Direct and indirect assessment of skeletal muscle blood flow in patients with congestive heart failure

Techniques which are currently used to measure skeletal muscle blood flow (SMBF) in patients with congestive heart failure (CHF) are neither convenient nor accurate. They have led to discrepant results in patients with congestive heart failure and are, in part, responsible for the ongoing debate regarding the factors which limit the rise in body oxygen consumption during exercise in these patients. However, direct measurement of SMBF may not be needed during exercise in patients with severe CHF. Their skeletal muscles maximally extract oxygen. Consequently, increase in oxygen consumption by the skeletal muscles is only mediated by a concomitant increase in SMBF. In patients with severe CHF, peak body oxygen consumption attained during maximal exercise closely depends on the rise in SMBF, and thus provides an indirect measurement of SMBF.     

Static magnetic resonance imaging of the pelvic floor muscle morphology in women with stress urinary incontinence and pelvic prolapse

In a study, the magnetic resonance imaging (MRI) findings of 69 women were analyzed to define the typical MRI appearance of the pelvic floor musculature in healthy subjects (n = 20) and women with urinary incontinence (UI) and/or genitourinary prolapse (GP) (n = 49). The following parameters were determined: thickness and signal intensity of the levator muscles on each side, distance between the urethra and symphysis, diameter of the proximal urethra, and thickness and configuration of the anterior vaginal wall. These parameters were correlated with the patients' age and parity, urodynamic parameters, and the clinical assessment of the pelvic floor. In contrast to healthy subjects, the frequent findings in women with UI and/or GP are higher signal intensity of the levator muscles (p < 0.05) and loss of the hammock-like configuration of the vagina (p < 0.01). On static MRI, the morphometry of the levator musculature identified no findings typical of either UI or GP. Analysis of MRI combined with patients' parity suggests that the severity of damage to the pelvic floor at delivery is determined by the traumatic event as such and not by the number of deliveries. Urethral diameter, distance of the symphysis to the urethra, and vaginal wall thickness cannot distinguish between controls and women with UI and/or GP. Urodynamic and functional clinical parameters do not correlate with the changes in the pelvic floor musculature demonstrated by static MRI. Although morphological changes in UI and/or GP can be demonstrated by MRI, they can be assigned a pathogenic role only if clinical symptoms are present.     

Abdominal pain in women attending a genitourinary medicine clinic: who has PID?

Eighty-one women who presented to a genitourinary medicine clinic with mild to moderate acute or chronic abdominal pain were studied in order to compare the clinical features of those who had pelvic inflammatory disease (PID) and those who did not. The diagnosis was made by laparoscopy, and PID was detected in 14%, adhesions in 11% and endometriosis in 16%. Women with PID were clinically indistinguishable from women with other diagnoses or no obvious cause.     

Vaginal topography does not correlate well with visceral position in women with pelvic organ prolapse

The objective was to determine whether vaginal topography accurately predicts the location of the pelvic viscera on fluoroscopy in women with pelvic organ prolapse. Eighty-nine women undergoing preoperative evaluation for reconstructive pelvic surgery at a tertiary care referral practice formed the study population. Each woman completed a comprehensive urogynecologic history and physical examination, which included a quantified (POP-Q) assessment of her vaginal topography, as described by Bump et al. In addition each woman underwent pelvic floor fluoroscopy (PFF). Visceral sites were selected which corresponded clinically to the vaginal sites measured by the POP-Q. The most dependent portion of the bladder, small intestine, rectum and urethrovesical junction was measured. Twenty-five (28%) women had stage II prolapse, 34 (38%) had stage III prolapse, and 28 (32%) had stage IV prolapse. The remaining 2 women were symptomatic, with stage I prolapse. For the entire study population there was no correlation between the fluoroscopic position of the small bowel and/or rectum and any apical or posterior wall POP-Q site (C, Ap or Bp). There was no correlation with the fluoroscopic position of the UVJ at rest or with straining and the corresponding POP-Q site (Aa). The fluoroscopic position of the most dependent portion of the bladder correlated only modestly with the upper (Ba, rho = 0.51) and lower Aa, rho = 0.68) anterior vaginal wall POP-Q sites. In women without prior surgery (n = 33) there was only modest correlation between the fluoroscopic position of the bladder and the corresponding POP-Q site (Aa, rho = 0.71). In this unoperated subpopulation there was no correlation with PFF and any other POP-Q site. In women who had undergone prior hysterectomy (n = 25) or hysterectomy with anterior and/or posterior colporrhaphy (n = 17), there was only a modest correlation of the most dependent portion of the bladder and the upper anterior vaginal wall site (Bb, rho = 0.67 and rho = 0.55, respectively). It was concluded that vaginal topography does not reliably predict the position of the associated viscera on PFF in women with primary or recurrent pelvic organ prolapse.     

Levator veli palatini muscle activity in relation to intraoral air pressure variation in cleft palate subjects

A comparison of the ranges of levator veli palatini EMG activity for speech versus a nonspeech task for subjects with cleft palate was the focus of this study. EMG values are also compared with subjects without cleft palate obtained in a previous study. Hooked-wire electrodes were inserted into the levator muscle of five adult subjects with cleft palate exhibiting mild hypernasality. Intraoral air pressure was measured concurrently. A blowing task was used to determine the subject's operating range for the levator muscle. Both the nonspeech and speech tasks were designed to sample the widest possible ranges of levator EMG activity. It was found that the subjects with cleft palate used a relatively high activation level for the levator muscle during speech, in relation to their total activation range, compared with the subjects without cleft palate. Implications are discussed in relation to possible anatomic and physiologic differences for cleft palate subjects compared to normal.     

Direct versus indirect personality assessment: Evidence and implications.

Discusses and evaluates results from a study comparing the validity of direct vs. indirect personality measures by W. Scott and R. Johnson (See PA, Vol. 48:Issue 6) in the context of previous relevant research. General findings support the utility of direct compared to indirect approaches to personality measurement. Some of the main limitations and implications of the findings are analyzed. (21 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in genitourinary specimens from men and women by a coamplification PCR assay

A coamplification PCR test for the direct detection of Neisseria gonorrhoeae and Chlamydia trachomatis in urethral and endocervical swabs and urine samples from men and women was compared to standard culture techniques. Processed specimens were amplified in single reaction tubes containing primers for both organisms, and PCR products were detected by a colorimetric microwell plate hybridization assay specific for each pathogen. Of 344 specimens from men, 45 (13.1%) urine specimens were PCR positive for C. trachomatis, 51 (14.8%) urethral swab specimens were PCR positive, and 29 urethral swab specimens (8.4%) were culture positive. After analysis of discrepancies, the resolved sensitivity and specificity of PCR for C. trachomatis were 96.2 and 99.3%, respectively, in urethral swab specimens, compared to 88.2 and 98.6% for urine specimens. Of the 192 specimens from women, 28 (14.6%) urine specimens were PCR positive for C. trachomatis, 32 (16.7%) endocervical specimens were PCR positive, and 19 (9.9%) endocervical specimens were culture positive. After analysis of discrepancies, the resolved sensitivity and specificity of PCR for C. trachomatis for endocervical specimens were both 100% compared to 100 and 99.4%, respectively, for urine specimens from women. In men, 68 (19.8%) urine specimens were PCR positive for N. gonorrhoeae, 73 (21.2%) urethral swabs were PCR positive, and 59 (17.2%) urethral swabs were culture positive. After analysis of discrepancies, the resolved sensitivity and specificity of PCR for N. gonorrhoeae were 97.3 and 97.0%, respectively, for urethral specimens compared to 94.4 and 98.5% for urine specimens. In women, 18 (9.4%) urine specimens were PCR positive for N. gonorrhoeae, 23 (12.0%) were endocervical swab PCR positive, and 15 (7.8%) endocervical specimens were culture positive. After analysis of discrepancies, the resolved sensitivity and specificity of PCR for N. gonorrhoeae were 100 and 99.4%, respectively, for endocervical specimens compared to 90.0 and 95.9% for female urine specimens. These results indicate that a multiplex PCR is highly sensitive for detecting both C. trachomatis and N. gonorrhoeae from a single urine or genital swab, providing a more cost-effective way of screening multiple pathogens.     

Upper airway muscle activity in normal women: influence of hormonal status

Obstructive sleep apnea is a disorder with a strong male predominance. One possible explanation could be an effect of female hormones on pharyngeal dilator muscle activity. Therefore, we determined the level of awake genioglossus electromyogram (EMGgg) and upper airway resistance in 12 pre- and 12 postmenopausal women under basal conditions and during the application of an inspiratory resistive load (25 cmH2O . l-1 . s). In addition, a subgroup of eight postmenopausal women were studied a second time after 2 wk of combined estrogen and progesterone replacement in standard doses. Peak phasic and tonic genioglossus activity, expressed as a percentage of maximum, were highest in the luteal phase of the menstrual cycle (phasic 23.9 +/- 3.8%, tonic 10.2 +/- 1.0%), followed by the follicular phase (phasic 15.5 +/- 2.2%, tonic 7.3 +/- 0.8%), and were lowest in the postmenopausal group (phasic 11.3 +/- 1.6%, tonic of 5.0 +/- 0.6), whereas upper airway resistance did not differ. There was a weak but significant positive correlation between progesterone levels and both peak phasic (P < 0.05) and tonic (P < 0.01) EMGgg. Finally, there was a significant increase in EMGgg in the postmenopausal group restudied after hormone therapy. In conclusion, female hormones (possibly progesterone) have a substantial impact on upper airway dilator muscle activity.     

Resting energy expenditures in Asian women measured by indirect calorimetry are lower than expenditures calculated from prediction equations

OBJECTIVE: Measured resting energy expenditure (REE) and REEs calculated using the Harris-Benedict equation, Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU) equations (FAO equations), and the Liu equation were compared in Asian women. DESIGN: REEs were measured using indirect calorimetry in the morning after an overnight fast and compared with REEs calculated using the Harris-Benedict equation, the FAO equations, and the Liu equation. Height, weight, and 3-day diet records were also obtained. SUBJECTS: Thirty-six healthy, free-living Asian women aged 19 to 52 years and living in the United States were recruited from Washington State University, Pullman, and completed the study. STATISTICAL ANALYSES: Paired t tests, stepwise regression, one-way analysis of variance, and Pearson correlation coefficients were used for the statistical analyses. Significance was set at P < or = .05. RESULTS: A significant correlation was found between measured REE and REE derived from the Harris-Benedict equation (R = 0.67, P < .0001), the FAO equations (R = 0.70, P < .0001), and the Liu equation (R = 0.70, P < .0001). However, measured REE was significantly lower than REE calculated using the Harris-Benedict and FAO equations by 8.5% (P < .001) and 5.4% (P < .01), respectively. No significant difference was noted between measured REE and REE derived from the Liu equation. APPLICATIONS: Caution must be taken when predicting REE of Asian women using the Harris-Benedict equation or the FAO equation. Indirect calorimetry or an equation specific to Asians, such as the Liu equation, is recommended when an accurate estimate is necessary.     

Quantification of Chlamydia trachomatis in cervical and urine specimens from women attending a genitourinary medicine clinic: implications for screening strategies

Population screening and intervention programmes can reduce the prevalence and incidence of infection with Chlamydia trachomatis, especially if sensitive molecular diagnostic tests are used. However, diagnostic tests that perform well on genitourinary medicine (GUM) clinic populations may be less useful for screening, particularly if the majority of infected subjects are asymptomatic and their samples contain fewer organisms. We have compared the extent of low organism load in cervical and urine samples from symptomatic and asymptomatic chlamydia-positive women, by using a direct fluorescent antibody staining method and counting the chlamydial elementary bodies (EBs). We have investigated the ability of an enzyme immunoassay (EIA; MicroTrak) and a DNA amplification (ligase chain reaction; LCR) assay to detect low numbers of organisms in cervical samples and the ability of the LCR assay to detect low numbers of organisms in urine. A low organism load (< 10 EBs) was seen by direct fluorescent antibody (DFA) staining in about 30% of cervical samples and in about 75% of urines from chlamydia-positive women; the proportions in symptomatic women were not significantly different from those in asymptomatic women. The EIA identified only 16% of cervical samples that contained < 10 EBs by DFA staining; the LCR identified 100% of cervical samples and 93% of urine samples that contained < 10 EBs by DFA staining. The findings suggest that the ability of chlamydial diagnostic tests to identify positive women should be similar among patients attending a GUM clinic and those taking part in a population screening programme, and that sensitive molecular assays such as the LCR should identify subjects with a low organism load in both groups.     

Racial differences in muscle strength in disabled older women

This study examines racial differences in muscle strength, and associations of muscle strength to level of physical activity and severity of disability, among a community sample of 254 black and 665 white, moderately to severely disabled women aged 65 and older. Potential confounders that were adjusted for in the models included age, body weight and height, joint pain, number of chronic conditions, and socioeconomic status. Hand grip, hip flexion, and knee extension forces were measured using portable hand-held dynamometers in the participants' homes. Hand grip strength was measured as the maximal isometric force. Hip flexion and knee extension forces were measured as the greatest force the tester had to apply to break the isometric contraction. A declining strength gradient was observed with increasing severity of disability and for decreasing level of physical activity in both races. At equal levels of disability or physical activity, blacks had better hand grip and hip flexion strength, but knee extension strength did not differ by race. The greater hand grip and hip flexion strength found in black women may be related to their greater muscle mass and known racial differences in body dimensions. No consistent racial differences were observed in the relationship between physical activity and muscle strength, or muscle strength and disability, suggesting that the role of muscle strength in the disablement process does not differ between races. Physical activity and exercise programs may be feasible ways to prevent worsening of disability in blacks and whites.     

Comparison of cognitive assessment methods with heterosocially anxious college women.

Investigated the comparability of self-statements generated by different cognitive assessment methods (structured questionnaire and thought listing) and the effect of an assessment delay on cognitive phenomena (self-statements; rational and irrational beliefs, evaluative, potency, and activity semantic schema; self-attributions; and self-ratings of discomfort and performance). The interrelationships among different cognitive variables were also studied. Ss were 64 high and low heterosocially anxious (as measured by the Social Avoidance and Distress Scale and a survey of heterosocial interactions) undergraduate females, who engaged in a conversation with a male confederate. One-half of the Ss completed the measures after the conversation, and the other half completed them 1 wk later. Findings show that although the 2 self-statement methods were counterbalanced, order effects were nonsignificant. Correlations indicated that self-statements (positive and negative thoughts) generated by the 2 methods were unrelated. Multivariate and univariate analyses failed to reveal significant effects for time of assessment. Significant effects were found on almost all variables for anxiety, constituting additional construct validity for these measures. A correlational matrix provided information about interrelationships among the cognitive variables. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Urodynamic assessment of women with urethral syndrome (author's transl)

Thirty women presenting with urethral syndrome were investigated. A full urologic, radiologic, gynecologic and urodynamic assessment was carried out. In most patients the cause of their troubles was found. In 19 of them an obstruction was demonstrated. Two types of obstruction were seen: The first occurred mainly in postmenopausal women. Here, a narrow distal segment of the urethra was demonstrated. The second type of obstruction was seen mainly in younger patients. The cause was an incomplete relaxation or a spasm of the external striated sphincter. Other causes of symptoms were instability and atony of the detrusor. In some women no cause for their symptoms and recurrent urinary infection was found.     

Experimental ablation of emphysematous rat lung with Nd: YAG laser: lung changes studied by histopathology and SEM

Many previous studies of obese rodents documented biochemical changes in pancreatic islets that contribute to hyperinsulinemia in vivo. Those studies used heterogeneous populations of islets, although the size of islets from obese rats ranges from < 100 to > 500 microm. Here, functional and morphological changes in size-sorted (< 125 and > 250 microm diameter) islets from obese Zucker (fa/fa) rats were correlated. Ultrastructural examination revealed that > 250 microm cultured islets had an increased number of immature secretory granules in the beta cells. The number of degranulated beta cells in > 250 and < 125 microm cultured islets from fa/fa rats was higher than in lean rat islets (33 vs 25%). The glucose EC50 values for cultured islets were 4.64 +/- 0.43, 7.9 +/- 0.70 and 7.29 +/- 1.64 mmol.l(-1) for > 250 microm, < 125 microm, and lean groups, respectively. Inhibition of insulin secretion by 10 mmol.l(-1) mannoheptulose was reduced by 50% in > 250 microm islets compared with small islets. Studies of individual beta cells by reverse hemolytic plaque assay revealed 3-fold more cells from > 250 microm islets were stimulated by 1.4 mmol.l(-1) glucose than cells from < 125 microm islets. We conclude that functional defects in mixed size populations of islets from fa/fa rats are mainly due to alterations in the large islets, whereas smaller islets have relatively normal function. Exposure to high glucose exacerbates morphological and functional differences of large islets, which could have important implications in the transition to noninsulin-dependent diabetes when beta cell insulin production is unable to compensate for hyperglycemia.     

Mitral valve prolapse in children: a problem defined by real-time cross-sectional echocardiography

An investigation was made of the association between the postrelease circumstances and behavior of 79 youthful heroin offenders and parole outcome. The data suggest that steady employment and the absence of drug use on parole are significantly related to parole success and to each other.     

Cryptosporidium parvum in patients with chronic diarrhea and AIDS: diagnosis by means of indirect immunofluorescence with monoclonal antibodies

The diagnosis of cryptosporidiosis is difficult when oocyst elimination is poor as occurs in AIDS patients. Aiming to improve the diagnosis, 144 fecal samples coming from AIDS patients with diarrhea, were studied using indirect immunofluorescence with anti-Cryptosporidium monoclonal antibodies. The results were compared with Ziehl Neelsen and safranine stainings. Twenty three samples (15.9%) were positive for Cryptosporidium with at least one of the three methods. Sensitivities were 78.3% for immunofluorescence, 86.9% for Ziehl Neelsen and 91.3 for safranine stainings. The specificity of the three methods was 100%. It is concluded that immunofluorescence does not improve the diagnostic accuracy of cryptosporidiosis and its high cost precludes its use in routine laboratories.