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[The antimycotica disc elution test: a new quantitative antimycotica test for yeasts (author's transl)].

The number of opportunistic yeast infections has increased during the last years. Therefore, testing of antimycotica has become important in terms of reliability and speed. Todays testing is essentially based on the disc diffusion susceptibility test and to a minor extent on the evaluation of the minimal inhibitory concentration. Two disc diffusion tests were compared. Both tests were shown to be practicable as a screening test. However, false positive results were obtained at a rather high percentage. Therefore, a new antimycotica test based on the disc elution test was developed and compared to a disc diffusion test. The resistance patterns for 5-fluorocytosine assayed by the disc elution test were in good agreement to the minimal inhibitory concentration. The test was shown to be adaptable for the imidazole-antimycoticas as well.

Antifungal Agents↗

[Experience with and prospects for emergency Ippan kensa (urinalysis, fecal tests and body fluid tests].

Ippan Kensa (defined as urinalysis, fecal tests, and tests of cerebrospinal fluid, pleural fluid, ascites, and other body fluids) are done of fresh samples, as a rule, and such samples should be tested as soon as possible. Even for tests not ordered in an emergency, rapid results are desirable. In these two senses, all tests are somewhat urgent. Along with the rest of the hospital, our section moved into a new hospital complex in 1993, and that time, an order-entry and reporting system was implemented. Urinalysis was totally systematized from the start with two automated analyzers connected to an automated transportation system, and other tests were gradually automated and computerized. Time and labor were saved without decreased quality. Most routine tests are now done within 2.5 hours of sampling. Emergency tests are not handled by a special, formally established procedure in our laboratory, but at the request of a physician, any test can be done rapidly when necessary, because the system allows interruption at any time for testing of samples out of order. Our experience with this system suggests that automation and computerization are essential if emergency and urgent tests are to be done rapidly by a small staff. Further improvements in the high-quality automated analyzers already available, speeding results but allowing fewer false-positives and false-negatives can be expected.

Automation↗

[Rotatory impulse test does not replace caloric tests].

We sought to determine whether the rotatory impulsional test was capable of exploring the canalar function with sufficient precision to replace the caloric test, as it has been recently affirmed. We first compared the observed preponderance from this test with that measured during a sinusoidal (20 and 4 s) test. We observed that, in the case of a significant preponderance for a given test, there was complete redondance with the preponderance observed with any other test. The rotatory impulsional test does not present any specific advantage compared to other kinetic test as far as the observation of the preponderance phenomenon. We then compared the preponderance with the results of the caloric tests and came to the following conclusions i) the absence of preponderance does not allow us to predict the absence of vestibular deficit, due to the fact that 37% of the deficits were compensated for including acoustic neuroma; ii) the presence of a preponderance does not allow a priori to say whether it is of vestibular, cervical, or central origin and systematic caloric tests shows that almost one fourth of preponderance observed is not associated with unilateral weakness iii) supposing that a clinical argument allow us to conclude as to the probable vestibular origin of a vestibular preponderance, the direction of this preponderance does not allow us to determine which side is involved. In fact, if the undercompensated deficits are 3 times more frequent than overcompensated deficits, the proportion of preponderance not linked to a significant deficit indicates that the probability of encountering a preponderance related to a specific undercompensated deficit is approximately 50%. We thus did not find in the rotatory impulsional test any specific advantage allowing us to predict the laterality of a vestibular lesion.

Caloric Tests↗

Practice effect and test-retest reliability of attentional and executive tests in middle-aged to elderly subjects.

There is a lack of data about the practice effect and test-retest reliability (TRR) on many attentional and executive tests in neuropsychology. In this study, 37 subjects aged 52 to 80 were tested three times with an inter-assessment interval of 14 days. The battery included the Rey Auditory Verbal Learning Test, the Stroop interference test, the Letter-Number Sequencing test, Wechsler Adult Intelligence Scale-III (WAIS-III), the Ruff 2 and 7 Selective Attention Test, the Tower of London, the Verbal Fluency test, and simple, choice, and sequential reaction time tests. The results showed that tasks were generally subject to a practice effect, except for those with alternate forms. In all tests, there were a number of scores demonstrating good TRR, but others, although largely used in clinical practice, failed to reach acceptable TRR standards. Usually, time derived scores were associated with the best TRR.

Aged↗

Comparing the enzyme allergosorbens and coated allergen particle tests for latex allergy: which in vitro test should be chosen by an anesthesiologist?

UNLABELLED: To determine sensitivity and specificity of the enzyme allergosorbens test (EAST) and the coated allergen particle Test (CAP) in detecting specific antibodies against latex, we compared these two methods in a previously investigated sample of an epidemiological study among our anesthesia staff. One hundred one blood samples were tested with EAST and CAP for specific antibodies against latex. Skin test results were used as references. CAP was more sensitive in detecting sensitized individuals than EAST (56% vs 18.8%). Two additional persons with previously negative skin tests were detected. These results suggest that the EAST system is not as sensitive as the CAP system. Therefore, the CAP system should be preferred for the in vitro diagnosis of latex allergy. IMPLICATIONS: Testing for latex allergy requires time-consuming and technically difficult tests. Easy to perform in vitro tests for latex allergy are desirable. Our results indicate that the coated allergen particle test is more sensitive and easy to use than the enzyme allergosorbens test.

Anesthesiology↗

Comparison of three prick test methods with the intradermal test and with the rast in the diagnosis of mite allergy.

Three prick test methods were compared in the diagnosis of mite allergy--the Morrow Brown standardized needle, the Multi-test device and a modified prick test. They were compared with the intradermal test and with specific IgE antibodies measured by RAST. Thirty patients and 10 control subjects were tested. The intradermal test was always positive in patients but induced two false positive reactions. All prick test methods gave false negative reactions. The Multi-Test device produced intermediate reactions between prick test and intradermal test.

Adolescent↗

Variation in proficiency testing performance by testing site.

CONTEXT: Congress enacted the Clinical Laboratory Improvement Amendments of 1988 (CLIA) to promote uniform quality and standards among all testing sites in the United States. The performance indicators specified in the legislation are proficiency testing (PT) performance and periodic inspections. OBJECTIVE: To evaluate variation in PT performance by type of testing facility during the first year of compulsory participation under CLIA. DESIGN: All 1994 PT score data electronically reported to the Health Care Financing Administration as a component of compliance with the CLIA regulations were obtained. Over 1.2 million PT event scores from 17058 unique testing sites were sorted into 2 groups based on the type of testing facility: hospitals and independent laboratories (HI) and all other testing sites (AOT). MAIN OUTCOME MEASURES: Satisfactory and unsatisfactory performance rates for HI and AOT for each analyte and/or test, according to the criteria specified by the CLIA regulations. RESULTS: The aggregate rates of satisfactory event performance for all regulated analytes, tests, and specialties were 97% and 91% for the HI and AOTgroups, respectively. The aggregate odds ratio for unsatisfactory PT event performance for the AOT group compared with the HI group was 2.89, with a range of 2.19 to 7.51 for the individual analytes. CONCLUSION: There was a consistent difference in PT performance during the first full year of compulsory PT under the CLIA regulations based on the type of testing facility performing the analysis. Traditional testing sites achieved higher rates of satisfactory performance than newly regulated, alternative testing sites.

Centers for Medicare and Medicaid Services, U.S.↗

Circumventing multiple testing: a multilocus Monte Carlo approach to testing for association.

Advances in marker technology have made a dense marker map a reality. If each marker is considered separately, and separate tests for association with a disease gene are performed, then multiple testing becomes an issue. A common solution uses a Bonferroni correction to account for multiple tests performed. However, with dense marker maps, neighboring markers are tightly linked and may have associated alleles; thus tests at nearby marker loci may not be independent. When alleles at different marker loci are associated, the Bonferroni correction may lead to a conservative test, and hence a power loss. As an alternative, for tests of association that use family data, we propose a Monte Carlo procedure that provides a global assessment of significance. We examine the case of tightly linked markers with varying amounts of association between them. Using computer simulations, we study a family-based test for association (the transmission/disequilibrium test), and compare its power when either the Bonferroni or Monte Carlo procedure is used to determine significance. Our results show that when the alleles at different marker loci are not associated, using either procedure results in tests with similar power. However, when alleles at linked markers are associated, the test using the Monte Carlo procedure is more powerful than the test using the Bonferroni procedure. This proposed Monte Carlo procedure can be applied whenever it is suspected that markers examined have high amounts of association, or as a general approach to ensure appropriate significance levels and optimal power.

Alleles↗

Comparison of the COBAS TaqMan HBV test with the COBAS Amplicor monitor test for measurement of hepatitis B virus DNA in serum.

Quantitation of low hepatitis B virus (HBV) DNA levels in patients with chronic hepatitis B is important for monitoring natural history of disease and treatment efficacy. This study aimed to compare the quantitation range and analytical sensitivity of the newly developed COBAS TaqMan HBV test (TaqMan test) with the COBAS Amplicor HBV Monitor Test (Amplicor test), using the Eurohep HBV reference plasma and serum samples from patients. Serial dilutions (2.7x10(1)-2.7x10(8) copies/ml) of the Eurohep HBV reference plasma and 50 serum samples from chronic hepatitis B patients were tested by both assays. The TaqMan test could detect seven (2.7x10(2)-2.7x10(8) copies/ml) of eight dilutions of the reference plasma, while the Amplicor test could only detect three of them (2.7x10(3)-2.7x10(5) copies/ml). The HBV DNA values measured by the TaqMan test correlated very well with the theoretical Eurohep standard values (r=0.998, P<0.001). There were good correlations between the HBV DNA levels measured by the two assays on both the Eurohep reference plasma (r=0.993, P<0.001) and serum samples from patients (r=0.904, P<0.001). Compared to the Amplicor test, the TaqMan test had a higher sensitivity (50 vs. 300 copies/ml), shorter assay time (6 vs. 10 hr), and wider dynamic range (8 vs. 3 logs), and was more cost-effective in a clinical setting. These data indicate that the TaqMan test is an excellent tool for HBV DNA quantitation.

Adolescent↗

Power comparison of two-sided exact tests for association in 2 x 2 contingency tables using standard, mid p and randomized test versions.

Exact Pearson's chi square, likelihood ratio (LR), and Fisher's tests are obtained from the conditional distribution of its test statistic, given the row and column sums of the contingency table. The power and obtained significance level of the standard, mid p, and randomized versions of these tests are compared for two-sided tests in 2 x 2 tables, using binomial and multinomial sampling. The mid p type I error probabilities seldom exceed the nominal significance level. The mid p and randomized test versions have approximately the same power, and higher power than the standard test version. The power of the Pearson's chi square, LR and Fisher's test differ, and they differ in approximately the same way for standard, mid p and randomized test versions for any given set of parameters. There is no general ranking between the three tests. In many cases, Pearson's chi square and Fisher's tests have almost equal power, and higher power than LR. In a few cases, perhaps characterized by poorly balanced designs, LR performs best. Fisher's test seems to be slightly more robust even if the design is poor.

Binomial Distribution↗

Correlations between behavior of mice in Porsolt's swim test and in tests of anxiety, locomotion, and exploration.

This study examined whether the behavior of male NIH Swiss mice in a putative animal model of depression, Porsolt's swim test, is related to that in other behavioral tests. The other tests were the plus-maze test of anxiety, the holeboard test of exploration and locomotor activity, and a test of seizure threshold to bicuculline. The immobility of the mice in the swim test did not correlate with their behavior in any of the other tests used. The only significant correlations found occurred between individual measures in the holeboard and plus-maze tests. The data suggest that immobility in the swim test is not related to behavior in the tests of anxiety, directed exploration, locomotor activity, or seizure threshold.

Animals↗

A comparison of the rapid thermonuclease test and the lysostaphin susceptibility test in the presumptive identification of Staphylococcus aureus from positive Bactec blood cultures.

We compared the ability of a rapid 2-hour thermonuclease test and a Gram-stained lysostaphin susceptibility test to presumptively identify Staphylococcus aureus from 72 blood cultures. The thermonuclease test identified 25 of 27 S. aureus; there were no false positives. The predictive values of positive and negative thermonuclease tests were 100% and 95.7%, respectively. The lysostaphin test correctly identified 24 of 27 S. aureus; however, there were eight false positives. The predictive values of positive and negative lysostaphin tests were 75% and 95.2%, respectively. Lysostaphin MICs were greater than or equal to 1.6 micrograms/ml for only 28 of 41 coagulase negative staphylococci strains. We now routinely apply the thermonuclease test in the clinical laboratory. Of the first 304 blood cultures tested in this setting, the thermonuclease test correctly identified 63 of 68 S. aureus. There have been no false positives. The thermonuclease test is superior to the lysostaphin test and accurately identifies S. aureus in blood cultures within 2 hours of the first positive reading.

Bacterial Typing Techniques↗

Is the type of test used for mass colorectal cancer screening a determinant of compliance? A cluster-randomized controlled trial comparing fecal occult blood testing with flexible sigmoidoscopy.

BACKGROUND: The efficacy of colorectal cancer screening has been proved, and three different screening tests are recommended by international guidelines: the faecal occult blood test, flexible sigmoidoscopy and colonoscopy. While the effectiveness of a screening program depends on the compliance obtained, the role of the type of test on compliance has not yet been sufficiently studied. AIMS: To measure the effect of the type of screening test used, i.e. faecal occult blood test or flexible sigmoidoscopy, on the compliance to colorectal cancer screening programs. SUBJECTS AND METHODS: A cluster-randomized two-arm trial was conducted. We randomly assigned 20 GP's practices that had an average of 150 patients between 50 and 74 years old. RESULTS: 1449 individuals were referred to faecal occult blood test and 1538 to flexible sigmoidoscopy. The faecal occult blood test obtained higher compliance: 17.2% (95%CI 12.5-25.7) versus 7.0% (95%CI 5.7-9.0). The socio-economic status was an effect modifier of the test type: the effect of the type of test was smaller in low socioeconomic classes. CONCLUSIONS: The type of screening test used for colorectal cancer is a determinant of participation. In a low compliance area, better compliance will result from offering the faecal occult blood test than from the flexible sigmoidoscopy.

Aged↗

The role of nonstress tests, fetal biophysical profile, and contraction stress tests in the outpatient management of insulin-requiring diabetic pregnancies.

Antepartum fetal surveillance methods applicable in a home glucose-monitored population of pregnant diabetic women have been evaluated. A testing sequence of nonstress heart rate testing, backed up by either the fetal biophysical profile or contraction stress testing employed at a twice weekly interval, in 107 outpatients was compared with the management of 140 historic control patients by weekly nonstress tests and daily plasma estriols. There were 617 of 672 (91.8%) reactive nonstress tests in outpatients compared to 566 of 626 (90.4%) reactive tests in hospitalized control patients. Of 13 contraction stress tests performed in the outpatient group, only one was positive. Although 2,670 estriol determinations were done on hospitalized control patients, none was used for outpatients. No losses were attributed to unexplained antenatal stillbirth in either group. A fetal biophysical score of 8 was found to be at least as reliable as a reactive nonstress test. Antenatal surveillance in the well-controlled, insulin-requiring diabetic woman can be safely achieved with a testing sequence that consists of twice weekly nonstress tests backed up by the fetal biophysical profile and contraction stress tests.

Diabetes Mellitus, Type 1↗

Plasma membrane integrity of cryopreserved human sperm: an investigation of the results of the hypoosmotic swelling test, the water test, and eosin-Y staining.

OBJECTIVE: [1] To examine the relationship between sperm membrane integrity and motion parameters before and after cryopreservation; [2] to determine the capacity of the membrane integrity tests to predict the outcome of cryopreservation in fertile and infertile men; and [3] to examine the degree of agreement between tail and head membrane integrity of testicular and ejaculated immotile sperm cryopreserved for intracytoplasmic sperm injection. DESIGN: Prospective study. SETTING: Academic tertiary care institution. PATIENT(S): Fertile donors and normozoospermic oligozoospermic, and asthenozoospermic subfertile men. INTERVENTION(S): Semen samples were cryopreserved and thawed for analysis. MAIN OUTCOME MEASURE(S): Sperm membrane integrity and computer-assisted motion parameters. RESULT(S): The hypoosmotic swelling test and water test had a significant and positive correlation in the fresh and cryopreserved ejaculates of all groups. The results of the hypoosmotic swelling test correlated positively with the percent motility in the fresh ejaculates of fertile and subfertile men. None of the membrane integrity tests correlated with the cryosurvival rate in any group. In the ejaculated and testicular samples with no postcryopreservation motility, the simultaneous assessment of hypoosmotic swelling test and eosin showed that of 33% sperm exhibiting coiling with the hypoosmotic swelling test, only 9% were eosin negative, whereas 24% were eosin positive. CONCLUSION(S): [1] The water test may be a simpler replacement for the hypoosmotic swelling test; [2] none of the membrane integrity tests predicted sperm motility after cryopreservation; and [3] there was a high degree of disagreement between the hypoosmotic swelling test and eosin in the samples with no postcryopreservation motility.

Cell Membrane↗

How does the pre-massage and post-massage 2-glass test compare to the Meares-Stamey 4-glass test in men with chronic prostatitis/chronic pelvic pain syndrome?

PURPOSE: The Meares-Stamey 4-glass test is the standard method of assessing inflammation and the presence of bacteria in the lower urinary tract in men presenting with the chronic prostatitis syndrome. However, most urologists do not use it in daily practice because of the time and difficulty in performing it, as well as the additional expense. We evaluated a simpler test, the 2-glass pre-massage and post-massage test, and compared it with the Meares-Stamey 4-glass test to detect inflammation and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome. MATERIALS AND METHODS: The study population included 353 men enrolled in the National Institutes of Health Chronic Prostatitis Cohort study with baseline leukocyte counts and 2-day bacterial cultures on specimens obtained from a standard 4-glass test (VB1, VB2, expressed prostatic secretions, VB3). The chi-square test was performed to assess associations of white blood cell counts in expressed prostatic secretions and VB3. A receiver operating characteristic curve was constructed to determine the optimal cut point of white blood cells in VB3 in predicting white blood cells in expressed prostatic secretions. Sensitivity and specificity of VB3 cultures predicting expressed prostatic secretions and positive Meares-Stamey results were calculated from 2 x 2 contingency tables. RESULTS: Analysis of binary leukocyte outcomes (no white blood cells vs any white blood cells) suggests that white blood cells tend to be present in expressed prostatic secretions when there are any white blood cells in VB3, p <0.0001, the optimal cut point being white blood cell counts of 3 in VB3 (best predictive ability with area under ROC 0.771) to predict 5+ in expressed prostatic secretions with a sensitivity of 76% and specificity of 70%. The optimal cut point of white blood cells in VB3 to predict 10 white blood cells in expressed prostatic secretions was 4 (62% sensitivity and 75% specificity). Uropathogens localizing to expressed prostatic secretions or VB3 confirms a positive 4-glass Meares-Stamey localization test. The sensitivity and specificity of a VB3 localizing culture only in predicting a positive Meares-Stamey 4-glass test result for any uropathogen were 44% to 54% (depending on definition) and 100%, respectively. The pre-massage and post-massage test predicted a correct diagnosis in more than 96% of subjects. CONCLUSIONS: The value of localizing leukocytes and uropathogens to prostate specific specimens remains controversial in chronic heavily pretreated patients, but these data may help direct therapy (anti-inflammatory or antimicrobial) when obtained at first presentation. The pre-massage and post-massage test has strong concordance with the 4-glass test and is a reasonable alternative when expressed prostatic secretions are not obtained.

Bacteria↗

Office screening test for intrinsic urethral sphincter deficiency: pediatric Foley catheter test.

OBJECTIVE: To evaluate an office-based test as a screening method for intrinsic sphincter deficiency. METHODS: One hundred seventy-three women with urinary incontinence were evaluated prospectively by complete urodynamic studies. After catheterization, the pediatric Foley catheter test was performed on an empty bladder by withdrawing the inflated bulb of an 8-French Foley catheter through the urethra. The test was considered positive if the inflated catheter bulb could be withdrawn completely through the urethra. Women with grade 3 genital prolapse or higher were excluded. Intrinsic sphincter deficiency was defined as the presence of genuine stress incontinence and low maximum urethral closure pressure (at most 20 cm H(2)O). RESULTS: Seventy-six of 173 women (44%) had positive tests and 97 (56%) had negative tests. Seventy-six percent of those with positive tests were diagnosed with intrinsic sphincter deficiency, compared with 19% in women with negative tests (P <.001). All women with positive tests and negative cotton swab tests had intrinsic sphincter deficiency. The sensitivity, specificity, and positive and negative predictive values for diagnosing intrinsic sphincter deficiency were 76, 81, 76, and 81%, respectively. CONCLUSION: A positive pediatric Foley catheter test in the absence of urethral mobility strongly suggests intrinsic sphincter deficiency. The pediatric Foley catheter test may be useful in screening for intrinsic sphincter deficiency.

Aged↗

Flavor preferences conditioned by sucrose depend upon training and testing methods: two-bottle tests revisited.

In confirmation of prior work, rats given one-bottle training with flavored 5% and 30% sucrose solutions (CS5 and CS30) strongly preferred the CS5 when both flavors were presented in intermediate 17.5% sucrose solutions. The CS5 preference has been attributed to a conditioned satiety response to the CS30 flavor, but equal intakes of CS5 and CS30 in one-bottle tests did not support this view. To determine if sweetness differences between training and test solutions contributed to the CS5 preference, new rats were trained and tested with flavored 10% sucrose solutions. One flavor (CS5) was paired with matched intragastric (ig) water infusions (=net 5% solution) and another flavor (CS30) was paired with matched infusions of 50% sucrose (=net 30% solution) during one-bottle training. In two-bottle tests with both flavors paired with an intermediate infusion (25%=net 17.5%), the rats initially showed no overall preference for the CS5 or CS30. Following additional training, the rats significantly preferred the CS30 to the CS5. The intragastric data suggested that a change in sweet taste context between training and testing might have accounted for the strong CS5 preference obtained in the first experiment. This was confirmed in a third experiment in which rats were trained with flavored 5% and 30% sucrose solutions and then given two-bottle tests with both flavors presented either in 5% sucrose or 30% sucrose. Rats tested with 30% sucrose strongly preferred the CS5 flavor, whereas rats tested with 5% sucrose significantly preferred the CS30 flavor. Thus, the outcome of two-bottle flavor preference tests and presumably other tests of conditioned flavor reward may be greatly influenced by the solutions used in the tests. The impact of this variable may be greatest when the training solutions do not substantially differ in their net postingestive reinforcing actions. This appears to be the case with 5% and 30% sucrose solutions because the satiating effect of the concentrated solution tends to counteract its nutrient reinforcing action.

Animals↗