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Ramp exercise protocols for clinical and cardiopulmonary exercise testing.

Historically, the protocol used for exercise testing has been based on tradition, convenience or both. In the 1990s, a considerable amount of research has focused on the effect of the exercise protocol on test performance, including exercise tolerance, diagnostic accuracy, gas exchange patterns and the accuracy with which oxygen uptake (VO2) is predicted from the work rate. Studies have suggested that protocols which contain large and/or unequal increments in work cause a disruption in the normal linear relation between VO2 and work rate, leading to an overprediction of metabolic equivalents. Other studies have demonstrated that such protocols can mask the salutary effects of an intervention, and some have suggested that the protocol design can influence the diagnostic performance of the test. Guidelines published by major organisations have therefore suggested that the protocol be individualised based on the patient being tested and the purpose of the test. The ramp approach to exercise testing has recently been advocated because it facilitates recommendations made in these guidelines. This article reviews these issues and discusses the evolution of ramp testing which has occurred in the 1990s.

Energy Metabolism↗

The Residency Review Committee for Radiology: its organization, function, and performance in diagnostic radiology.

The accreditation process for training in radiology is managed by the Residency Review Committee for Radiology under a prescribed system. That system and the actions taken by the Committee in recent years are described. Most applications for new or continuing programs in 1975-1981 were approved. An analysis of the adverse actions of the Committee indicates the most common deficiencies were inadequate clinical experience in subspecialty areas, inadequate formal teaching, and understaffing of the clinical program. Certain trends in radiology are apparent. The numbers of programs in diagnostic and therapeutic radiology have not changed significantly over the past 5 years, whereas opportunities for training in nuclear radiology have increased greatly. The number of trainees in diagnostic radiology has increased 13% during this period; the number in radiation therapy remains unchanged. The number of women trainees in diagnostic radiology has increased from 15% to 22%, and the number of foreign graduate trainees has decreased from 19% to 11%.

Accreditation↗

Influence of topical anesthesia on tests diagnostic of blepharitis-associated dry eye syndrome.

PURPOSE: Despite the high frequency and clinical relevance of blepharitis-associated dry-eye syndrome, no agreement exists about whether diagnostic tests should be performed with or without topical anesthesia. The aim of this study was to compare the influence of topical anesthesia on the mean values of Schirmer's test, tear lysozyme, tear lactoferrin, and tear osmolarity in patients suffering from blepharitis-associated dry eye syndrome. METHODS: The authors compared the mean values of Schirmer's test, tear osmolarity, tear lysozyme (turbidimetric assay), and tear lactoferrin (radial immunodiffusion) before and after topical anesthesia in the following groups: 56 normal subjects (group 1), 62 blepharitis patients (group 2), and 15 patients with blepharitis-associated dry eye syndrome (group 3). All clinical and laboratory tests were performed by masked observers. RESULTS: In group I, mean values of Schirmer's test decreased 24.8% (p < 0.01) when performed after application of topical anesthesia. The other tests were not significantly modified. In groups 2 and 3, significant differences were seen in Schirmer's test (25.33% and 24.19% respectively, p < 0.001) and the lysozyme determination (14.00% and 13.22% respectively, p < 0.01). Differences between the normal subjects (group I) and the patient groups increased when the tests were performed after application of topical anesthesia reaching statistical significance in group 3 for all the tests. CONCLUSIONS: Performing diagnostic tests after topical anesthesia instillation could be useful in detecting dry eye associated with blepharitis.

Adrenergic alpha-Agonists↗

S100P as a Shared Biomarker in Inflammatory Bowel Disease, Colorectal Cancer, and Pancreatic Adenocarcinoma: An Integrated Transcriptomic Analysis.

Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC) and pancreatic adenocarcinoma (PAAD), yet the molecular features shared among these diseases remain incompletely understood. This study aimed to identify common genes and biological pathways associated with IBD, CRC, and PAAD through integrated transcriptomic analysis and experimental validation. Gene expression datasets for IBD, CRC, and PAAD were obtained from The Cancer Genome Atlas and Gene Expression Omnibus databases. Weighted gene co-expression network analysis and differential expression analysis were performed to identify disease-associated and shared genes. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (analyses were used to explore enriched biological functions and pathways. Immune cell infiltration was evaluated using Cell-type Identification by Estimating Relative Subsets of RNA Transcripts. Receiver operating characteristic analysis was performed to assess the diagnostic performance of common genes. Single-cell RNA sequencing analysis was conducted to examine the cellular distribution of S100P. In addition, the effects of S100P downregulation were evaluated in lipopolysaccharide (LPS)-stimulated colonic epithelial cells. A total of 162 disease-associated genes and four common genes were identified. Functional enrichment analyses indicated significant enrichment of immune- and inflammation-related pathways, including the interleukin-17 signaling pathway. Immune infiltration analysis revealed similar trends in several immune cell populations across IBD, CRC, and PAAD. Single-cell analysis showed elevated S100P expression in epithelial cells from all three diseases. Downregulation of S100P restored the proliferative capacity of LPS-stimulated colonic epithelial cells and reduced inflammatory cytokine expression. Integrated transcriptomic analysis identified S100P as a biomarker associated with IBD, CRC, and PAAD and highlighted shared immune-related features across these diseases.

Humans↗

[Substantiation of indication to performance of diagnostic thoracoscopy and thoracotomy in patients with pleuropulmonary diseases using method of oncological testing].

New approach for decision making concerning conduction of surgical treatment of the patients with pleuropulmonary diseases is proposed. This approach especially important in differential diagnosis of dissemination of obscure etiology. He is based on usage of a new screening diagnostic method "Oncotest", which intends setting of photohistochemical reaction in the blood smears, sections and serum for detection of biomolecular markers of cancer. Results of oncotesting of 172 patients with various pleuropulmonary diseases are analyzed. Application of a new approach permits to administer to the patient surgical or endoscopic intervention timely.

Adolescent↗

Laparoscopic variability of the internal inguinal ring: review of anatomical variation in children with and without a patent processus vaginalis.

PURPOSE: Diagnostic laparoscopy is routinely performed at our institution in children with a unilateral inguinal hernia to determine whether the contralateral processus vaginalis is patent. We reviewed the anatomical variability of the inguinal ring at laparoscopy in children with and without a hernia in various age groups. MATERIALS AND METHODS: Since 1992, we have performed diagnostic laparoscopy in more than 1,500 children with a known inguinal hernia. Intraoperative imaging was correlated with clinical and operative findings to characterize the anatomical variability of the internal ring. RESULTS: The internal ring had many variations. The photographs presented show evidence of the progression from the flat closed ring to the widely open sac. Clefts and veils of peritoneum sometimes made determining the exact anatomy difficult. Experience shows that the various anatomical variations are associated with different pathological conditions. CONCLUSIONS: Characterization of the anatomical variability of the internal ring is essential for determining the patency of the processus vaginalis at diagnostic laparoscopy in children with a known inguinal hernia. We classified these variations in accordance with clinical and surgical findings.

Hernia, Inguinal↗

Paratubal cyst: a case report.

Paratubal cyst can undergo torsion that can make it difficult to diagnose since tubal cysts mimic ovarian cysts. Most reported cases of paratubal cysts have occurred in pediatric patients, and this type of cyst rarely causes symptoms of lower abdominal pain mimicking appendicitis. We present the case of a 28-year-old female who was taking Carbergoline for hyperprolactinoma associated with a pituitary adenoma who came to the ER at Henry Ford Hospital in Detroit experiencing severe abdominal pain. Her pain was not accompanied by nausea, vomiting or other gastrointestinal symptoms. A transvaginal ultrasound revealed a normal uterus with the right ovary containing a cyst measuring 3 cm. x 2 cm. She was released on analgesics and seen at the clinic at Henry Ford Hospital three days later. She was still experiencing pain and was given antibiotics and Darvocet. When the pain had not subsided 48 hours later, a decision was made to perform diagnostic laparoscopy. Surgery was performed 10 days later and a paratubal cyst was removed that was twisted twice on its pedicle. This case illustrates the fact that torsion of paratubal cyst should be included in the differential diagnosis of adnexal pain.

Abdominal Pain↗

A new high-performance PCR diagnostic for the detection of pyrethroid knockdown resistance kdr in Anopheles gambiae.

Monitoring the spread of the knockdown resistance allele kdr in areas of extensive pyrethroid use is critical to vector-control projects. Currently available methods for detecting kdr from DNA samples are characterized by poor amplification, time-consuming steps, and primers that exhibit frequent null alleles. We describe a new PCR diagnostic that uses fluorescent primers based on conserved priming sites and enables simple detection of the kdr allele on a sequencer. Using samples from a West African Anopheles gambiae population, we show that the new PCR yielded significantly higher rates of amplification and more accurate estimates of kdr frequency. The method works equally well for the leucine to phenylalanine substitution found in West Africa and the East African leucine to serine substitution.

Animals↗

Performance and diagnostic application of a two-site immunoradiometric assay for parathyrin in serum.

The "N-tact" immunoradiometric assay (IRMA) from INCSTAR for parathyrin (PTH) in serum involves a 125I-labeled affinity-purified antiserum to PTH 1-34 and an affinity-purified antiserum to PTH 39-84, the latter bound to a polystyrene bead. The mean detection limit, determined in six consecutive assays, was 4 ng/L. The within-batch CV was less than 7% in the range 15 to 2135 ng/L. The between-batch CV was 11.7% and 5.3% at 30 and 371 ng/L, respectively. Serum PTH in 14 proven cases of primary hyperparathyroidism was 49-808 (median 111) ng/L, undetectable (less than 5 ng/L) in 10 cases of primary hypoparathyroidism and in 10 cases of hypercalcemia associated with malignancy, compared with 7-39 ng/L in 45 normal subjects. PTH was 9 to 19 ng/L in four patients with familial benign hypercalcemia. In 39 patients with renal failure, apparent concentrations were 14 to 857 (median 133) ng/L, but sera from these patients pre-diluted with zero standard did not parallel dilutions of the standard, PTH 1-84. PTH concentrations were not significantly decreased in blood or serum kept at 20 degrees C for up to 6 h. After successful removal of a parathyroid adenoma, the mean half-time for disappearance of PTH in vivo in five hyperparathyroid patients was 3.3 min.

Adult↗

[Nodular pulmonary lesions. Evaluation of the significance of the radiographic semeiotics correlated with the results of transbronchial fiberscopic pulmonary biopsy and transparietal needle aspiration].

The results obtained in 148 patients affected by nodular lung lesions have been evaluated. Transbronchial pulmonary biopsies (TBPB) and/or transthoracic fine needle biopsies (NB) have been performed. Diagnostic yield of the performed procedures was 61.5% for TBPB and 91.5% for NB. Radiographic findings and their incidence rates in benign and malignant nodular lung lesions have been considered. Accuracy rate of radiographic features, evaluated by discriminant analysis, was 77.4%. Radiographic appearance has been more related to NB (87.6%) than to TBPB (72.5%).

Adolescent↗