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PubMed1976

Immunofluorescent titration of thymocyte reactive membrane antibodies as a suggested in vitro correlate of the immunosuppressive potency of anti-human thymocyte globulin.

Continued utilization of antilymphocyte and antithymocyte sera for clinical use as an immunosuppressant emphasizes the need for a reproducible in vitro assay that will correlate closely with graft protection in vivo. In this regard the in vitro serologic reactivity of antibodies in three preparations of horse anti-human thymocyte globulin (HAHTG) to cell surface antigens of human thymocytes (thymic lymphocytes) as determined by agglutination, cytotoxicity and in particular for the present study by immunofluorescence (IF) have been compared with their in vivo immunosuppressive potency as measured by prolongation of graft survival. Titration by IF of antibodies in HAHTG reactive with surface antigens of cells of the thymolymphatic system appeared to provide a reasonably simple, reliable and complement-independent in vitro correlate of immunosuppressive potency.

Agglutination Tests↗
PubMed1980

Titration of a cytoplasmic polyhedrosis virus by a tissue microculture assay: some applications.

A simple tissue microculture technique was developed for the titration of a cytoplasmic polyhedrosis virus (CPV) from Euxoa scandens. The procedure was similar to the 50% tissue culture infectious dose assay, but a single infected cell, detected by the presence of cytoplasmic polyhedra, was scored rather than the degeneration of cell monolayers. The filtration of CPV suspensions resulted in decreased virus titers under certain conditions. This microculture assay was used to determine the effect of cell disruption methods on virus yields. Sonication of infected cells was more efficient than freeze-thawing for the recovery of nonoccluded virus.

Animals↗
PubMed1995

Fluorometric riboflavin titration in plasma by riboflavin-binding apoprotein as a method for vitamin B2 status assessment.

A method for plasma riboflavin determination by riboflavin-binding apoprotein titration has been proposed for vitamin B2 status evaluation. The method is based on the formation of riboflavin-apoprotein complex accompanied by full loss of fluorescence peculiar to free riboflavin. The data obtained have demonstrated a correlation with indicators of the vitamin B2 status such as urinary excretion, erythrocyte content, and stimulation of the glutathione reductase activity by flavin adenine dinucleotide. Levels > 6 ng/ml blood plasma may be considered to be a criterion for normal vitamin B2 supply.

Adolescent↗
PubMed1985

Coulometric titration of sweat collected with the Webster Collection System.

Presented here are chloride results obtained by direct titration of undiluted sweat collected with the Webster Sweat Collection System. Six hundred and thirty-two sweat chloride results were reported on 604 patients. Thirty-six of thirty-nine sweat chloride results of 60 mM or greater were from patients with cystic fibrosis. Three results (61, 63 and 64 mM) were from a 12-year-old female who had one episode of rectal prolapse but after one year does not have clinical evidence of cystic fibrosis. There was one patient with a cystic fibrosis variant with intermediate range sweat chloride. All others in the intermediate range (40-59 mM) did not have cystic fibrosis. One patient with a sweat chloride reported of less than 40 mM was subsequently found to have cystic fibrosis at another institution.

Chlorides↗
PubMed1983

The use of particle counting immunoassay (PACIA) for the titration of specific antibodies. Application to sera from honeybee venom-desensitized patients.

Particle counting immunoassay (PACIA) is shown to be a suitable nonradioisotopic method for the titration of anti-phospholipase A2 antibodies in the sera from honeybee venom-desensitized patients. The sensitivity of the method is equal to the RAST-IgG with a correlation coefficient between the two methods of r = 0.94. Within-day and between-day precisions were 2.5 and 9.2%, respectively. The main advantages of PACIA are: (i) the use of easily prepared non-radioactive reagents having a shelf-life of at least 1 year at -20 degrees C: (ii) partial automation; (iii) calibration with antisera of animal origin, and (iv) the possibility of allergen standardization of honeybee venom extracts.

Agglutination↗
PubMed1991

Effects of pH and calcium on hydrolysis of Na2SiF6 and Na2SnF6. A quasi-constant composition titration study.

In the present work, hydrolysis reactions of sodium hexafluorosilicate (Na2SiF6) and sodium hexafluorostannate (Na2SnF6) were studied at various combinations of pH and calcium ion (Ca2+) concentrations using a quasi-constant composition titration method. Under high concentrations of hydrogen ion (H+) and Ca2+, the promoting effect of Ca2+ on the hydrolysis of Na2SiF6 was stronger than the inhibition effect of H+. However, the inhibition effect of H+ on the hydrolysis of Na2SnF6 was stronger than the promoting effect of Ca2+. Na2SiF6 and Na2SnF6 were found to have hydrolysis properties that may make them suitable for use with an acidic calcium phosphate solution in a topical fluoride treatment which forms dicalcium phosphate dihydrate as an intermediate.

Calcium↗
PubMed2004

Determinants of blood pressure response to quinapril in black and white hypertensive patients: the Quinapril Titration Interval Management Evaluation trial.

Race has been considered an important factor in determining blood pressure response to treatment and selection of antihypertensive drug therapy. Data collected during a clinical trial that evaluated rapidity of medication up-titration with blood pressure response to monotherapy with the angiotensin-converting enzyme (ACE) inhibitor quinapril were used to characterize response in 533 black and 2046 white participants. Our objectives were to examine the influence of race and other factors on blood pressure response and to assess the degree to which nonrace factors account for apparent racial differences in response. Average systolic and diastolic blood pressure responses (baseline minus follow-up) to treatment were assessed with treatment groups combined. Crude systolic and diastolic blood pressure responses averaged 4.7 and 2.4 mm Hg less, respectively, in black compared with white participants; however, the response distributions largely overlapped. In multivariate linear regression models adjusted for study design variables and measured participant characteristics, the racial difference in systolic response was reduced by 51% to 2.3 mm Hg, and diastolic response by 21% to 1.9 mm Hg. In these models, participant characteristics, including age, gender, body size, and pretreatment blood pressure severity, significantly predicted either attenuated or enhanced blood pressure response to treatment. Our findings demonstrate that a large source of variability of blood pressure response to treatment is within, not between, racial groups, and that factors that vary at the level of the individual contribute to apparent racial differences in response to treatment.

Adult↗
PubMed1986

Management of hypertension in high school students by using new salt titrator tape.

In a blood pressure screening program involving 6589 high school students, 180 male (4.7%) and 17 female (0.6%) students were identified as borderline hypertensive. The 174 hypertensive male adolescents studied further showed pathophysiological features such as a significantly higher frequency of obesity, higher 24-hour urinary sodium excretion, higher hematocrit value, higher sodium and lower potassium concentration in red blood cells, and higher ouabain-sensitive sodium efflux compared with the control group (231 male students; p less than 0.05). When used alone, the ordinary 10-week period of counseling about a low salt diet failed to significantly reduce the blood pressure of hypertensive students. However, when education and counseling efforts were combined with self-monitoring of salt (chloride) excretion in overnight urine samples using a new salt titrator tape developed in our laboratory, 24-hour urinary sodium excretion, weight, and blood pressure decreased significantly over 10 weeks (mean reduction: 52 mEq/day for 24-hour urinary sodium excretion, 1.7 kg for weight, 12/7 mm Hg for blood pressure). These results indicate that blood pressure of borderline hypertensive adolescents could be effectively reduced with this nonpharmacological method of dietary education. Such systematic management might be of importance for the prevention of essential hypertension.

Adolescent↗
PubMed2001

Open-label dose-titration safety and efficacy study of tizanidine hydrochloride in the treatment of spasticity associated with chronic stroke.

BACKGROUND AND PURPOSE: Spasticity is a frequently observed motor impairment that develops after stroke; it can cause pain and disability in those affected. The objective of the present study was to evaluate the safety and efficacy of tizanidine, a centrally acting alpha(2)-adrenergic agonist, in the treatment of stroke-related spasticity. METHODS: Forty-seven patients, who were a minimum of 6 months poststroke and had significant spasticity, were studied at 4 centers. Tizanidine was administered in an open-label manner for 16 weeks, beginning at 2 mg/d and slowly titrated to a maximum of 36 mg/d. The Modified Ashworth Scale, muscle strength testing, functional assessments, and Pain and Functional Spasticity Questionnaires were administered at baseline and at 4, 8, 16, and 18 weeks (after 1 week off tizanidine). RESULTS: Spasticity was significantly improved between baseline and week 16, with a decrease in total upper extremity Modified Ashworth Scale score of 2.80+/-0.47 (P<0.0001). No decline in strength was noted. Treatment with tizanidine resulted in a significant improvement in pain intensity (P=0.0375), quality of life (P=0.0001), and physician assessment of disability (P=0.0001). The most frequent side effects were somnolence (62%) and dizziness (32%). No serious adverse events were considered to be drug related. Ten of 47 patients (21%) were able to reach the maximum daily dosage of 36 mg. CONCLUSIONS: Overall, the data suggest that tizanidine is safe and efficacious in the treatment of stroke-related spasticity, preserving muscle strength while reducing muscle tone and painful spasms in affected patients.

Clonidine↗
PubMed2002

Randomized, placebo-controlled trial of titrated intravenous lamifiban for acute coronary syndromes.

BACKGROUND: Platelet glycoprotein IIb/IIIa inhibitors reduce the rate of death or myocardial infarction among patients with acute coronary syndromes without persistent ST-segment elevation, but their effects may depend on plasma concentrations. We tested whether the addition of lamifiban, titrated to achieve target plasma concentrations, to standard care would improve clinical outcomes. METHODS AND RESULTS: We randomized 5225 patients at 389 centers in 29 countries to receive a bolus and </=72-hour infusion of lamifiban or placebo, adjusted for renal function, with aspirin and heparin. The primary end point was the composite of death, myocardial infarction, or severe, recurrent ischemia at 30 days. Baseline characteristics did not differ significantly by treatment. The primary end point occurred in 11.8% of lamifiban-treated patients and in 12.8% of placebo-treated patients (OR, 0.914; 95% CI, 0.769 to 1.087; P=0.329). Bleeding was more common in lamifiban-treated patients, but intracranial hemorrhage was not increased. Among the subgroup who had plasma lamifiban concentrations measured, 91% had a concentration >18 ng/mL at steady state, but their outcomes did not differ from those with lower concentrations. CONCLUSIONS: Lamifiban showed no significant effects on clinical outcomes in patients with non-ST-elevation acute coronary syndromes, despite achievement of adequate plasma concentrations.

Acetates↗
PubMed1987

Effects of electrode placement on the efficacy of titrated, low-dose ECT.

This double-blind, random-assignment study contrasted the relative efficacy of bilateral and unilateral right ECT with a low-dose titration procedure. In 52 patients with primary major depressive disorder, bilateral ECT was markedly superior in short-term symptom reduction to unilateral right ECT. The two conditions did not differ in the duration of generalized seizures or in the number of treatments administered to achieve clinical response. The findings challenge the claim that the elicitation of generalized seizure is, in and of itself, sufficient for the antidepressant properties of ECT. Rather, a dose in excess of seizure threshold may contribute to the efficacy of ECT, particularly with a unilateral right electrode placement.

Clinical Trials as Topic↗
PubMed1990

Titration streptomycin therapy for bilateral Meniére's disease. Follow-up report.

Initial reports of the use of parenteral streptomycin for bilateral Meniere's disease (MD) have demonstrated success in reducing the vestibular symptoms and, in some patients, stabilizing hearing. The long-term follow-up (mean, 5.1 years) of 19 patients treated with intramuscular streptomycin for bilateral MD is presented. The amount of streptomycin administered (5 to 50 g) was determined by clinical symptoms and by serial testing of the reduction in the slow-phase velocity on electronystagmography. Episodic vertigo was totally relieved in 12 patients and improved in severity and frequency in an additional 4 patients. Permanent posttreatment dysequilibrium occurred in 47% of the patients treated. The changes in hearing (speech reception threshold) were independent of the therapeutic effect of streptomycin on the vestibular system. The overall results suggest that the intramuscular titration of streptomycin should continue to be considered as one of the therapeutic options in patients with disabling vertigo due to bilateral MD.

Adult↗
PubMed1999

Assessing heparin neutralization following cardiac surgery: sensitivity of thrombin time-based assays versus protamine titration methods.

Adequate assessment of heparin neutralization following cardiac surgery is critical in reducing the patient's exposure to protamine. Both excessive protamine and residual heparin have been associated with postoperative bleeding and poor patient recovery. The activated clotting time (ACT) is the preferred intraoperative heparin monitor, while both protamine titration (i.e. a protamine-containing ACT) and thrombin time methods have been used to detect circulating residual heparin after protamine administration. Following initial protamine dosing using the protamine response test (PRT), postoperative monitoring was employed in the operating room prior to transport of the patient to intensive care. Two point-of-care assays, the thrombin time (TT) and the protamine dose assay (PDA), were evaluated to determine their relative heparin sensitivity and their usefulness to quantitate protamine dose. The PDA, which is based on the ACT, was shown in laboratory and clinical studies to detect residual heparin above 0.25 units/ml and to quantify additional minidoses of protamine (as low as 25 mg) required to obtain complete heparin neutralization. Differential evaluation of the TT and heparin neutralized thrombin time (HNTT) was shown in laboratory studies to be more sensitive to small amounts of residual heparin than the ACT. Clinical evaluations confirmed that additional protamine is required in approximately 12% of cardiac surgical cases managed using the PRT system. Both the PDA and TT/HNTT provided useful postoperative assessment of the adequacy of heparin neutralization. The TT/HNTT had slightly improved heparin sensitivity even in the presence of significant fibrinogen loss. These point-of-care assays provide the opportunity to optimize heparin and protamine management in the cardiac surgery patient.

Anticoagulants↗
PubMed2005

Rapid dose titration of quetiapine for the treatment of acute schizophrenia and acute mania: a case series.

To quickly reduce symptoms and to optimize long-term outcome, patients with an acute episode of schizophrenia or mania require prompt treatment intervention. The atypical antipsychotic quetiapine ('Seroquel') has been approved for the treatment of schizophrenia and manic episodes associated with bipolar disorder. For patients with acute symptoms such as aggression or agitation, higher doses of quetiapine than the recommended initiation schedule are often required. This report presents the tolerability findings from rapid initiation with high-dose quetiapine for eight patients who were consecutively admitted with acute symptoms of schizophrenia (n 5) or mania (n 3). The results from this case series show that quetiapine treatment could be safely titrated at a more rapid rate and to doses greater than that described in the current prescribing information. For most patients, rapid dose escalation was well tolerated; no serious side effects were observed and vital clinical parameters were unchanged; one patient experienced transient somnolence. In conclusion, these results suggest that rapid dose escalation of quetiapine could be a useful treatment approach for acutely ill patients with schizophrenia and bipolar mania in order to improve acute symptoms and support the need for randomized controlled trials. However, dose adjustments should be considered with respect to each patient's individual level of tolerability.

Acute Disease↗
PubMed2003

Titrating versus targeting home care services to frail elderly clients: an application of agency theory and cost-benefit analysis to home care policy.

The article summarizes the shortcomings of current home care targeting policy, provides a conceptual framework for understanding the sources of its problems, and proposes an alternative resource allocation method. Methods required for different aspects of the study included synthesis of the published literature, regression analysis of risk predictors, and comparison of actual resource allocations with simulated budgets. Problems of imperfect agency ranging from unclear goals and inappropriate incentives to lack of information about the marginal effectiveness of home care could be mitigated with an improved budgeting method that combines client selection and resource allocation. No program can produce its best outcome performance when its goals are unclear and its technology is unstandardized. Titration of care would reallocate resources to maximize marginal benefit for marginal cost.

Aged↗
PubMed1987

Esmolol: a novel cardioselective, titratable, intravenous beta-blocker with ultrashort half-life.

Esmolol is an ultrashort-acting, cardioselective, intravenous beta-blocker with an elimination half-life of about nine minutes. After administration of a loading dose, its full therapeutic effect is evident within five minutes. Its efficacy in treating supraventricular arrhythmias is equal to that of propranolol, but unlike propranolol, the action of esmolol is titratable and is largely reversed within 10 to 30 minutes after stopping its administration. Esmolol is also effective in attenuating life-threatening perioperative tachycardia and hypertension caused by adrenergic stimulation in high-risk patients.

Adrenergic beta-Antagonists↗
PubMed2004

Fast and reliable salt iodine measurement: evaluation of the WYD Iodine Checker in comparison with iodometric titration.

Iodine deficiency persists as the leading cause of preventable brain damage and reduced intellectual capacity in the world. The most effective method for the elimination of iodine deficiency is the consumption of adequately iodized salt. Ensuring that a population receives adequately iodized salt demands careful monitoring of the salt iodine content. We evaluated the WYD Iodine Checker, a hand-held instrument that quantitatively measures the salt iodine content on the basis of a colorimetric method, and compared its performance with iodometric titration. Performance testing results indicated that the WYD Iodine Checker is a highly precise, accurate, and sensitive tool for measuring salt iodine content. It is a user-friendly instrument that is based on a simple methodology and a straightforward salt sample preparation and testing procedure. We recommend further testing to examine the field performance of the WYD Iodine Checker when measuring iodate salt samples.

Colorimetry↗
PubMed2004

Automatic CPAP titration with different self-setting devices in patients with obstructive sleep apnoea.

Autotitrating continuous positive airway pressure (CPAP) devices automatically adjust the pressure according to upper airway obstructions. The aim of this study was to compare the treatment effects of different automatic CPAP devices (AutoSet, Horizon and Virtuoso) with conventional CPAP in patients with obstructive sleep apnoea independently of financial manufacturer support. Twelve male patients with obstructive sleep apnoea were submitted to a crossover study protocol with overnight polysomnography for 6 consecutive nights. After diagnostic polysomnography, the CPAP pressure was manually titrated. Over the next 4 nights, the patients were treated with any one of the three automatic CPAP devices or fixed CPAP in random order. The apnoea/hypopnoea index on the diagnostic night was 67.3+/-21.7 events h(-1), and was significantly reduced to 0.7+/-1.2, 3.0+/-2.9, 2.3+/-2.5 and 12.0+/-13.6 events x h(-1) with the fixed CPAP, AutoSet, Horizon and Virtuoso devices respectively. An apnoea/ hypopnoea index of <5 events h(-1), an indicator of optimal treatment, was achieved in all patients with fixed CPAP and in 10 patients using the Autoset and Horizon devices, but in only six of the 12 using the Virtuoso. The mean pressure was significantly lower with the AutoSet and Virtuoso devices, but not with the Horizon as compared to fixed CPAP. The maximum pressure was significantly higher with the Horizon. It is concluded that automatic continuous positive airway pressure devices produce a significant reduction in apnoea/hypopnoea index; however, there is considerable difference in the efficacy of the various devices.

Adult↗