Ambulatory blood pressure measurement in type 2 diabetic patients: methodological aspects.

Ambulatory blood pressure was measured over 24 h on two occasions in 29 Type 2 diabetic patients age 65 (range 52-74) years, and the reproducibility compared with that of ordinary clinic measurements recorded by Hawskley's random zero sphygmomanometer. The variability of the difference between blood pressure measurements on the two occasions was twice as large for clinic measurement as for ambulatory measurement (2p less than 0.01). If applied to clinical trials this would allow a fourfold reduction of patient numbers without losing test power. In the group of patients treated with antihypertensive medication (n = 16) the spontaneous decline in blood pressure after leaving the hospital proved to be most prominent in those patients with the highest clinic blood pressure, a phenomenon with importance for the management of hypertension. The individual difference between clinic measurements and ambulatory day-time measurements from the same day was unpredictable. Ambulatory blood pressure measurement in the outpatient clinic may be a practicable approach for optimizing antihypertensive treatment in Type 2 diabetic patients.     

Measurement of range of movement in the lumbar spine—what methods are valid? A systematic review

Objectives

To examine the validity of low-tech procedures used in routine clinical practice to determine the range of movement of the lumbar spine in comparison to the ‘gold’ standard of measurement.

Data sources

AMED, CINAHL, Embase, OVID Medline, The Cochrane Library, Spine and other relevant journals.

Review methods

A search of electronic databases (January 2006) was complemented by hand searching reference lists of identified studies and journals, plus consultation with recognised experts to identify English language studies designed to evaluate the validity of low-tech procedures used to determine range of movement of the lumbar spine in adult human subjects presenting with non-specific low back pain.

Results

Four relevant studies were identified for analysis. Three studies investigated the use of the double-inclinometer method and one study investigated the modified-modified Schober test. The appraisal was performed using the modified QUADAS tool. The studies were considered heterogeneous and thus qualitative analysis was undertaken. This indicated limited positive evidence that the double-inclinometer method is valid for measuring total lumbar range of movement, conflicting evidence for double-inclinometer measurement of lumbar flexion range, limited evidence that the modified-modified Schober test is not valid for measurement of lumbar flexion range and limited evidence that the double-inclinometer method is not valid for measuring lumbar extension range.

Conclusion

There is little evidence to support the use of current methods of range of movement measurement in the lumbar spine. If range of movement is to continue to be used during routine clinical practice to assess spinal function, degree of impairment and response to therapeutic input there is a need for scientific evidence on the validity of these procedures.     

Three‐dimensional CT Improves the Reproducibility of Stability Evaluation for Intertrochanteric Fractures

Objectives

Femoral intertrochanteric fractures are among the most common fractures in the elderly. There are various classification systems in intertrochanteric fractures. The aim of these classification systems is to help surgeons choose an appropriate treatment. The treatment of femoral intertrochanteric fractures depends on the results of a stability evaluation using imaging studies. However, it is difficult to evaluate the true fracture line using plain X‐ray films, especially on the sagittal plane and for intertrochanteric fractures with complex morphologies. The aim of the current study was to determine whether three‐dimensional CT (3DCT) improves the reproducibility of stability evaluation for femoral intertrochanteric fractures.

Methods

This was a single‐center observational study of intertrochanteric fractures. We retrospectively collected patients in our hospital with intertrochanteric fractures that underwent plain X‐ray (anteroposterior, lateral view) CT scans with axial images (2DCT) and 3DCT for an injured hip between 1 December 2011 and 30 November 2015. The exclusion criteria were pathological fractures (due to metastasis or primary bone tumors) and previous intertrochanteric surgery. During this period, 61 patients were enrolled. Two patients were excluded because lateral view X‐rays were not available. A total of 59 patients (27 women, 32 men) with an average age of 77 years (range, 55–96 years) were included in our final analysis. The stability evaluation (i.e. stable or unstable) and implant choices (i.e. dynamic hip screws or Gamma nail) were recorded independently by four observers (two attending physicians and two residents). All images were reviewed and classified using the AO/OTA and Evans modified by Jensen (EVJE) classification systems. The session was repeated after a 3‐month wash‐out period. The inter‐observer agreement was evaluated using the Kappa test.

Results

The inter‐observer agreements, measured by the mean weighted kappa values (expressed as X‐ray vs 3DCT) were as follows: For stability evaluation, the mean kappa values for attending physicians and residents were 0.68 versus 0.76 and 0.55 versus 0.56. For implant choices, the mean kappa values for attending physicians and residents were 0.68 versus 0.76 and 0.57 versus 0.65. For AO/OTA classification, the values for attending physicians and residents were 0.67 versus 0.65 and 0.70 versus 0.81. For EVJE classification, the values for attending physicians and residents were 0.66 versus 0.63 and 0.56 versus 0.55.

Conclusions

Three‐dimensional CT improved the reproducibility of stability evaluation for femoral intertrochanteric fractures. Preoperative CT scanning may provide a diagnostic benefit for evaluating the stability of intertrochanteric fractures.

     

Interobserver reproducibility of the visual estimation of range of motion of the shoulder

OBJECTIVES: To assess interobserver reproducibility (agreement and reliability) of visually estimated shoulder range of motion (ROM) and to study the influence of clinical characteristics on the reproducibility. DESIGN: Test-retest analyses. SETTING: Various health care settings in the Netherlands. PARTICIPANTS: Consecutive patients with shoulder complaints (N = 201) referred by 20 general practitioners, 2 orthopedic physicians, and 20 rheumatologists. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Independent visual estimation by 2 physiotherapists of the ROM. Agreement was calculated as the mean difference in visual estimation between examiners +/-1.96 x standard deviations of this mean difference. The intraclass correlation coefficient (ICC) was calculated as a measure of reliability, based on a 2-way random effects analysis of variance. RESULTS: The lowest level of agreement was for visual estimation of active and passive elevation (limits of agreement, -43.4 to 39.8 and -46.7 to 41.5, respectively, for the difference between the affected and contralateral sides), for which the level of agreement was most clearly associated with pain severity and disability. The ability to differentiate between subjects was acceptable for all movements for the difference between the affected and contralateral sides (ICCs, > .70) except for horizontal adduction (ICC = .49). CONCLUSIONS: Interobserver agreement was low for the assessment of active and passive elevation, especially for patients with a high pain severity and disability. Except for horizontal adduction, visual estimation seems suitable for distinguishing differences between affected and contralateral ROM between subjects.     

Cross-cultural adaptation of the Pelvic Girdle Questionnaire (PGQ) into Brazilian Portuguese and clinimetric testing of the PGQ and Roland Morris questionnaire in pregnancy pelvic pain

Objective

To translate and cross-culturally adapt the Pelvic Girdle Questionnaire (PGQ) into Brazilian Portuguese and test the measurement properties of the PGQ and the Roland Morris Disability Questionnaire (RMDQ) in women with pelvic pain during pregnancy.

克隆测序方法检测三核苷酸重复次数的可靠性

目的 探讨克隆测序技术用于检测三核苷酸(CAG)重复次数的可靠性.方法 对1例临床确诊的遗传性脊髓小脑性共济失调1型(SCA1)患者,PCR法扩增ATXN1基因的CAG重复次数,8%变性聚丙烯酰胺凝胶电泳(DPAGE)分离PCR产物以协助确诊.2.5%琼脂糖凝胶电泳分离PCR产物的大小片段,割胶回收大小片段测序.另外将割胶回收的大片段进行TA克隆测序.结果 DPAGE提示大片段存在CAG的异常扩增,故该患者可确诊为SCA1.PCR产物大小片段直接测序结果为:小片段为26次CAG重复,大片段为47次重复.而将大片段克隆测序后,则有50、47、46、41、32、28、27、26、25及24次共10种不同的CAG重复次数,而且出现了CCG、CGG、CTG、CAA、TAT等序列变异现象.结论 克隆测序检测CAG重复次数会造成重复次数变异,且存在各种碱基变异.因此不宜单用TA克隆测序检测CAG重复次数及筛查碱基变异,需联合应用多种方法以提高结果的可靠性.     

Reproducibility and robustness of metabolome analysis in rat plasma of 28-day repeated dose toxicity studies

BASF has developed a rat plasma metabolomics database (MetaMap^®Tox) containing the metabolome of more than 500 chemicals, agrochemicals and drugs, for which the toxicity is well known, derived from 28-day repeated dose toxicity studies in rats. The quality/reproducibility of data was assessed by comparing the metabolome of 16 reference compounds tested at least twice under identical experimental conditions at three time points (day 7, day 14 and day 28). Statistical correlation analysis showed that the repeated treatment induced very similar changes to the metabolome. For all repetitions the modes of action of the compounds were always correctly identified. Moreover, when compared against the metabolome of all compounds available in the MetaMap^®Tox database, the repetitions showed in most cases the highest degree of overall similarity with the metabolome of the original study. In addition, we also evaluated the robustness of our metabolomics technique, displayed by constancy of variability in control groups over time. Based on these results, it can be concluded, that metabolomics can reproducibly be applied during toxicological in vivo testing in rats under the conditions applied here.     

Are posterior default-mode networks more robust than anterior default-mode networks? Evidence from resting-state fMRI data analysis

Intrinsic brain activity known as default-mode networks (DMNs) has been observed predominantly within the medial/superior frontal areas, anterior/posterior cingulate gyri, and precuneus using blood-oxygenation-level-dependent (BOLD) functional MRI (fMRI). Despite anecdotal evidence of distinct spatial patterns reflecting neuropsychiatric conditions in these DMNs, rigorous analysis of the characteristic traits of DMNs has been limited in previous studies. In this letter, the reproducibility and potential variability of the anterior and posterior DMNs were evaluated based on individual-level variations in effect sizes, activated areas, and causal interactions. Our results indicated that the DMNs were indeed reproducible between sessions/subjects. Region-specific traits were also observed: the posterior DMN seemed more robust to individual-level variations than the anterior DMN. The proposed analytical methods and reported findings may be useful in the development of a wide range of applications, including those involving clinical populations, which utilize the characteristic traits of DMNs.     

Reproducibility of 24-Hour Combined Multiple Intraluminal Impedance (MII) and pH Measurements in Infants and Children. Evaluation of a Diagnostic Procedure for Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a common disease in infants and children. Prolonged (24-hr) pH monitoring in the esophagus for determination of increased acid exposure has, together with endoscopy, been the only routinely implemented method for GERD diagnosis. The recently introduced multiple intraluminal impedance (MII) provides additional information about the number of both acid and nonacid episodes of retrograde bolus movement in the esophagus. The aim of this study was to investigate the day-to-day reproducibility and the interobserver variability of 24-hr combined MII (number of nonacid and acidic reflux episodes) and pH in the esophagus in infants and children. Upper endoscopy followed by 2 × 24-hr consecutive combined MII and pH monitoring was performed in 33 infants and children referred to a tertiary center for evaluation of GERD. The study was performed in a hospital setting without dietary restrictions. Bland-Altman difference versus mean plots and calculation of the limits of agreement (LOA) were used for assessment of the reproducibility of the total number of acidic and nonacidic reflux episodes. LOA for the number of acidic reflux episodes on day 2 were 0.2–5.3 times the value obtained on day 1. For the total number of nonacidic reflux episodes, LOA were 0.04–8.6; for the total number of reflux episodes, 0.3–3.3. An abnormal reflux index on one or both recording days was found in 7 of 30 patients. In conclusion, considerable day-to-day variability was found for nonacidic reflux episodes. Less variability was found for acidic reflux episodes. This variability must be taken into consideration for the use of MII in the clinical evaluation of infants and children with GERD.