful in predicting LAD disease. The quantitative software we used is well validated. On the other hand, Svenssson et al. compared three myocardial perfusion quantification software packages and found considerable variation, especially in the presence of perfusion defects. The state of perfusion to the apex was not helpful to detect significant LAD disease. It is known that the LAD usually supplies the apex. Matzer et al. found that requiring the presence of an apical defect improved specificity. This could not be confirmed by Lebtahi et al. or Vaduganathan et al. LIMITATIONS: A definite limitation of our study was that treadmill stress testing was performed in seven patients. It is currently recommended by most authors that pharmacological stress be performed in patients with LBBB Selection bias is also a limitation because only patients who also had angiography were included in the study (18 out of 91). CONCLUSION: A visual improvement in anteroseptal and apical myocardial perfusion between stress and rest with Tc-99m MIBI in patients with LBBB probably indicates significant LAD stenosis. In our hands, quantitative software did not aid in the diagnosis. A well-designed, prospective study using a standardized stress protocol (probably dipyridamole or adenosine), which specifically evaluates visual reversibility in the anteroseptal wall and apex, will obviate the need for a Bonferroni correction, and could confirm these findings.

Adult↗

PubMed2006

Variability of centric relation position in TMD patients.

Reproducibility of the centric relation position for patients with temporomandibular disorders (TMD) is not documented in the current literature. It was the objective of this study to assess clinical variability of the centric relation position for TMD patients with a muscle-determined technique by means of an anterior deprogramming device, the leaf gauge. A sample of 60 patients with signs of TMD was selected, 8 men (Mean age 28,6, SD 5,2) and 52 women (Mean age 30,5, SD 10,1). All patients were examined with the Research Diagnostic Criteria, including pain on movement and/or function, mouth opening, joint sounds and palpation of masticatory muscles. All 60 patients were allocated to one of the following diagnostic subgroups: myofascial pain, disk displacement with reduction, disk displacement without reduction, osteoarthritis, trauma. Twelve control subjects were taken from a previous study. Three sequential centric relation records were taken; the first one was used to mount a set of casts to an articulator. Criteria of precision were formulated beforehand: 2 out of 3 centric relation records had to be identical in a split-cast procedure. Variables XL and XR represented mandibular displacement in the sagittal plane, variables YL and YR in the transversal plane, and ZL and ZR in the vertical plane, on the left and right condylar level respectively. Variables XMIN, YMIN and ZMIN represented the minimal sagittal, transversal and vertical displacement left or right respectively. Likewise, variables XMAX, YMAX and ZMAX represented the maximal sagittal, transversal and vertical displacement left or right. XDIFF, YDIFF and ZDIFF represented the difference between the minimal and maximal values of X, Y and Z. The diagnostic subgroup trauma was excluded, because there was only one patient. The null-hypothesis of no between-group differences in within-subject and total variability was tested with an analysis of variance (ANOVA). The level of significance was set at 0.05. To minimize type I errors caused by multiple testing Scheffe's test was used to maintain an overall significance of 0.05. No significant difference between patients and control subjects could be found for variables XL, XR, YL, YR, ZR and ZL. Variables XMIN, YMIN, ZMIN, XMAX, YMAX, ZMAX, XDIFF, YDIFF and ZDIFF showed no significant differences. Scheffe's testing for the variables XL, XR, YL, YR, ZL and ZR, as well as the variables XMIN, YMIN, ZMIN, XMAX, YMAX, ZMAX, XDIFF YDIFF and ZDIFF showed no significant differences. The results of this study suggest no variability in centric relation position between TMD-patients and control subjects by means of the leaf gauge.

Adult↗

PubMed1998

[The family practitioner and the postcoital test].

There is still a great deal of controversy on the value of the postcoital test. Some consider it to be a valuable method for the general practitioner to evaluate the interaction in vivo between spermatozoa and cervical mucus, in spite of the poor predictive value of the test. The postcoital test is in fact only an indirect method for the detection of the production of moving sperms. As a negative postcoital test is frequently due to bad timing of the test, multiple mandatory intercourse is often necessary, which may lead to frustration and sexual dysfunction. Moreover, there are no indications that the postcoital test with its poor discriminatory power may be better in general practice than the fertility evaluations by a specialist as standardisation and reproducibility problems are equal in both settings. Therefore semen analysis appears to be a better option, for the general practitioner as well.

Family Practice↗

PubMed2006

Variability of the initial phase of the ventilatory response to hypoxia in sleeping infants.

Most of the available data on the hypoxic ventilatory response (HVR) in infants has been obtained in quiet sleep (QS), and only one study has made repeated tests in the same infant. We aimed to gain a more complete knowledge of the maturation and consistency of the initial phase of the HVR by performing multiple tests in both QS and active sleep (AS) over the first 6 mo of life in term infants. Fifteen healthy term infants were studied with daytime polysomnography longitudinally at 2-5 wk, 2-3 mo, and 5-6 mo after birth. Each infant received multiple hypoxic (15% O2, balance N2) challenges (three or more) in both AS and QS. In AS, infants consistently aroused to hypoxia; however, in QS, infants both aroused and failed to arouse. The initial phase of the HVR varied considerably between infants with the changes in ventilation/kg [SD of inspired minute ventilation per kilogram of body weight (V(I)/kg)] being more variable during AS than QS at all three ages and overall decreasing with postnatal age in both sleep states. The variability between replicate V(I)/kg measurements was also significantly greater in AS compared with QS at 2-5 wk postnatal age. There was no evidence of habituation to repeated hypoxic tests in either sleep state. Our study has demonstrated that the initial phase of the HVR is variable both between and within term infants in both AS and QS, with responses being markedly more variable during AS, and becoming more consistent with increasing postnatal age. By performing only one test or by failing to account for arousal responses, previous studies may not have detected the natural variation of the infant HVR.

Age Factors↗

PubMed2006

Prediction of one repetition maximum strength from multiple repetition maximum testing and anthropometry.

The purpose of this study was to quantify the decrease in the load lifted from 1 to 5, 10, and 20 repetitions to failure for the flat barbell bench press (chest press; CP) and plate-loaded leg press (LP). Furthermore, we developed prediction equations for 1 repetition maximum (RM) strength from the multiple RM tests, including anthropometric data, gender, age, and resistance training volume. Seventy subjects (34 men, 36 women), 18-69 years of age, completed 1, 5, 10, and 20RM testing for each of the CPs and LPs. Regression analyses of mean data revealed a nonlinear decrease in load with increasing repetition number (CP: linear S(y.x) = 2.6 kg, nonlinear S(y.x) = 0.2 kg; LP: linear S(y.x) = 11.0 kg, nonlinear S(y.x) = 2.6 kg, respectively). Multiple regression analyses revealed that the 5RM data produced the greatest prediction accuracy, with R(2) data for 5, 10, and 20RM conditions being LP: 0.974, 0.933, 0.915; CP: 0.993, 0.976, and 0.955, respectively. The regression prediction equations for 1RM strength from 5RM data were LP: 1RM = 1.0970 x (5RM weight [kg]) + 14.2546, S(y.x) = 16.16 kg, R(2) = 0.974; CP: 1RM = 1.1307 x (5RM weight) + 0.6999, S(y.x) = 2.98 kg, R(2) = 0.993. Dynamic muscular strength (1RM) can be accurately estimated from multiple repetition testing. Data reveal that no more than 10 repetitions should be used in linear equations to estimate 1RM for the LP and CP actions.

Adolescent↗

PubMed1996

A new method for in vivo evaluation of antimicrobial agents by translocation of complex dense populations of cutaneous bacteria.

Previously, we described methods for measuring in vivo antimicrobial activity in which the resident bacterial flora of the forearm is expanded by occlusion with an impermeable plastic film, test agents are applied and quantitative cultures are obtained at varying time points. This methodology allows for an in vivo quantitative assessment of antimicrobial effects directed against a dense flora comprised primarily of staphylococci. This method may not be applicable to situations in which there is a high density of multiple species of bacteria. We describe herein new methods which permit in vivo determination of antimicrobial activity against a dense, mixed flora. Swabs moistened with a dilute nonionic detergent are used to remove bacteria from the subject's axilla or groin which are then translocated to the subject's forearm. Occlusion of the forearm with a large, sterile plastic chamber provides the necessary humid environment to yield a dense flora (10(5)-10(6) CFU) consisting of gram-positive cocci, gram-positive coryneforms and gram-negative rods. In this manner, multiple test sites are created on each forearm allowing for the simultaneous evaluation of multiple antimicrobial agents in a single subject. This method allows for the evaluation of the immediate, as well as sustained, in vivo bactericidal effect of an antimicrobial agent against a dense mixed flora with quantitative cultures obtained at varying time points after application of the test agent. Furthermore, ecological pressures which select for resistant organisms or allow for an overgrowth of nonsensitive bacteria can be evaluated by determining the composition of the flora after single or repeated applications of a test agent. The testing methodologies described herein can provide relevant information regarding the antimicrobial effectiveness of an agent in a variety of situations such as use against the axillary flora (including its utility as a deodorant), use as a perineal cleanser for critically ill, hospitalized patients and use in situations where a dense mixed flora exists, e.g. stasis ulcers and infected intertriginous dermatoses.

Adult↗