Abnormal predicted diffusion capacities in healthy Asians: an inequality with a solution

BACKGROUND: Asian lung volumes are 10-15% less than those of Caucasians. OBJECTIVES: To test the hypothesis that healthy Asians might be labeled as abnormal using three commonly used Caucasian-derived prediction equation estimates (PEE) of DLCO currently used. In addition, a Chinese-derived PEE of DLCO was tested to determine its validity in non-Chinese Asians. METHODS: Forty-one healthy Asians underwent DLCO testing. Controls consisted of the PEE and 12 healthy Caucasians. Measured DLCO was compared with the Miller, Knudson, Crapo and one Chinese PEE. Abnormal was defined as a DLCO <80% predicted. Gas dilution and plethysmography estimated alveolar volume. Proportions in parentheses in the results below are DLCO adjusted for alveolar volume. RESULTS: The average Asian DLCO was 25.75 +/- 5.55 ml/min/mm Hg, no different than the predicted DLCO of 25.29 +/- 5.53 seen with Chinese PEE. This was different (p < 0.01) than the predicted DLCO of 27.82 +/- 5.09, 33.66 +/- 6.29, and 31.64 +/- 5.33 for the Miller, Knudson, and Crapo equations, respectively. This resulted in 4/41 (0/41), 27/39 (2/39), 21/41 (3/41) and 1/41 (0/41) DLCO measurements being defined as abnormal using Miller, Knudson, Crapo and Chinese PEE, respectively. In Caucasians, the measured DLCO was similar to the Miller but significantly lower than the Knudson and Crapo PEE. Measured lung volumes were significantly smaller compared to predicted for the three Caucasian PEE in Asians, with no difference in Caucasians. There was no difference in measured lung volumes and Chinese PEE. CONCLUSIONS: Current Caucasian PEE for DLCO when used in healthy Asians result in an abnormal reading that is incorrect from 10 to 50% of the time. This PEE failure is related to a reduction in lung volume not accounted for. The Chinese PEE for DLCO works for non-Chinese Asians and should replace Caucasian PEE in the US in all Asians.     

用多元逐步回归分析法预测离退休心理适应期

本文借助Apple-Ⅱ计算机,用多元逐步回归分析的方法,对107例男性离退休人员离退休前的12个心理社会因素进行了研究,以建立离退休心理适应期的预测模型。结果表明,在给定的筛选自变量的F水平下,得方程(2):Y=-3.7641 1.6164X_1 1.0092X_3 1.7589X_8 1.3149X_(11);简化方程:Y=-4 2X_1 X_3 2X_8 X_(11),回代符合情况较好。本文还对预测模型的使用及其意义进行了讨论。     

Oxalate loading test: a screening test for steatorrhoea.

To investigate the possibility of measuring urinary oxalate output instead of faecal fat excretion as an outpatient screening test for steatorrhoea, we determined 24 hour urinary oxalate and five day faecal fat excretion before and during an oral load of sodium oxalate 600 mg daily (oxalate 4.44 mmol), in 32 patients with suspected malabsorption on a diet containing oxalate 30 mg (0.33 mmol), fat 50 g (180 mmol), and calcium 1 g (25 mmol). Nineteen patients proved to have steatorrhoea (mean faecal fat 62 mmol/24 h, range 19--186 mmol) of varying aetiologies. On the diet alone, urinary oxalate was raised in only nine of these patients (mean 0.25 mmol/24 h, range 0.08--0.59 mmol) (normal less than 0.20). By contrast, when the diet was supplemented with oral sodium oxalate, all 19 patients with steatorrhoea had hyperoxaluria (mean 0.91 mmol/24 h, range 0.46--1.44 mmol) (normal less than 0.44). There was a significant positive linear relationship between urinary oxalate and faecal fat when the 32 patients were on the high oxalate intake (r = 0.73, P less than 0.001), but not when they were on the low oxalate intake. Mean percentage absorption of orally administered oxalate was 5.8 +/- 0.99% (+/- 1 SD) in normal subjects and 14.7 +/- 6.0% (P less than 0.002) in patients with steatorrhoea. Measurement of urinary oxalate output during oral sodium oxalate loading appears to be a reliable and convenient screening test for steatorrhoea.     

ICT filariasis test: a new screening test for Bancroftian filariasis

Bancroftian filariasis can be detected by using the ICT Filariasis test kit which is composed of specific polyclonal and monoclonal antibodies to Wuchereria bancrofti antigen. Chromatographic reaction with serum or plasma shows a result within 5 minutes. When compared with 454 thick blood films (standard smear method) within the same study, the ICT Filariasis test had sensitivity = 100%, specificity = 96.37%, efficiency = 96.70%, predictive value positive (PVP) = 70.70%, predictive value negative (PVN) = 100%. Compared with 454 membrane filtration technic (MFT), the MFT had sensitivity = 95.10%, specificity = 99.50%, efficiency = 99.12%, PVP = 95.10%, PVN = 99.50%. When we compared capillary tube technic (CAP) with TBF, CAP showed sensitivity = 85.40%, specificity = 100%, efficiency = 98.68%, PVP = 100%, PVN = 98.60%. With the convenience, high sensitivity-efficiency, lack of cross-reactions, no night blood collection, single reagent and rapidity of the test, the ICT Filariasis test can be recommended for screening of Bancroftian filariasis, and is suitable for the confirmation of suspected cases in the field where microscopic diagnosis is not available.     

The wafer test: a semi-quantitative test to screen for xerostomia

OBJECTIVE: To develop a screening test for xerostomia. METHODS: A cross-sectional study was conducted among 152 healthy subjects aged <20-60 yr, 30 patients with primary Sj?gren's syndrome and 60 patients with other connective tissue diseases, sampled randomly. A validated screening questionnaire for sicca syndrome and the Schirmer-1 and wafer tests were carried out in all subjects. In addition, non-stimulated whole salivary flow was measured in a random sample of 113 participants. The main outcome was the time of dissolution of the wafer. RESULTS: Time of dissolution of the wafer was 2.8+/-2.1 min in the healthy group, 3.3+/-1.5 min in the connective tissue diseases group, and 9.2+/-3.9 min in the primary Sj?gren's syndrome group (P<0.001). The correlation coefficient between the wafer test and non-stimulated whole salivary flow was -0.60 [95% confidence interval (CI) -0.47, -0.71]. A cut-off value of 4 min ('wafer 4') showed sensitivity of 92.9%, specificity of 71.7%, a positive predictive value of 31.7%, a negative predictive value of 98.6%, accuracy of 74.3%, an ROC (receiver operating curve) value of 82.3 and a likelihood ratio of 3.3 (95% CI 2.3, 4.6) for xerostomia. The proportion of patients with wafer 4 was 8% in the healthy group, 23% in the connective tissue diseases group and 93% in the primary Sj?gren's syndrome group (P<0.001). Wafer 4 was a significant predictor of xerostomia after controlling for age, gender, temperature and relative humidity. CONCLUSION: The wafer test is valid and reliable for identifying subjects with xerostomia.     

Fluorescein dilaurate serum test: a rapid tubeless pancreatic function test

The value of a modified fluorescein dilaurate (FDL) serum test for the detection of pancreatic exocrine insufficiency was investigated in 89 patients with and without pancreatic disease. This test modification with fluorescein serum determination following metoclopramide (10 mg) and secretin (1 U/kg) i.v. injection appeared efficacious in a pilot study in six healthy volunteers. Individual peak fluorescein serum concentration was achieved within 180 min after the test meal in 96% of all subjects studied. Peak fluorescein serum concentration within this time period allowed the best discrimination between normal and abnormal pancreatic function. Sensitivity in detection of chronic pancreatitis was 86% (38 of 44 patients) when the lower normal fluorescein serum concentration was considered 4.5 micrograms/ml (this value corresponds to mean - 2 SD). The specificity of this test in detecting chronic pancreatitis was 100% when healthy controls were considered, but fell to 78% when patients with different gastrointestinal disorders, including those with secondary pancreatic insufficiency, were included. The correlation between serum and urinary fluorescein determination was significant (r = 0.61; p less than 0.01). Duodenal bicarbonate output/h after secretin also showed a significant correlation with peak fluorescein serum concentration (r = 0.79; p less than 0.001).     

Cyprus as a degraded landscape or resilient environment in the wake of colonial intrusion

Concerns about global warming, degradation of fragile ecosystems, and environmental and societal collapse have increased interest for lessons and/or solutions for today's environmental issues. Popular writers have turned to a classic degradation thesis of deforestation and presumed desertification within the Eastern Mediterranean as a cautionary tale of how past societies have committed ecological suicide. However, degradation and/or collapse is far more complex than the thesis permits, and uncritical adoption of such simplified stories encourages continued use of inaccurate assumptions about human-environment interaction. In Cyprus, such a degradation story materialized 150 y ago, and its promoters aimed to impress on readers their responsibility to reverse past environmental mistakes. Both the British Colonial authorities (1878-1960) and the post-Independence Cypriot government used it to justify their environmental policies. Unfortunately, this thesis was formed around several misunderstandings about Cypriot environments and society: (i) judgment of degradation without appropriate consideration of the difference between degradation and change; (ii) oversimplified representation of ruling powers and those people ruled; and (iii) denigration of the shepherd lifestyle and its presumed environmental impact. A multimethod approach using archival and field research offers a more nuanced understanding of the complexity of human-environment interaction, the underappreciated environmental and societal resilience of areas classified as degraded, and the importance of placing events within changing socioeconomic and political contexts. This study of natural resource management and environmental resilience illustrates that the practices that the colonial government viewed as unsustainable likely were sustainable.     

Measurement of physical capacities in the elderly: a secondary analysis of the Quebec longitudinal study NuAge

OBJECTIVE: To assess the validity of a battery of functional capacity tests in community-living elderly Canadians. MATERIAL AND METHODS: Design: cross-sectional study. Study population: baseline data from 1793 men and women aged 74.4 +/- 4.1 participating in the NuAge longitudinal study were collected from December 2003 to April 2005 and used for the analyses. A global score measuring functional capacities (BFC) was constructed as the sum of four tests according to a method proposed by Guralnik [Timed Up and Go, walking speed (4 m), chair stands (five times), standing balance]. Multivariate linear regression analysis was used to study the relationship between age, sex, and physical activity, and BFC score. RESULTS: The global functional capacities score had an internal consistency of 0.74. It was significantly associated with age, sex and measures of mental and physical health status including: cognitive function (< 0.001), depressive symptoms (< 0.001), nutritional risk (< 0.001), burden of disease (< 0.001), and level of physical activity (< 0.001) thus supporting the construct validity of the global score. Age related differences in BFC were consistent and similar among men and women. CONCLUSION: The global score of functional capacity tests provided a valid assessment of physical capacities in the community-living elderly. While men had higher global BFC scores than women, among both sexes the best performance was observed in the youngest age group and in those reporting more physical activity.     

Validation study of the three-objects-three-places test: a screening test for Alzheimer's disease

The aim of the present study was to validate a short, ecological test of episodic memory for the screening of Alzheimer's disease (AD). The validation was performed by computing intrarater reliability, homogeneity, internal coherence, convergent, discriminant and known group validities in the performance of normal subjects (N = 65), mild cognitive impairment (MCI) patients (N = 114), and AD (N = 44) and non-AD demented (N = 39) patients. Intrarater reliability was 0.88, homogeneity ranged from 0.81 to 0.97, and internal coherence was 0.87. With respect to convergent and discriminant validities, the test loaded strongly on memory factor (value = 0.64) and weakly on other nonmemory factors. The known group validity showed a specificity between 87% and 91% and a sensitivity between 92% and 100% in correctly identifying AD in age classes ranging from 50 to 65 and 66 to 80 years. The test is a valid instrument for the screening of AD.     

The Neuropad test: a visual indicator test for human diabetic neuropathy

Aims/hypothesis The commercially available Neuropad test was developed as a simple visual indicator test to evaluate diabetic neuropathy. It uses a colour change to define the integrity of skin sympathetic cholinergic innervation. We compared the results of Neuropad assessment in the foot with established measures of somatic and autonomic neuropathy. Methods Fifty-seven diabetic patients underwent Neuropad assessment, quantitative sensory and autonomic function testing, and evaluation of intra-epidermal nerve fibre density in foot skin biopsies. Results Neuropad responses correlated with the neuropathy disability score (r _s = 0.450, p < 0.001), neuropathic symptom score (r _s = 0.288, p = 0.03), cold detection threshold (r _s = 0.394, p = 0.003), heat-as-pain perception threshold visual analogue score 0.5 (r _s = 0.279, p = 0.043) and deep-breathing heart rate variability (r _s = −0.525, p < 0.001). Intra-epidermal nerve fibre density (fibres/mm) compared with age- and sex-matched control subjects (11.06 ± 0.82) was non-significantly reduced (7.37 ± 0.93) in diabetic patients with a normal Neuropad response and significantly reduced in patients with a patchy (5.01 ± 0.93) or absent (5.02 ± 0.77) response (p = 0.02). The sensitivity of an abnormal Neuropad response in detecting clinical neuropathy (neuropathy disability score ≥5) was 85% (negative predictive value 71%) and the specificity was 45% (positive predictive value 69%). Conclusions/interpretation The Neuropad test may be a simple indicator for screening patients with diabetic neuropathy.     

Reform: a test of management fundamentals.

The structure of the country's healthcare system is obviously far from being an easy one to understand. The challenge is upon the healthcare industry to carefully and systematically assess what works and what should be enhanced.     

Human fetal testis: second trimester proliferative and steroidogenic capacities

The period of Leydig cell hyperplasia (14-18 weeks gestation) in human fetal testis is crucial for normal gonad development. We have studied the spatio-temporal distribution of key developmental and functional markers in human fetal testis between 13-19 weeks gestation. Proliferating cell nuclear antigen-positive cells were immunolocalized to both interstitium and tubules. Image analysis confirmed an increase in positive interstitial cells during Leydig cell hyperplasia (P: < 0.05). c-Myc was localized to the interstitium with no gestational changes. The steroidogenic enzymes 3beta-hydroxysteroid dehydrogenase (protein) and cytochrome P450 17alpha-hydroxylase/C(17-20)-lyase (P450c17; messenger ribonucleic acid and protein) were confined to the Leydig cells. The number of immunopositive cells increased between 13 and 19 weeks (P: < 0.001). P450c17 mRNA (in situ hybridization) and protein were localized to the same population of interstitial Leydig cells. Androgen receptor and Bcl-2 protein (anti-apoptotic) were gradually restricted to the peritubular myoid cells as gestation progressed. Conversely, Bax protein (pro-apoptotic) was predominantly localized to the tubule Sertoli cells, whereas the germ cells were Bax immunonegative. In conclusion, human fetal Leydig cell hyperplasia is characterized by increasing numbers of proliferating cells and increased expression of steroidogenic enzymes. The Bcl-2-positive, Bax-negative status of the peritubular myoid cells may be a strategy for cell survival.