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How does the plethysmogram derived from the pulse oximeter relate to arterial blood pressure in coronary artery bypass graft patients?

UNLABELLED: Twenty patients scheduled for coronary artery bypass grafting had their ear and finger oximeter and radial artery blood pressure (Bp(meas)) waveforms collected. The ear and finger pulse oximeter waveforms were analyzed to extract beat-to-beat amplitude and area and width measurements. The Bp(meas) waveforms were analyzed to measured systolic blood pressure (BP), mean BP, and pulse pressure. The correlation coefficient was determined between the derived waveforms from the pulse oximeter and Bp(meas) for the first 10 patients. The ear pulse oximeter width (Width(Ear)) had the best correlation (r = 0.8). Linear regression was done between Width(Ear) and Bp(meas) based on slope (b) and intercept (a) values, BP was calculated (Bp(calc)) in the next 10 patients as: [equation: see text] where i = systolic BP, mean BP, and pulse pressure. The initial bias was too large to be clinically useful. To improve clinical applicability a period of calibration was introduced in which the first 50 readings of Width(Ear) and Bp(meas) for each patient were used to calculate the intercept. After calibration the systolic BP, mean BP and pulse pressure bias values were -2.6, -1.88 and -1.28 mm Hg, and the precision values were 15.9 10.09, and 9.94 mm Hg, respectively. The present attempt to develop a clinically useful method of noninvasive BP measuring was partly successful with the requirement of a calibration period. IMPLICATIONS: Statistical comparison was made between measured blood pressure (BP) from arterial line and calculated BP derived from ear pulse oximeter waveform in 10 patients undergoing coronary artery bypass graft surgery. Using 62,077 paired readings, the mean difference for systolic BP, mean BP, and pulse pressure between the 2 methods was -2.6, -1.88, and -1.28 mm Hg, respectively.

Blood Pressure↗

Esmolol and left ventricular function in the awake dog.

Hypotension has been the most frequently reported adverse reaction associated with infusion of the beta 1-adrenergic receptor antagonist esmolol. In some patients, this hypotension has apparently occurred independent of reduction in heart rate or systemic vascular resistance, suggesting decreased stroke volume. In the present study, the preload recuitable stroke work area (PRSWA) model was used to evaluate the negative inotropic effects of esmolol in nine chronically instrumented awake dogs. Left ventricular (LV) transmural pressure and minor axis diameter were measured by micromanometers and sonomicrometry, respectively. Vena caval occlusions were performed so that an analog of stroke work (area within LV transmural pressure-diameter loop) could be measured over a range of preloading conditions during esmolol infusions of 0, 100, 300, 1000, and 3000 micrograms/kg-1.min-1 (n = 9), and at 15 and 30 min after termination of esmolol (n = 8). The linear relationship between stroke work and end-diastolic diameter was characterized for each caval occlusion by a slope and x-intercept. PRSWA was calculated for each caval occlusion as slope/two times the square of the difference between x-intercept and the largest end diastolic diameter observed in the study of a particular dog. Heart rate was different from control (91 +/- 4) only at the highest esmolol dose (127 +/- 4). LV peak positive dP/dt, minor axis ejection shortening, stroke work, and PRSWA were depressed from control at esmolol doses greater than or equal to 300 micrograms.kg-1.min-1. All parameters except dP/dt recovered within 30 min following termination of esmolol.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗

The effects of halothane in hypoxic pulmonary vasoconstriction.

Human and animal experiments have not consistently shown halothane to inhibit hypoxic pulmonary vasoconstriction (HPV). The authors used a canine lung lobe perfused in situ to more precisely characterize the effects of halothane on HPV. The pulmonary vasculature can be divided into inflow, middle, and outflow segments by sequentially occluding the lobar inflow and outflow of blood. The lobes were ventilated with four different gas mixtures (normoxia, hypoxia, normoxia/halothane, hypoxia/halothane) and measured inflow, outflow, and middle segment (Rm) resistances using this stop-flow technique. All values are shown as means +/- standard deviation. The authors found that hypoxia increased Rm from normoxia values of .006 +/- .005 cmH2O.ml-1.min-1 to .025 +/- .008 cmH2O.ml-1.min-1 (P less than 0.05). During hypoxia/halothane Rm returned to .005 +/- .004 cmH2O.ml-1.min-1. The relationship between pressure and flow (P-Q) for the lobes for each gas mixture was also determined. The slopes of the P-Q lines by linear regression were all similar. The zero-flow pressure intercepts of the P-Q lines for normoxia (3.2 +/- .9 cmH2O) and hypoxia (4.4 +/- 1.1 cmH2O) were significantly decreased after the administration of halothane (1.7 +/- 1.0 cmH2O and 2.6 +/- 1.0 cmH2O, respectively). Since the zero-flow intercept likely reflects the tone at alveolar vessel level, the authors conclude that halothane inhibits HPV by decreasing the tone in the middle vascular segment.

Animals↗

Low-dose halothane anesthesia does not affect the hemodynamic estimation of myocardial oxygen consumption in dogs.

The accuracy of the product of systolic blood pressure and heart rate as a correlate of myocardial oxygen consumption has been questioned in anesthetized patients, suggesting that anesthesia alters the relationship between myocardial oxygen consumption and the hemodynamics. This relationship was reexamined in the awake state and during 0.95% end-tidal halothane anesthesia in seven chronically instrumented dogs. Measurements of myocardial oxygen consumption were compared with two indices, the systolic pressure rate product and the pressure work index. The latter is a weighted combination of the systolic pressure rate product and external cardiac work. A wide range in myocardial oxygen consumption (3.0-38.2 ml O2.min-1.100g-1) and hemodynamic states (range in pressure rate 4,100-40,700 mmHg/min and range in pressure work 3.7-37.0 ml O2.min-1.100g-1) was achieved with infusions of norepinephrine, nitroglycerin, neosynephrine, nitroprusside, and isoproterenol. Both the pressure rate product and the pressure work index correlated closely with myocardial oxygen consumption not only when the animals were awake but also during anesthesia. For each animal best-fit regression analysis for the awake and the anesthetized data did not reveal any significant change in the slope or y-intercept. Pooled data analysis that only permitted a change in slope with the addition of anesthesia (intercept unchanged) revealed a 17% decrease (P less than 0.05 on t test) in the slope constant when the pressure rate product was applied and no change in slope when the pressure work index was used to estimate myocardial oxygen consumption. It was concluded that myocardial oxygen consumption can be estimated during 0.95% halothane anesthesia by either index but that the pressure work index performs better than the systolic pressure rate product.

Anesthesia↗

Accuracy of a cerebral oximeter in healthy volunteers under conditions of isocapnic hypoxia.

BACKGROUND: A cerebral oximeter measures oxygen saturation of brain tissue noninvasively by near infrared spectroscopy. The accuracy of a commercially available oximeter was tested in healthy volunteers by precisely controlling end-tidal oxygen (P[ET]O2) and carbon dioxide (P[ET]CO2) tensions to alter global cerebral oxygen saturation. METHODS: In 30 healthy volunteers, dynamic end-tidal forcing was used to produce step changes in P[ET]O2 resulting in arterial saturation ranging from approximately 70% to 100% under conditions of controlled normocapnia (each person's resting P[ET]CO2) or hypercapnia (resting plus 7-10 mmHg). Blood arterial (SaO2) and jugular bulb venous (S[jv]O2) saturations during each P(ET)O2 interval were determined by co-oximetry. The cerebral oximeter reading (rSO2) and an estimated jugular venous saturation (S[jv]O2), derived from a combination of SaO2 and rSO2, were compared with the measured S(jv)O2. RESULTS: The S(jv)O2 was significantly higher with hypercapnia than with normocapnia for the same SaO2. The rSO2 and S(jv)O2 were both highly correlated with S(jv)O2 for individual volunteers (mean r2 = 0.91 for each relation); however, the slopes and intercepts varied widely among volunteers. In three of them, the cerebral oximeter substantially underestimated the measured S(jv)O2. CONCLUSIONS: During isocapnic hypoxia in healthy persons, cerebral oxygenation as estimated by near infrared spectroscopy precisely tracks changes in measured S(jv)O2 within individuals, but the relation exhibits a wide range of slopes and intercepts. Therefore the clinical utility of the device is limited to situations in which tracking trends in cerebral oxygenation would be acceptable.

Adult↗

Lung mechanical profiles in acute respiratory failure: diagnostic and prognostic value of compliance at different tidal volumes.

The mean airway pressure difference within a respiratory cycle at end-inspiration was measured at different tidal volumes (VT) in 59 patients treated with mechanical ventilation, and plotted in a pressure-volume (P-V) diagram. Regression analysis revealed three types of regression lines which were clearly correlated with clinical pulmonary condition and outcome. The slope of such regression lines may be a more realistic representation of lung elasticity than conventional total static compliance, which is measured at only one VT, and the intercept of these lines may be a more appropriate reflection of operating lung volume than functional residual capacity. Ventilator settings should put the patient's lungs on the steepest part of the P-V curve with the smallest intercept, while maintaining acceptable arterial blood gas tensions.

Adult↗

Comparison of measurements of cardiac output by bioimpedance and thermodilution in severely ill surgical patients.

In order to evaluate a new thoracic electrical bioimpedance (TEB) system for measurement of stroke volume based on the Sramek-Bernstein equation, 391 paired values of cardiac output were measured simultaneously with the standard thermodilution method. These values were obtained from 16 patients selected for having the most severe illness during a 6-month period; the intent was to evaluate the bioimpedance method in the worst possible situations. The correlation coefficient (r) was 0.83, slope was 0.87, intercept was 1.53, and the mean difference between the two methods was 16.2 +/- 11.8 (SD)% in the total series. In 285 paired samples where satisfactory conditions were met, r was 0.90, slope was 0.98, intercept was 0.34, and the mean difference was 11.8 +/- 8.9%. The data indicate satisfactory correlations between these two methods. When the TEB waveform is satisfactory, the agreement between TEB and thermodilution is as good as the agreement between serial thermodilution methods. Difficulties may arise with dysrhythmias, tachycardia (heart rate greater than 150 beat/min), metal in the chest or chest wall, sepsis, hypertension, and extremely oily skin. Mechanical ventilation did not appear to be a problem.

Cardiac Output↗

Evaluation of noninvasive measurements of oxygenation in stable infants.

The accuracy with which transcutaneous measurements of oxygen tension reflect PaO2 in older infants has recently been questioned. We therefore examined the effect of maturation, i.e., age or skinfold thickness, on the accuracy of transcutaneous oxygen tension (PtcO2) and oxygen saturation (StcO2) measurements in 19 infants (age 1 to 61 wk) undergoing elective cardiac catheterization. Twenty-seven simultaneous arterial and transcutaneous measurements revealed a good correlation between PtcO2 and PaO2 (r = .91, slope .77, intercept 3.23 torr). The mean arterial-transcutaneous PO2 difference of 10 torr (range - 15 to 35) was independent of age but was significantly correlated with skinfold thickness (r = .45, p less than .05). There was also a good correlation between StcO2 and SaO2 (r = .95, slope .65, intercept 27.8%). The mean arterial-transcutaneous oxygen saturation of 1.4% (range - 17.3 to 14) was unaffected by age or skinfold thickness. However, neither PtcO2 or StcO2 measurements were accurate in patients with severe hypoxemia; StcO2 consistently overestimated the SaO2 when the SaO2 was below 70%. Thus, in this study the discrepant PtcO2 measurements in older infants were due to increasing skinfold thickness rather than age. PtcO2 monitoring still has an important role in oxygen monitoring and together with StcO2 provides valuable information on oxygenation.

Aging↗

Myocardial dysfunction after successful resuscitation from cardiac arrest.

OBJECTIVE: To investigate the functional and metabolic changes in the myocardium after successful resuscitation from cardiac arrest. DESIGN: Prospective, randomized, sham-controlled study. SETTING: Animal laboratory at a university center. SUBJECTS: Domestic pigs. INTERVENTIONS: Electric induction of ventricular fibrillation by alternating current delivered to the right ventricular endocardium through a pacing electrode. Electric defibrillation was attempted after an interval of 12 mins of ventricular fibrillation, which included 4 mins of untreated ventricular fibrillation and 8 mins of precordial compression in 13 animals, seven of which were successfully resuscitated. Seven additional animals were randomized to serve as "sham" controls, in which cardiac arrest was not induced. MEASUREMENTS AND MAIN RESULTS: Left ventricular pressure-volume relationships utilizing the conductance method were obtained in conjunction with conventional hemodynamic and metabolic measurements at baseline and during a 6-hr interval after successful cardiac resuscitation. Progressive and striking increases in left ventricular volumes were observed after successful cardiac resuscitation. The end-diastolic volume increased from a prearrest level of 89 +/- 21 mL to a maximum of 154 +/- 53 mL (p<.05) at 360 mins after successful resuscitation. The time-coincident end-systolic volume increased from 54 +/- 21 to 126 +/- 54 mL (p<.05), such that the ejection fraction was reduced from 0.41 +/- 0.10 to 0.20 +/- 0.07 ( p<.05). Ventricular dilation was associated with marked reductions in stroke volume and ventricular work. However, compensatory increases in heart rate maintained cardiac output at levels that sustained adequate systemic oxygen delivery. The slope of the end-systolic pressure-volume relationships progressively decreased from 5.04 +/- 1.88 to 2.00 +/- 0.57 mm Hg/mL (p<.05) at 360 mins after successful resuscitation. The volume intercept at left ventricular pressure of 100 mm Hg increased from 43 +/- 19 to 94 +/- 51 mL (p=.03). Both the decrease in the slope and the increase in the volume intercept were characteristic of progressive impairment in contractile function. The rate of left ventricular pressure decrease was unchanged. Accordingly, no substantial changes in lusitropic properties were identified. Despite large increases in end-diastolic volume, the end-diastolic pressure remained unchanged. CONCLUSION: Postresuscitation myocardial dysfunction in this animal model was characterized by impaired contractile function, decreased work capability, and ventricular dilation.

Animals↗

Prostaglandin E1 antagonizes hypoxic pulmonary vasoconstriction but reduces systemic blood pressure in dogs.

OBJECTIVE: To investigate whether prostaglandin E1 (PGE1) directly inhibits hypoxic pulmonary vasoconstriction in dogs. DESIGN: Prospective, longitudinal study. SETTING: University research laboratory. SUBJECTS: Six mongrel dogs in vivo. INTERVENTIONS: The left thorax of anesthetized and ventilated dogs was opened and the left lower lobe was separately ventilated. The tip of the thermodilution pulmonary artery catheter was introduced into the left lower lobe pulmonary artery. The left lower lobe was ventilated with hyperoxic (95% oxygen and 5% CO2) or hypoxic (95% nitrogen and 5% CO2) gas. By manipulating the occluders placed on both pulmonary arteries, blood flow in the left lower lobe was regulated. Continuous pressure-flow plots for the left lower lobe were then obtained. MEASUREMENTS AND MAIN RESULTS: Measurements included continuous pressure-flow plot generation, thermodilution cardiac output and blood flow in the left lower lobe, and blood gas analysis. Alveolar hypoxia of the left lower lobe caused blood flow in the left lower lobe to decrease from 371.8 +/- 63.4 to 95.0 +/- 23.4 mL/min and shifted the pressure-flow plot to the right, with a decreased slope and with an increase in the pressure-axis intercept. Subsequently, systemic venous infusion of PGE1 at a rate of 0.3 microg/kg/min had no effect on the pressure-flow plot configuration, blood flow in the left lower lobe, pulmonary vascular resistance, systemic vascular resistance, and PaO2. However, there was a decrease in the pressure-axis intercept of the pressure-flow plot. Infusion of PGE1 at a rate of 3.0 microg/kg/min (high-dose) during hypoxia reduced pulmonary vascular resistance and systemic vascular resistance by 19% and 25%, respectively, and returned the pressure-flow plot toward normal while blood flow in the left lower lobe increased to 122.6 +/- 21.0 mL/min. Consequently, PaO2 decreased from 270 +/- 31 to 144 +/- 32 torr (36.0 +/- 4.1 to 19.2 +/- 4.3 kPa). CONCLUSION: High-dose PGE1 essentially inhibits hypoxic pulmonary vasoconstriction, at the expense of a deterioration in pulmonary gas exchange and systemic blood pressure in dogs.

Alprostadil↗

Multicenter study of whole-blood creatinine, total carbon dioxide content, and chemistry profiling for laboratory and point-of-care testing in critical care in the United States.

OBJECTIVES: To introduce a creatinine biosensor and a total carbon dioxide content (TCO2) method for whole-blood measurements, to evaluate the clinical performance of a new transportable analyzer that simultaneously performs these two and six other tests (Na+, K+, Cl-, glucose, urea nitrogen, and hematocrit), and to assess the potential of the new analyzer for point-of-care testing in critical care by comparing results obtained by nonlaboratory personnel and by medical technologists. DESIGN: Multicenter sites compared whole-blood measurements with the transportable analyzer to plasma measurements from the same specimens with local reference instruments. One site compared whole-blood results produced by nonlaboratory personnel vs. medical technologists and evaluated day-to-day and within-day precision at the point of care. SETTINGS AND PATIENTS: Four medical centers in the United States. Venous and arterial specimens from 710 critically ill patients with a variety of diagnoses. Point-of-care testing in the emergency room and operating room. RESULTS: The linear regression analyses at the four medical centers showed the following: creatinine (a) slope, 0.91 to 1.22, (b) y intercept, -0.07 to 0.15 mg/dL, and (c) r2, 0.77 to 1.00; and TCO2: (a) slope, 0.64 to 1.00, (b) y intercept, 1.36 to 9.6 mmol/L, and (c) r2, 0.52 to 0.72 (yi, whole-blood analyses; xi, plasma reference measurements). Bland-Altman plots also were used to assess multicenter creatinine and TCO2 results. Of the other analytes, K+, glucose, and urea nitrogen had the highest r2-values. For the eight chemistry profile tests performed at the point of care (yi, nonlaboratory personnel results; xi, medical technologist results), the average value of r2 was 0.96 (SD 0.08) in the operating room and 0.96 (SD 0.06) in the emergency room, and mean paired differences (yi - xi) were not statistically or clinically significant. Precision was acceptable. CONCLUSIONS: The performance of the creatinine biosensor and the TCO2 method was acceptable for whole-blood samples. Comparisons of whole-blood results from the transportable analyzer and plasma results from the local reference instruments revealed analyte biases that may be attributed to differences between direct whole-blood analyses and indirect-diluted plasma measurements and other factors. Performance of nonlaboratory personnel and medical technologists was equivalent for point-of-care testing in critical care settings. The whole-blood analyzer should be useful when patient care demands immediate results.

Biosensing Techniques↗

Movement of radionuclides in terrestrial ecosystems by physical processes.

Physical processes that effect the movement of radionuclides in the temperate environments post-deposition are considered in this paper. The physical processes considered include the interception of radionuclides by vegetation, resuspension, and vertical migration in soil. United States and Russian results on the interception of radionuclides are reviewed and defined in terms of models that are currently undergoing evaluation and revision. New results on resuspension are evaluated, and a preliminary new model for the time-dependent resuspension factor is proposed. Chernobyl-related results on the movement of radionuclides into the soil column are presented, as is a revised model for this process based upon recent results from Ukraine.

Ecosystem↗

Saturation kinetics of iopanoate in the dog.

Experiments were carried out in dogs with a modified Thomas cannula in the duodenum through which the common bile duct could be catheterized. Constant intravenous infusion of sodium iopanoate at different infusion rates greater than the apparent excretion maximum revealed linearity of the blood concentration with time above a threshold concentration. When the slopes of the blood curves were plotted against the known infusion rates, a straight line relationship was obtained. The X axis intercept of this straight line represents an apparent transport maximum. This value obtained from the X axis intercept matched closely with the observed excretion maximum determined from bile and urine collection. The slope of this same line equals the inverse of the volume of distribution of the drug. Although previous workers have failed to appreciate an apparent transport maximum for iopanoate, the current studies clearly demonstrate that iopanoate is excreted by a saturable mechanism. Using this technique the apparent transport maximum for iopanoate was evaluated at high and low rates of taurocholate replacement to evaluate the quantitative effect of bile salt on the apparent transport maximum. A five-fold increase in taurocholate replacement led to an average 40% increase in the apparent transport maximum of iopanoate without effecting its volume of distribution significantly.

Animals↗

Computer-assisted assessment of the kinetic function of disk-type artificial heart valves.

A simple and accurate computer simulation method was developed to evaluate the geometrical parameters of disk-type artificial heart valves from cinefluorographic recordings. In vitro valve models with preset occluder angles were used to test the accuracy of the method. Linear regression analysis produced slope 1.00055 and intercept 0.0402, with r = 0.999. In vivo reproducibility was tested through repeated measurements, taken several weeks apart, of OMS valves in situ. Regression with slope 1.02 and intercept -0.95, r = 0.95 were found.

Computer Simulation↗

Quantitative dual-energy coronary arteriography.

Subtraction techniques for digital cardiac imaging have been hampered by misregistration artifacts. The use of dual-energy imaging is being evaluated as a means for reducing these artifacts. Results reported previously indicate that the dual-energy technique may be useful for applications such as exercise ventriculography and general quantification tasks. The purpose of the current study is to investigate the use of dual-energy subtraction imaging for quantitative coronary arteriography. In vivo coronary vessel phantoms (0.2 to 7 mm2 in cross-sectional area) were used to study the potential advantages of tissue suppressed energy subtracted images over unsubtracted images for quantification of absolute vessel cross-sectional area when cardiac motion is present. Estimates of lumen cross-sectional area (N = 20) were determined using videodensitometric analysis of selected energy subtracted and unsubtracted images. Linear regression analysis of measured and actual cross-sectional area showed energy subtracted image data (slope = 1.06, intercept = 0.48 mm2, r = 0.99) to have improved accuracy (P less than .05) and precision (P less than .05) over unsubtracted image data (slope = 1.24, intercept = 1.07 mm2, r = 0.95).

Angiography, Digital Subtraction↗

High sodium sensitivity and glomerular hypertension/hyperfiltration in primary aldosteronism.

OBJECTIVE: To assess sodium sensitivity and glomerular haemodynamics in patients with primary aldosteronism. DESIGN AND METHODS: Two-week studies were performed in six patients with primary aldosteronism whose diagnosis had been confirmed by histology of the removed adrenal adenoma. Patients were fed normal or sodium-restricted diets for 1 week each and renal clearance measured during the normal sodium diet. Pressure-natriuresis relationships were drawn by plotting the urinary sodium excretion on the y-axis as a function of the systemic mean arterial pressure on the x-axis. RESULTS: The extrapolated x-intercept of the pressure-natriuresis curve was 118 +/- 9 mmHg. The sodium sensitivity, which corresponds to the reciprocal of the slope, was augmented to 0.111 +/- 0.013 mmHg/mmol per day, and the reduction in mean arterial pressure by sodium restriction was 11 +/- 2%. As we had reported previously, the difference between the mean arterial pressure (137 +/- 5 mmHg) with the normal-sodium diet and the x-intercept was assumed to be the effective filtration pressure across the glomerular capillary walls (18.2 +/- 2.0 mmHg). By dividing the glomerular filtration rate (128 +/- 10 ml/min per 1.73 m2) by the effective filtration pressure, the whole kidney ultrafiltration coefficient in these patients was estimated to be 0.127 +/- 0.021 ml/s per mmHg, which was approximately normal. The glomerular capillary pressure was calculated to be 54 +/- 2 mmHg. CONCLUSION: Compared with non-sodium-sensitive essential hypertension patients (n = 18) whose glomerular filtration rate and capillary hydraulic pressure were 84 +/- 3 ml/min per 1.73 m2 and 47 +/- 1 mmHg, the sodium sensitivity of blood pressure in patients with primary aldosteronism was augmented, and both glomerular hyper-filtration and glomerular capillary hypertension were observed. We confirmed that the glomerular haemodynamic characteristics in primary aldosteronism are typical of those expected for sodium-sensitive hypertension caused by enhanced tubular sodium reabsorption.

Adult↗

Repeatability of the sugar-absorption test, using lactulose and mannitol, for measuring intestinal permeability for sugars.

Differential sugar-absorption tests for measuring intestinal permeability for sugars have been studied in a variety of gastrointestinal diseases. Their use in general practice has been hampered by a lack of data on reference values and repeatability of the test and the laboratory assay. In this study, we determined the reference values of the sugar-absorption test, using lactulose and mannitol as probe molecules, for children and adults. The repeatability of the test is good; linear relationship: slope, 0.825 [95% confidence interval (CI), 0.571, 1.152); intercept, 0.005 (95% CI, -0.004, 0.010). The repeatability of the laboratory assay for the sugar-absorption test is excellent; linear relationship: slope, 1.014 (95% CI, 0.870, 1.094); intercept, 0.002 (95% CI, -0.005, 0.010). The validation of the sugar-absorption test makes the test useful as a simple, noninvasive, reliable intestinal permeability test for sugars, which can be of use for clinical practice. Taking possible interfering factors into account, the sugar-absorption test can be used as a diagnostic test for enteropathy of different etiologies and evaluation of therapeutic interventions in both children and adults. Studies with the sugar-absorption test may clarify the role of intestinal permeability in the pathophysiology of a variety of gastrointestinal diseases.

Adolescent↗

Heart rate reserve is equivalent to %VO2 reserve, not to %VO2max.

Percentage of heart rate reserve (%HRR) is widely considered to be equivalent to % of maximal oxygen consumption (%VO2max) for exercise prescription purposes. However, this relationship has not been established in the literature, and a theoretically stronger case can be made for an equivalency between %HRR and %VO2 Reserve (%VO2R) (i.e., the difference between resting and maximal VO2). The current study hypothesized that %HRR is equivalent to %VO2R, not %VO2max, and that the discrepancy between %HRR and %VO2max would be inversely proportional to fitness level. Sixty-three adults performed incremental maximal exercise tests on an electrically braked cycle ergometer. HR and VO2 at rest, at the end of each stage of exercise, and at maximum were used to perform linear regressions on %HRR versus %VO2max, and %HRR versus %VO2R for each subject. For %HRR versus %VO2max, the mean intercept and slope were -11.6 +/- 1.0 and 1.12 +/- 0.01, respectively, which were significantly different (P < 0.001) from 0 and 1, respectively. For %HRR versus %VO2R, the mean intercept and slope were -0.1 +/- 0.6 and 1.00 +/- 0.01, respectively, which were not distinguishable from the line of identity. There was a significant (P < 0.01) inverse relationship between fitness level (VO2max) and the discrepancy between %HRR and %VO2max. In conclusion, %HRR should not be considered equivalent to %VO2max. Rather, %HRR is equivalent to %VO2R, and this relationship should be used in exercise prescription.

Adult↗