Initial experience with a new method for the dynamic assessment of pelvic floor function in women: the Kolpexin Pull Test

The aim of this study was to evaluate a newly developed, simple test for assessing pelvic floor muscular function in women. Pelvic floor strength in women with symptomatic pelvic floor dysfunction was evaluated with a newly developed assessment tool, the Kolpexin Pull Test, and compared to a clinically validated digital pelvic floor strength assessment scale (DPA). A 36-mm Kolpexin sphere was inserted into the vagina above the levator plate and connected to a digital tensiometer/force gauge. The force required to remove the sphere was recorded for three resting trials and three maximum pelvic floor contractions. Results of the DPA and Kolpexin Pull Test were analyzed using ANOVAs of contrast variables, intraclass correlations, and regression analyses. Twenty-one women participated in the study. Age range was 36–85 years, parity range was 2–5. All six trials required less than 5 min to perform in each patient. Intraperson maximum contraction data were correlated at 0.96 (95% CI: 0.91, 0.98), and were greater at higher DPA scores (p=0.016). There were positive correlations between the maximum contraction and DPA data (adjusted R²=0.52; p <0.001), and the maximum contraction minus resting vs DPA data (adjusted R²=0.54; p< 0.001). The Kolpexin Pull Test is reproducible, rapid, and correlates with digital clinical assessment of pelvic floor strength during maximal contractions.Abbreviations DPA Digital pelvic assessment - MC Maximum pelvic floor contraction - RP Relaxed pelvic floor Editorial Comment: This paper is an interesting pilot study of a new technique to measure pelvic muscle strength. Several other techniques have already been described. As the authors have stated, all methods have flaws, including the relatively easy and reproducible digital pelvic assessment (DPA). The Kolpexin sphere offers the hope of more objective testing than the DPA, overcomes the contribution of Valsalva to the pressure perineometry readings, and is easier to perform than ultrasound or EMG. The authors did not fully convince us of the objectivity of the measurements, as the study was not blinded. Also, we do not know whether the size of the sphere altered the readings in women in different heights and/or weights. If, on further testing, this technique is shown to have inter- as well as intraexaminer reproducibility, it may contribute to the evaluation of patients for management as well as for research.     

Long-term efficacy and safety of atazanavir with stavudine and lamivudine in patients previously treated with nelfinavir or atazanavir

The purpose of the study was to determine long-term efficacy, safety, and tolerability of atazanavir plus stavudine/lamivudine in 346 HIV-infected patients previously treated with atazanavir or nelfinavir. BMS AI424-044 is an ongoing, multicenter, international, open-label, rollover/switch study initiated in June 2001. Patients completing >or=48 weeks in trial BMS AI424-008 with a plasma HIV RNA viral load <10,000 copies/mL were eligible to continue on atazanavir (400 or 600 mg) or to switch from nelfinavir to atazanavir (400 mg) once daily. Antiviral efficacy, change in CD4 cell counts, and effect on lipid parameters were measured. After 24 weeks of atazanavir use in BMS AI424-044, 83%, 85%, and 87% of the atazanavir 400-mg, atazanavir 600-mg, and nelfinavir-to-atazanavir-switched patients, respectively, had HIV RNA levels <400 copies/mL compared with 76%, 76%, and 63%, respectively, at week 48 of BMS AI424-008. Atazanavir-treated patients showed minimal changes in lipid levels compared with baseline. Patients switched from nelfinavir to atazanavir showed significant mean percent decreases in total cholesterol (-16%), fasting low-density lipoprotein cholesterol (-21%), and fasting triglycerides (-28%) (P<0.0001) by week 12 of atazanavir treatment. No new safety issues were identified, and the overall incidence of treatment-emergent adverse events during BMS AI424-044 was comparable across treatment groups. Atazanavir was safe, tolerable, and effective during extended use and in patients switched from nelfinavir. Extended atazanavir use resulted in continued viral suppression and lipid changes that were not clinically relevant. In virologically suppressed nelfinavir-treated patients switched to atazanavir, virologic improvement continued, whereas nelfinavir-induced lipid elevations were reversed within 12 weeks, approaching pretreatment values.     

Cognitive and behavioural effects of music-based exercises in patients with dementia

OBJECTIVE: To evaluate the effect of a musical exercise programme on mood state and cognitive function in women with dementia. DESIGN: Randomized controlled trial. SETTING: Public Psychiatric Hospital Rekem, Belgium. PATIENTS: Twenty-five patients with dementia. INTERVENTIONS: Fifteen patients attended exercise training for three months, which consisted of daily physical exercises supported by music for 30 min/session. They were compared with a group of 10 control patients, who received an equal amount of attention through daily conversation. MAIN MEASURES: The effect on cognition was measured by the Mini-Mental State Examination (MMSE) and the Amsterdam Dementia Screening Test 6 (ADS 6). Behaviour was evaluated with the abbreviated Stockton Geriatric Rating Scale (BOP scale). The assessments were made before, after six weeks of intervention and immediately after the three-month experimental period. RESULTS: The exercise group showed a significant improvement in cognition. This was documented by an increased MMSE mean score of 12.87-15.53, and by a higher median score, rising from 10 to 14 points, on the subset 'fluency' (ADS 6 test). The control group showed no significant improvement, either on the MMSE (mean score of 10.80-11.00) or on the fluency subtest of the ADS 6 (median scores were 6.5-7 points). The effects on behavioural changes were not significant. CONCLUSION: The present study suggests a beneficial effect of cognition using a music-based exercise programme in a group of patients with moderate to severe dementia. Further studies are needed to confirm these findings.     

Watchful waiting versus immediate catheter removal in ICU patients with suspected catheter-related infection: a randomized trial

Objective To find a subset of patients with suspected central venous catheter (CVC)-related infection (CRI) in whom CVC removal is not needed.Design Randomized controlled trial.Setting Thirty-three-bed ICU.Patients and participants One hundred and forty four patients with suspected CRI in which a change of CVCs was planned were evaluated for inclusion.Interventions Hemodynamically stable patients without proven bacteremia, no insertion site infection, and no intravascular foreign body were randomized to a standard-of-care group (SOC, all CVCs were changed as planned) or a watchful waiting group (WW, CVCs changed when bacteremia was subsequently confirmed or hemodynamic instability occurred).Measurement and results Study groups were compared for incidence of CVC-related bloodstream infection (CR-BSI), resolution of fever, C-reactive protein, SOFA score, duration of ICU stay, and mortality. Of 144 patients with suspected CRI, 80 patients met exclusion criteria. Sixty-four were randomized. Forty-seven of 80 excluded patients were shown to be bacteremic, 20 (25%) of whom had a CR-BSI. Five of 64 (8%) included patients had a CR-BSI during their subsequent ICU stay (two in SOC and three in WW group). All 38 CVCs were changed in the SOC group versus 16 of 42 in the WW group (62% reduction, P<0.01). Resolution of fever, C-reactive protein, SOFA score, duration of ICU stay, and ICU mortality did not differ between SOC and WW group (P>0.1 for all).Conclusions The use of a simple clinical algorithm permits a substantial decrease in the number of unnecessarily removed CVCs without increased morbidity.An editorial regarding this article can be found in the same issue ()     

Association between visual perceptual deficits and motor deficits in children with developmental coordination disorder

This study explored the relation between a motor-free visual perceptual deficit, different visual-motor integration deficits, and different motor skills in children with developmental coordination disorder (DCD). Thirty-six children (22 males), aged 9 or 10 years, with DCD and a control group (n=36), matched for age and sex, were assessed with the Movement Assessment Battery for Children (MABC), a ball-catching test, a jumping test, a timed response task to a visual moving stimulus, and the Beery-Buktenica Developmental Test of Visual-Motor Integration, incorporating copying, visual discrimination, and tracing tasks. Children with DCD performed significantly worse than the control group on all measures. The visual discrimination task did not correlate significantly with any of the motor tasks. The visual timing task correlated significantly with the ball-catching test in the DCD group. The copying test was significantly correlated with the MABC in the DCD group. The association between visual-perceptual deficits and motor tasks was shown to be task specific.     

Noise exposure of music teachers

A noise exposure survey was performed to assess the risk of hearing loss to school music teachers during the course of their activities. Noise exposure of 18 teachers from 15 schools was measured using noise dosimeters. The equivalent continuous noise level (L(eq)) of each teacher was recorded during single activities (classes) as well as for the entire day, and a normalized 8-hour exposure, termed the noise exposure level (L(ex)) was also computed. The measured L(eq) exceeded the 85-dBA limit for 78% of the teachers. L(ex) exceeded 85 dBA for 39% of the teachers. Limited recommendations on how to reduce the noise exposures are provided. The need for a hearing conservation program has also been emphasized.     

Plasma D-glucose, D-fructose and insulin responses after oral administration of D-glucose, D-fructose and sucrose to normal rats

OBJECTIVE: To assess whether oral D-fructose modifies the plasma D-glucose and insulin responses to oral D-glucose administration in normal rats. DESIGN: Oral D-glucose (1.7, 3.5, 6.9 or 13.9 micromol/g body weight), D-fructose (6.9 micromol/g), both D-glucose and D-fructose (1.7 or 3.5 micromol/g of each hexose) or sucrose (3.7 micromol/g) were administered intragastrically to overnight fasted rats and the plasma concentration of D-glucose, D-fructose and insulin measured over the ensuing 120 minutes. Control experiments were conducted after oral administration of H(2)O or saline. RESULTS: The administration of D-fructose, given as the free hexose or as sucrose, instead of augmenting the plasma D-glucose concentration evoked by the concomitant administration of D-glucose, tended both to improve the insulin response of the pancreatic B-cell and to minimize hyperglycemia, when compared to the results of experiments including the administration of equimolar amounts of D-glucose alone. For instance, the area under the plasma D-glucose curve was comparable in the rats receiving both D-glucose and D-fructose (3.5 micromol/g of each hexose) and the rats receiving only D-glucose (3.5 micromol/g), averaging respectively 836 +/- 32 and 850 +/- 34 mM . min each. Likewise, the paired ratio between the areas under the plasma insulin and D-glucose curves, when corrected for the threshold concentration for the insulinotropic action of the hexose (2.05 +/- 0.10 mM), averaged 44.3 +/- 3.0 nmol/mol in the 16 rats receiving D-fructose alone, sucrose alone or both D-glucose and D-fructose, as compared to 37.7 +/- 2.9 nmol/mol in the 22 rats receiving increasing amounts of D-glucose alone. CONCLUSIONS: The intake of D-fructose, as the free hexose or as sucrose, favours D-glucose homeostasis. This is likely to be attributable to the reciprocal effects of the aldose and ketose upon their respective phosphorylation by glucokinase in both hepatocytes and insulin-producing pancreatic islet cells.     

Effect of genital prolapse on assessment of bladder neck mobility by the Q-tip test

OBJECTIVE: To investigate the effect of vaginal prolapse and bladder fullness on Q-tip test assessment of urethral mobility. METHODS: Twenty-six women with genital prolapse to or beyond the hymen and undergoing urodynamics for urogynecologic dysfunction were assessed by the Q-tip test. Measurements were obtained with the bladder empty, with and without the prolapse reduced by the posterior blade of a Graves speculum. Angles were repeated at bladder capacity. Measured Q-tip angles were compared using the Wilcoxon signed rank test. RESULTS: Q-tip angles were significantly altered by vaginal prolapse and bladder fullness. With an empty bladder, the median Q-tip angle measured with the prolapse reduced was significantly less than that measured without reduction (53 degrees, interquartile range 25-65, versus 68 degrees, interquartile range 45-75; P <.001). With a full bladder, similar but lesser results were obtained (33 degrees, interquartile range 15-55 [reduced] versus 48 degrees, interquartile range 31-60 [unreduced]; P <.001). The median Q-tip angle with an empty bladder was greater than that with a full bladder. With the prolapse reduced, the Q-tip angle was 53 degrees (interquartile range 25-65) with an empty bladder versus 33 degrees (interquartile range 15-55) with a full bladder (P <.001). Without the prolapse reduced, the median Q-tip angle was 68 degrees (interquartile range 45-75) with an empty bladder and 48 degrees (interquartile range 31-60) with a full bladder (P <.001). CONCLUSION? Measurement of urethral mobility by the Q-tip test is significantly affected by genital prolapse. Q-tip angles are less with the reduction of vaginal prolapse and with the bladder full. Standardization of measurement technique is necessary for the development of clinical management recommendations.