Adaptive behaviour deficits in individuals with 3q29 deletion syndrome

BACKGROUND

3q29 deletion syndrome (3q29del) is associated with a significantly increased risk for neurodevelopmental and neuropsychiatric phenotypes. Mild to moderate intellectual disability (ID) is common in this population, and previous work by our team identified substantial deficits in adaptive behaviour. However, the full profile of adaptive function in 3q29del has not been described nor has it been compared with other genomic syndromes associated with elevated risk for neurodevelopmental and neuropsychiatric phenotypes.

METHODS

Individuals with 3q29del (n = 32, 62.5% male) were evaluated using the Vineland Adaptive Behaviour Scales, Third Edition, Comprehensive Parent/Caregiver Form (Vineland-3). We explored the relationship between adaptive behaviour and cognitive function, executive function, and neurodevelopmental and neuropsychiatric comorbidities in our 3q29del study sample, and we compared subjects with 3q29del with published data on fragile X syndrome, 22q11.2 deletion syndrome and 16p11.2 deletion and duplication syndromes.

RESULTS

Individuals with 3q29del had global deficits in adaptive behaviour that were not driven by specific weaknesses in any given domain. Individual neurodevelopmental and neuropsychiatric diagnoses had a small effect on adaptive behaviour, and the cumulative number of comorbid diagnoses was significantly negatively associated with Vineland-3 performance. Both cognitive ability and executive function were significantly associated with adaptive behaviour, and executive function was a better predictor of Vineland-3 performance than cognitive ability. Finally, the severity of adaptive behaviour deficits in 3q29del was distinct from previously published data on comparable genomic disorders.

CONCLUSIONS

Individuals with 3q29del have significant deficits in adaptive behaviour, affecting all domains assessed by the Vineland-3. Executive function is a better predictor of adaptive behaviour than cognitive ability in this population and suggests that interventions targeting executive function may be an effective therapeutic strategy.

Epigenetic effects of folate and related B vitamins on brain health throughout life: Scientific substantiation and translation of the evidence for health improvement strategies

Suboptimal status of folate and/or interrelated B vitamins (B12 , B6 and riboflavin) can perturb one-carbon metabolism and adversely affect brain development in early life and brain function in later life. Human studies show that maternal folate status during pregnancy is associated with cognitive development in the child, whilst optimal B vitamin status may help to prevent cognitive dysfunction in later life. The biological mechanisms explaining these relationships are not clear but may involve folate-related DNA methylation of epigenetically controlled genes related to brain development and function. A better understanding of the mechanisms linking these B vitamins and the epigenome with brain health at critical stages of the lifecycle is necessary to support evidence-based health improvement strategies. The EpiBrain project, a transnational collaboration involving partners in the United Kingdom, Canada and Spain, is investigating the nutrition-epigenome-brain relationship, particularly focussing on folate-related epigenetic effects in relation to brain health outcomes. We are conducting new epigenetics analysis on bio-banked samples from existing well-characterised cohorts and randomised trials conducted in pregnancy and later life. Dietary, nutrient biomarker and epigenetic data will be linked with brain outcomes in children and older adults. In addition, we will investigate the nutrition-epigenome-brain relationship in B vitamin intervention trial participants using magnetoencephalography, a state-of-the-art neuroimaging modality to assess neuronal functioning. The project outcomes will provide an improved understanding of the role of folate and related B vitamins in brain health, and the epigenetic mechanisms involved. The results are expected to provide scientific substantiation to support nutritional strategies for better brain health across the lifecycle.

Impact of COVID-19 contact tracing on human resources for health - A Caribbean perspective

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Border reopening will increase burden on contact tracing (CT) resources.

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Governments of tourism-based economies must build quality health workforce capacity.

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Prevalence of COVID-19 in the source country predicted CT capacity needed.

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Mobile app technology will facilitate only a small decrease in workforce needs.

Inducing remission of Type 2 diabetes in the Caribbean: findings from a mixed methods feasibility study of a low-calorie liquid diet-based intervention in Barbados

AIM

In a high proportion of people with recently diagnosed Type 2 diabetes, a short (2-3-month) low-calorie diet is able to restore normal glucose and insulin metabolism. The aim of this study was to determine the feasibility of this approach in Barbados.

METHODS

Twenty-five individuals with Type 2 diabetes diagnosed within past 6 years, not on insulin, BMI ≥ 27 kg/m² were recruited. Hypoglycaemic medication was stopped on commencement of the 8-week liquid (760 calorie) diet. Insulin response was assessed in meal tests at baseline, 8 weeks and 8 months. Semi-structured interviews, analysed thematically, explored participants' experiences. 'Responders' were those with fasting plasma glucose (FPG) < 7 mmol/l at 8 weeks.

RESULTS

Ten men and 15 women (mean age 48, range 26-68 years) participated. Mean (sd) BMI was 34.2 kg/m² (6.0); FPG 9.2 mmol/l (2.2). Mean weight loss at 8 weeks and 8 months was 10.1 kg [95% confidence interval (CI) 8.1, 12.0] and 8.2 kg (95% CI 5.8, 10.6); FPG was lower by 2.2 mmol/l (95% CI 1.2, 3.2) and 1.7 mmol/l (95% CI 0.8, 2.7) respectively. Nine of 11 (82%) of those who lost ≥ 10 kg were 'responders' compared with 6 of 14 (43%) who lost < 10 kg (P = 0.048). The 30-min insulin increment was higher in responders at baseline and follow-up (P ≤ 0.01). A food culture based on starchy foods and pressures to eat large amounts at social events were among the challenges identified by participants.

CONCLUSIONS

The feasibility of this approach to weight loss and diabetes remission in a predominantly black population in Barbados was demonstrated.

Age, sex, race and ethnicity representativeness of randomised controlled trials in peri-operative medicine

The applicability of the results of any clinical trial will depend to a large extent on whether the study population is representative of the population seen in clinical practice. The growing older surgical population presents challenges for peri-operative researchers to ensure there is adequate representation of patients in terms of their age, sex, race and ethnicity in clinical trials. A review of purposively sampled published randomised controlled trials was performed to establish the age, sex, race and ethnicity of study participants. These data were compared with national registry data for the relevant surgical populations. We included 224 peri-operative trials that were cited in 469 retrieved meta-analyses. Of these, 50 (22.3%) had an upper age limit to recruitment. The median (range [IQR]) difference in study population age from the registry population age was: -2.4 (-6.2 to 1.0 [-34.7 to 14.5]) years for all randomised controlled trials; -6.2 (-9.4 to -2.8 [-18.6 to 4.6]) years for randomised controlled trials of patients undergoing hip arthroplasty; and -3.4 (-9.6 to -1.1 [-34.7 to 2.9]) years for randomised controlled trials of patients undergoing hip fracture surgery. In 92 (41.1%) randomised controlled trials, the proportion of each sex in the study population was more than 25% different from the proportion in the registry population. Only 5 (2.2%) trials published data on the race or ethnicity of participants. We conclude that peri-operative randomised controlled trials are unlikely to be representative of the age and sex of clinically treated surgical populations. Researchers must endeavour to ensure representative study populations are recruited to future clinical trials.

Analysis of extensometer, photogrammetry and laser scanning monitoring techniques for measuring floor heave in an underground limestone mine

An underground limestone mine in eastern Ohio was experiencing significant floor heave and roof falls, attributed to high horizontal stresses. Areas of the mine showing floor heave were monitored with roof-to-floor extensometers and photogrammetry surveys to determine the rate and magnitude of heave. Extensometer data were recorded hourly at four locations across adjacent entries while photogrammetry surveys of the floor were performed at the same locations every two to five weeks. A final survey was performed using an I-Site 8200 laser scanner. Following instrumentation, floor heave up to 10.1 cm (4 in.) was measured by the extensometers, photogrammetric reconstructions and laser scanner over a six-month period. The extensometers were biased by the location where they were placed, failing to consistently capture the location and extent of floor heave and cracking. The photogrammetry surveys were not precise enough to capture small magnitude movements. Mining in the area was halted and within several months the floor movement and incidence of roof falls were significantly lessened.

Team-Based Learning in a Pipeline Course in Medical Microbiology for Under-Represented Student Populations in Medicine Improves Learning of Microbiology Concepts

As part of an undergraduate pipeline program at our institution for students from underrepresented minorities in medicine backgrounds, we created an intensive four-week medical microbiology course. Team-based learning (TBL) was implemented in this course to enhance student learning of course content. Three different student cohorts participated in the study, and there were no significant differences in their prior academic achievement based on their undergraduate grade point average (GPA) and pre-course examination scores. Teaching techniques included engaged lectures using an audience response system, TBL, and guided self-directed learning. We hypothesized that more active learning exercises, irrespective of the amount of lecture time, would help students master course content. In year 2 as compared with year 1, TBL exercises were decreased from six to three with a concomitant increase in lecture time, while in year 3, TBL exercises were increased from three to six while maintaining the same amount of lecture time as in year 2. As we hypothesized, there was significant (p < 0.01) improvement in performance on the post-course examination in years 1 and 3 compared with year 2, when only three TBL exercises were used. In contrast to the students' perceptions that more lecture time enhances learning of course content, our findings suggest that active learning strategies, such as TBL, are more effective than engaged lectures in improving student understanding of course content, as measured by post-course examination performance. Introduction of TBL in pipeline program courses may help achieve better student learning outcomes.

Towards an inpatient diabetes curriculum: medical student-generated aims, objectives and methods for ward-based learning of non-critical, non-perioperative inpatient diabetes care

AIMS

To create a summative document containing aims, objectives and methods that can be used for the training of healthcare professionals in inpatient diabetes care.

METHODS

A four-stage approach was introduced for the ward-based teaching of inpatient diabetes care at the University of the West Indies, Cave Hill over the 2014-2015 academic year. Within this approach, 55 students (100%) submitted aims, objectives and methods to support two 2-h, ward-based sessions. This was guided by brief instructions and access to a copy of the Endocrine Society Clinical Practice Guideline on the management of non-critical, non-perioperative inpatient diabetes. Conceptual content analysis was used to convert submissions into a unifying document.

RESULTS

Six themes emerged from students' submissions: diagnosis; assessment and investigation of diabetes and its complications; planning individualized care and pharmacological management; hypoglycaemia management, including severe hypoglycaemia; patient education; discharge planning; and multidisciplinary teamwork. Students were primarily interested in patient management and treatment using higher-level objectives and active learning methods.

CONCLUSIONS

This study produced comprehensive, student-generated, and hence student-centred, aims, objectives and methods for inpatient diabetes care with objectives appropriately set for higher cognitive levels of learning. This material can be used to guide teaching or for further development into a curriculum. This is the first known publication of content that could be used in a ward-based inpatient diabetes curriculum.

Shale Failure Mechanics and Intervention Measures in Underground Coal Mines: Results From 50 Years of Ground Control Safety Research

Ground control research in underground coal mines has been ongoing for over 50 years. One of the most problematic issues in underground coal mines is roof failures associated with weak shale. This paper will present a historical narrative on the research the National Institute for Occupational Safety and Health has conducted in relation to rock mechanics and shale. This paper begins by first discussing how shale is classified in relation to coal mining. Characterizing and planning for weak roof sequences is an important step in developing an engineering solution to prevent roof failures. Next, the failure mechanics associated with the weak characteristics of shale will be discussed. Understanding these failure mechanics also aids in applying the correct engineering solutions. The various solutions that have been implemented in the underground coal mining industry to control the different modes of failure will be summarized. Finally, a discussion on current and future research relating to rock mechanics and shale is presented. The overall goal of the paper is to share the collective ground control experience of controlling roof structures dominated by shale rock in underground coal mining.

The hopeless age? A qualitative exploration of the experience of menopause in Arab women in Qatar

OBJECTIVE

The aim of this study was qualitatively to describe and examine the expectations and experiences of the midlife transition in Arab women living in Qatar.

METHOD

Six focus groups were conducted with Arab women living in Qatar: three groups of local Qatari women, and three groups of non-Qatari Arab women originating from neighboring countries. A purposive sample of 41 pre-, peri-, and postmenopausal women aged 40-60 years participated. The semi-structured group format encouraged discussion around knowledge about menopause; physical, emotional and social experiences related to menopause; and cultural differences that may exist related to menopause.

RESULTS

The majority of women considered menopause as a maturing experience, although the term 'menopause' was considered to have negative connotations. Postmenopausal women described menopausal symptoms consistent with general knowledge, but many premenopausal women were unaware of symptoms, even if they knew someone who had experienced menopause. Postmenopausal women were more socially active than before and were able to participate in religious activities that they previously could not attend during menses. How a woman experienced menopause depended on the husband's level of support, and some women believed that Western women did not have the appropriate support from husbands and families that Arab women have; they felt this lack of support could lead to negative outcomes such as being at an increased risk for suicide caused by depression during menopause.

CONCLUSION

Qatari and non-Qatari women had many similarities in how they perceived and experienced menopause, although they collectively believed that the experiences of Western women are different.

Employment after a breast cancer diagnosis: a qualitative study of ethnically diverse urban women

Employment status is related to treatment recovery and quality of life in breast cancer survivors, yet little is known about return to work in immigrant and minority survivors. We conducted an exploratory qualitative study using ethnically cohesive focus groups of urban breast cancer survivors who were African-American, African-Caribbean, Chinese, Filipina, Latina, or non-Latina white. We audio- and video-recorded, transcribed, and thematically coded the focus group discussions and we analyzed the coded transcripts within and across ethnic groups. Seven major themes emerged related to the participants' work experiences after diagnosis: normalcy, acceptance, identity, appearance, privacy, lack of flexibility at work, and employer support. Maintaining a sense of normalcy was cited as a benefit of working by survivors in each group. Acceptance of the cancer diagnosis was most common in the Chinese group and in participants who had a family history of breast cancer; those who described this attitude were likely to continue working throughout the treatment period. Appearance was important among all but the Chinese group and was related to privacy, which many thought was necessary to derive the benefit of normalcy at work. Employer support included schedule flexibility, medical confidentiality, and help maintaining a normal work environment, which was particularly important to our study sample. Overall, we found few differences between the different ethnic groups in our study. These results have important implications for the provision of support services to and clinical management of employed women with breast cancer, as well as for further large-scale research in disparities and employment outcomes.

Minimally invasive surgery for resectable pancreatic cancer in the United States: From staging tool to treatment strategy

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Background: Debate exists regarding the use of laparoscopy in pancreatic malignancy. The goal of this study was to examine recent laparoscopy use in pancreatic resections for cancer in the US. We hypothesized that there would be two noticeable trends in the use of laparoscopy – the first reflecting staging laparoscopy, the second associated with advancement of laparoscopic pancreatectomy.

Methods: The Nationwide Inpatient Sample (NIS), 1998-2007, was used to identify patients ≥ 18 years old with pancreatic cancer who underwent pancreatic resection with or without associated laparoscopy. Patterns of laparoscopy use and correlated outcomes were examined.

Results: Among 47599 patients (nationally weighted) who underwent resection for pancreatic cancer, 2640 (5.5%) had procedures that included laparoscopy. Yearly trend analyses demonstrated a peak in laparoscopy in 2003 followed by decreased use, then steady increase after 2005. Laparoscopy at time of resection was not significantly associated with decreased complications (p=0.09), but was associated with lower mortality compared to open resection alone (3.2% vs. 5.9%, p = 0.008). On multivariate analysis, independent predictors of increased complications included older age, male sex, higher comorbidity (Charlson) score, urban location, and non-teaching hospital. For increased risk of death, predictors were older age, male sex, Charlson >2, non-teaching hospital, and non-use of laparoscopy.

Conclusions: Trends in the use of laparoscopy during pancreatic resections for cancer suggest initial increased use in the early 2000's following published staging recommendations, with a subsequent decrease contemporaneous with improving imaging techniques. A recent upward trend is likely associated with increased attempts at minimally-invasive resection. The use of laparoscopy is not associated with any difference in complication rate following surgery and is associated with improved perioperative survival. The effects of patient factors, selection, and volume status on minimally invasive pancreatectomy outcomes warrant further investigation.

No significant financial relationships to disclose.

Hereditary haemorrhagic telangiectasia: a cause of preventable morbidity and mortality

Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant condition whose effects are mediated through deficient blood vessel formation and regeneration, with multisystem involvement. Patients are usually aware of resulting skin telangiectasia and epistaxis, but are also exposed to dangers posed by occult vascular malformations in other organs. About 15-35% of HHT patients have pulmonary AVMs (PAVMs), 10% have cerebral AVMs (CAVMs), 25-33% suffer significant GI blood loss from GI tract telangiectasia, and an unknown but high percentage have liver involvement. In total, 10% of affected individuals die prematurely or suffer major disability from HHT, largely because of bleeding from CAVMs and PAVMs, or paradoxical embolization through PAVMs. Screening for and early intervention to treat occult PAVMs and CAVMs can largely eliminate these risks, and should be undertaken in a specialist centre. The National HHT Center in The Mercy University Hospital in Cork is the referral centre for HHT screening in Ireland.

Gender differences in repetitive language in fragile X syndrome

BACKGROUND

Verbal perseveration (i.e. excessive self-repetition) is a characteristic of male individuals with fragile X syndrome; however, little is known about its occurrence among females or its underlying causes. This project examined the relationship between perseveration and (1) gender, (2) cognitive and linguistic ability, and (3) language sampling context, among youth with fragile X syndrome.

METHOD

Language transcripts were obtained from adolescent male (n = 16) and female participants (n = 8) with fragile X syndrome in two language contexts (i.e. narration and conversation) designed to elicit spontaneous language samples. Transcripts were coded for utterance-level repetition (i.e. repetition of words, phrases, dependent clauses or whole utterances), topic repetition and conversational device repetition (i.e. repetition of rote phrases or expressions).

RESULTS

Male participants produced more conversational device repetition than did female participants. Gender differences in conversational device repetition were not explained by differences in non-verbal cognitive or expressive language ability. Context influenced the type of repetition observed; for example, more topic repetition occurred in conversation than in narration regardless of gender.

CONCLUSIONS

The observed gender differences in conversational device repetition among adolescents with fragile X syndrome suggest that, relative to females, male participants may rely more heavily on rote phrases or expressions in their expressive language. Further, results suggest that this gender difference is not simply the result of the correlation between gender and cognitive or linguistic ability in fragile X syndrome; rather, gender may make an independent contribution to conversational device repetition. Repetition type also varied as a function of expressive language context, suggesting the importance of assessing language characteristics in multiple contexts.

Dietary Calcium and Body Mass Index in a Mediterranean Population

This cross-sectional study evaluated the association between daily calcium intake and body mass index (BMI) in 647 subjects from Reus, Spain. 261 men and 313 women, aged 18 to 70 years, were randomly selected from the population census. Food intake was quantified by the 24-hour recall method, for three non-consecutive days including one holiday. Weight and height were measured. The study sample was divided into quartiles of calcium intake adjusted for age, energy, and total fat and fiber intake in both men and women. Average calcium intake was low (557.6 ± 234.0 mg/day). Calcium intake was significantly (p < 0.0001) and positively associated with energy intake (r = 0.50 for men; r = 0.49 for women; p < 0.0001) and dietary fiber consumption (r = 0.27 for men; r = 0.25 for women; p < 0.0001). After adjusting for age, energy intake, fat intake, and dietary fiber, the odds ratio of being in the highest quartile of BMI was significantly reduced in the highest quartile of calcium intake [men: 0.63 (0.30–1.29); women: 0.36 (0.17–0.79)] compared to the lowest quartile in both sexes. We conclude that our study showed a negative relationship between calcium intake and BMI in a Mediterranean community.

Determining the safety of chromium tripicolinate for addition to foods as a nutrient supplement

Trivalent chromium is an essential element required for normal carbohydrate, lipid, and protein metabolism in humans and animals. This article describes how one particular form of trivalent chromium, chromium tripicolinate (Chromax), a stable complex of trivalent chromium and picolinic acid, was determined to be safe for use as a nutrient supplement in foods (i.e., nutritional bars and beverages). A safety assessment of a nutrient supplement for use in food requires an evaluation of the safety of the product (Chromax), as well as an evaluation of the safety of the intended dietary ingredient (chromium tripicolinate). In this assessment, the production process, final product specifications, and product analysis results for Chromax were evaluated to determine the safety of the final product. Then, the Estimated Daily Intakes (EDIs) of trivalent chromium and picolinic acid from the proposed use of Chromax were calculated using data from the USDA's most recent Continuing Survey of Food Intakes by Individuals. The EDI for trivalent chromium was compared to the Acceptable Daily Intake (ADI) for this compound derived from animal studies, corroborated with human data, while the EDI for picolinic acid was compared to existing in vivo exposure to this compound that occurs naturally in the body. As long as the EDI of trivalent chromium is less than the ADI for this compound and the EDI of picolinic acid is less than its estimated in vivo exposure, Chromax can be considered safe for its intended use. Employing this approach, it was determined that Chromax is safe, as well as generally recognized as safe (GRAS), for use in nutritional bars and beverages as a nutrient supplement at a maximum use level of 2.4 mg of Chromax per product serving.

Preventive nutritional supplementation throughout the reproductive life cycle

Current interest in preventive nutritional supplementation strategies during the reproductive cycle in developed countries focuses mainly on iron and folic acid. Iron deficiency is the most common cause of anaemia. Inadequate iron nutrition is mainly a problem in developing countries but it also seems to affect a large proportion of pregnant women in the industrialised world. There is no chance for diet modification alone to meet iron requirements during pregnancy. However, dietary advice must be provided to increase iron intake and iron bioavailability. The best choice is prescribed supplementation adapted to the individual's needs. Folic acid supplementation during the periconceptional period reduces the occurrence and recurrence of neural tube defects (NTDs). According to the updated edition of American Dietary Reference Intakes, recommended dietary allowance for folate for women of childbearing age varies throughout the reproductive cycle from 400 microg day(-1) of dietary folate equivalents (DFEs) for non-pregnant women, to 600 microg day(-1) DFEs for pregnant women and 500 microg day(-1) DFEs in lactating women. Increasing dietary folate, fortifying staple foods with folic acid or use of folic acid supplements can increase folate intake.

Energy cost of physical task performance in men and women wearing chemical protective clothing

BACKGROUND

Chemical protective clothing (CPC) is required to perform certain occupations and is known to inhibit physical performance. Few data are available that quantify the physiological response of men and women during task performance while wearing CPC.

HYPOTHESIS

The mobility of a task will have a significant effect on the change in energy cost. The energy cost of wearing CPC will be greater in women than men during physical task performance.

METHODS

Energy cost (VO2) and the psychophysical scales, rating of perceived exertion (RPE) and respiratory distress (RD), were measured in 32 men and 26 women during the performance of 31 physical tasks. Tasks were categorized by mobility: stationary, intermittent or continuous. Between 6-12 men and 5-13 women conducted each task wearing 2 clothing conditions: battle-dress uniform (BDU, wt = 3.7 kg) and (CPC, wt = 9.3 kg).

RESULTS

VO2 L x min(-1), was higher in CPC compared with BDU for the continuous task category for both genders. However, when VO2 (ml x kg(-1) clothed wt x min(-1)) was normalized for clothing weight, there remained a significant clothing effect for the continuous category, but there were no gender differences. VO2, expressed as a % VO2max, was significantly increased for BDU compared with CPC for the continuous task category only. This difference was significantly greater for women than men. Women exercised at a higher % VO2max and reported a higher RPE than men for all categories in both BDU and CPC. Both genders reported higher RD wearing CPC for the continuous task category only.

CONCLUSIONS

There is an increase in energy cost wearing CPC during continuous tasks which can be attributed to both the clothing weight and the hobbling effect. Wearing CPC is more physiologically and psychologically demanding for women than men, especially when performing tasks of a continuous nature.

The discovery of non-basic atrial natriuretic peptide clearance receptor antagonists. Part 1

The cyclic peptide ANP 4-23 and the linear peptide analogue AP-811 have been shown to be selective ANP-CR antagonists. Via alanine scanning and truncation studies we sought to determine which residues in these molecules were important in their binding to the clearance receptor and the relationship between these two molecules. These studies show that several modifications to these compounds are possible which improve physical properties of these molecules while retaining high affinity for the ANP-CR.

Intra-arterial cerebral thrombolysis for acute ischemic stroke in a community hospital

BACKGROUND AND PURPOSE

Advances in thrombolytic therapy, brain imaging, and neurointerventional techniques provide new therapeutic options for acute stroke. Intra-arterial thrombolysis has proved to be a potent therapeutic tool. To show that this procedure can be performed in community hospitals, we describe our experience with a group of 11 patients treated for middle cerebral artery occlusions.

METHODS

Twenty-two patients seen during a period of 1 year with clinical findings of acute major-vessel stroke met screening criteria and were evaluated under an institutional review board-approved protocol. After CT scanning, 17 of those patients met strict criteria, gave informed consent, and underwent angiography. Eleven patients had M1 and M2 middle cerebral artery occlusions and received local thrombolytic therapy with urokinase. Recanalization efficacy, complications, and outcome data were compiled.

RESULTS

The average score on the National Institutes of Health Stroke Scale was 22.2 at the onset of treatment and 12.5 after therapy, with 91% of patients showing neurologic improvement. Complete (TIMI 3) recanalization occurred in 73% of cases and partial recanalization (TIMI 2) in 18%. At the 90-day follow-up evaluation, 56% of patients had good outcomes (modified Rankin score, 0 to 1). One intracranial hemorrhage occurred.

CONCLUSION

Intra-arterial thrombolysis can be performed in a community hospital by radiologists with interventional and neuroradiologic skills given appropriate institutional preparation.

Enzymic evaluation of thiamin, riboflavin and pyridoxine status of parturient mothers and their newborn infants in a Mediterranean area of Spain

OBJECTIVE

To determine the biochemical status of thiamin, riboflavin and pyridoxine in parturient mothers and their newborn infants in a Mediterranean region.

DESIGN

Transveral study.

SETTING

St Joan University Hospital and Faculty of Medicine & Health Sciences, Universitat Rovira i Virgili, Reus, Spain.

SUBJECTS

131 healthy parturient mothers, with normal pregnancies and deliveries in St Joan University Hospital, and their newborn infants.

INTERVENTIONS

Erythrocyte haemolysates were prepared from maternal blood at delivery and infants' umbilical cord blood and used to measure micronutrient status using the transketolase, glutathione reductase and aspartate aminotransferase coenzyme stimulation tests.

RESULTS

Maternal and infant coenzyme activities were significantly correlated, but infant coenzyme status was better than maternal, with significantly higher basal and stimulated activity (P < 0.001) and significantly lower activation coefficients (P < 0.001). Inadequate thiamin, riboflavin or pyridoxine status occured in 38.2 62.6% (50-82) of the mothers and 3.1-37.4% (4 49) of the infants; 85.2% (46/54), 12.9% (4/31) and 24.1% (12/54) of infants born to mothers with biochemical deficiency of either thiamin, riboflavin or pyridoxine, respectively also had inadequate status. Maternal deficiencies in more than one vitamin further increased the risk of infant thiamin and pyridoxine deficiency. Maternal and infant riboflavin status were significantly correlated with fetal development (e.g. length at birth, P < 0.001). The incidence of thiamin deficiency in paturient mothers in Spain was the highest out of a 12-country comparison.

CONCLUSIONS

Inadequate status for each vitamin was evident in mothers and infants. Maternal status of each individual vitamin, but especially riboflavin, was affected by maternal status of the other vitamins. Infant thiamin status was the most adversely affected by maternal deficiencies in more than one vitamin. Infant riboflavin status, however, was apparently protected from adverse maternal status.

Frequency of trisomy 20 in nonmalignant bronchial epithelium from lung cancer patients and cancer-free former uranium miners and smokers

Lung cancer is the leading cause of cancer-related deaths. The development of sensitive screening methods to identify at-risk individuals before emergence of clinical disease would permit early intervention that could decrease this mortality. Our previous studies have shown that cells with trisomy 7 can be detected in bronchial epithelium from cancer-free smokers and former uranium miners. However, the use of more than one molecular marker could increase the chance of identifying at-risk individuals. Trisomy 20, which is found in 43-57% of non-small cell lung cancers, is a candidate marker. The purpose of the current investigation was to determine the percentage of cells with trisomy 20 in persons with a high risk for lung cancer. Bronchial epithelial cells that had been assayed for trisomy 7 were assayed for trisomy 20 by fluorescence in situ hybridization. Trisomy 20 was detected in bronchial epithelial cells from lung cancer patients and from smokers and ex-uranium miners without lung cancer. In some cases, patients who were negative for trisomy 7 exhibited trisomy 20. Consequently, more people with field cancerization were identified using both markers. However, the two markers combined did not appear to stratify the risk for lung cancer.

Gender comparison of peak oxygen uptake: repetitive box lifting versus treadmill running

The gender differences in peak oxygen uptake (VO2peak) for various modes of exercise have been examined previously; however, no direct gender comparisons have been made during repetitive lifting (RL). In the present study the VO2peak between RL and treadmill running (TR) was compared between 20 men [mean (SD) age, height, body mass and body fat: 21 (3) years, 1.79 (0.06) m, 81 (9) kg, 19 (6)%, respectively] and 20 women [mean (SD) age, height, body mass and body fat: 21 (3) years, 1.63 (0.05) m, 60 (7) kg, 27 (6)%, respectively]. VO2peak (l x min[-1]), defined as the highest value obtained during exercise to volitional fatigue, was determined using discontinuous protocols with treadmill grade or box mass incremented to increase exercise intensity. For RL VO2peak, a pneumatically driven shelf was used to lower a loaded box to the floor, and subjects then lifted the box, at a rate of 15 lifts x min(-1). VO2peak (l x min(-1) and ml x kg(-1) x min[-1]) and minute ventilation (VE, l x min[-1]) were determined using an on-line gas analysis system. A two-way repeated measures analysis of variance revealed significant gender effects, with men having higher values for VO2peak (l x min(-1) and ml x kg(-1) x min[-1]) and VE, but women having higher values of the ventilatory equivalent for oxygen (VE/VO2). There were also mode of exercise effects, with TR values being higher for VO2peak (l x min(-1) and ml x kg(-1) x min[-1]) and VE and an interaction effect for VO2peak (l x min(-1) and ml x kg(-1) x min[-1]) and VE/VO2. The women obtained a greater percentage (approximately 84%) of their TR VO2peak during RL than did the men (approximately 79%). There was a marginal tendency for women to decrease and men to increase their VE/VO2 when comparing TR with RL. The magnitude of the gender differences between the two exercise modalities appeared to be similar for heart rate, VE and R, but differed for VO2peak (l x min(-1) and ml x kg(-1) x min[-1]). Lifting to an absolute height (1.32 m for the RL protocol) may present a different physical challenge to men and women with respect to the degree of involvement of the muscle groups used during lifting and ventilation.

Concurrent fluorescence in situ hybridization and immunocytochemistry for the detection of chromosome aberrations in exfoliated bronchial epithelial cells

OBJECTIVE

A procedure was developed to allow concurrent detection of chromosome aberrations and identification of bronchial epithelial cells.

STUDY DESIGN

Fluorescence in situ hybridization for chromosome 7 and immunocytochemistry for cytokeratin were performed on exfoliated bronchial epithelial cells in a sputum sample from a cancer patient.

RESULTS

The Spectrum Orange-labeled alpha satellite probe for chromosome 7 produced red fluorescence, nuclei were counterstained with 4,6-diamidino-2-phenylindole (blue), and cytokeratin was visualized using a fluorescein isothiocyanate (FITC)-conjugated secondary antibody (green).

CONCLUSION

This procedure allowed the rapid identification of airway epithelial cells with numerical chromosome aberrations in this sample. Ultimately, this procedure could increase the sensitivity and specificity of sputum cytology as a laboratory diagnostic tool for the early detection of lung cancer.

Encoded combinatorial chemistry: synthesis and screening of a library of highly functionalized pyrrolidines

The application of a new encoding technology for drug discovery is described. A combinatorial library of mercaptoacyl pyrrolidines has been prepared on a beaded polymeric support. Each polymer bead carries one library constituent in association with an oligomeric "tag," the structure of which is a record of the specific reagents from which that library member was prepared. After the ligands were solubilized, an array of such beads was screened for angiotensin-converting enzyme inhibitory activity, and the structures of active pyrrolidines were deduced by analysis of the associated tags at sub-picomole levels. Several extremely potent enzyme inhibitors were identified, many from multiple beads. The most potent inhibitor was found to have a Ki of 160 pM, approximately 3-fold more active than captopril in the same assay. Direct comparison with iterative deconvolution shows that the encoded screening strategy is a much more efficient means for extracting information from such compound collections, producing more data on a larger number of active structures.

Synthesis and protein kinase C inhibitory activities of acyclic balanol analogs that are highly selective for protein kinase C over protein kinase A

A series of balanol analogs in which the perhydroazepine ring and the p-hydroxybenzamide moiety were combined into an acyclic linked unit have been prepared and evaluated for their inhibitory properties against the serine/threonine kinase PKC. Several low-micromolar to low-nanomolar inhibitors of the alpha, beta I, beta II, gamma, delta, epsilon and eta PKC isozymes were prepared. In general, these acyclic balanol analogs were found to be highly selective for PKC over the serine/threonine kinase PKA. The type and number of atoms linking the benzophenone ester to the p-hydroxyphenyl group necessary for optimal PKC inhibition were investigated. The most potent compounds contained a three-carbon linker in which the carboxamide moiety of balanol had been replaced by a methylene group. The effect of placing substituents on the three-carbon chain was also investigated. The preferred compounds contained either a 2-benzenesulfonamido (6b) or a 1-methyl (21b) substituent. The preferred compounds 6b and 21b were tested against a panel of serine/threonine kinases and found to be highly selective for PKC. The more active enantiomer of 6b, (S)-12b, was 3-10-fold more active than the R-enantiomer against the PKC isozymes. The effect of making the analogs more rigid by making the three-carbon chain part of a five-membered ring, but with retention of the methylene replacement for the carboxamide moiety, led to potent PKC inhibitors including anti-substituted pyrrolidine analog 35b and the most potent PKC inhibitor in the series, anti-substituted cyclopentane analog 29b. The anti cyclopentane analog 29b, was a low-micromolar inhibitor of the PMA-induced superoxide burst in neutrophils, and its carboxylic ester was a high-nanomolar inhibitor of neutrophils. Finally esterification of 21b, (S)-12b, and 35b turned these potent PKC inhibitors into low-micromolar inhibitors of neutrophils.

Predictive value of prosthetic valve area index for early and late clinical results after valve replacement with the St Jude Medical valve prosthesis

BACKGROUND

Previous studies indicate that a minimal prosthetic valve area index (VAI) of > or = 0.9 cm2/m2 for aortic and > or = 1.3 cm2/m2 for mitral valves minimizes postoperative pressure gradients.

METHODS AND RESULTS

To determine VAI as an independent risk factor for postoperative events, 607 isolated aortic valve replacement (AVR) and 482 isolated mitral valve replacement (MVR) operations with the St Jude Medical valve were studied. End points included hospital deaths, NYHA functional class, late death and late valve-related death, major thromboembolism, anticoagulant-related hemorrhage, and reoperation. VAI was calculated from the ratio of prosthetic valve area to body surface area for each patient, and a range and mean were obtained for each valve size. Follow-up ranged from 1 to 120 months, totaled 2964 patient-years, and was 98% complete. Mean and range of VAI (cm2/m2) were 1.31 (0.74 to 2.86) in the aortic and 2.5 (1.4 to 6.32) in the mitral group. There were 33 AVR (5.4%) and 38 MVR (7.9%) hospital deaths. VAI was not a risk factor for NYHA class, early death, late death, or other postoperative events. The actuarial survival rates, 84% for AVR and 80% for MVR at 5 years, were not affected by VAI.

CONCLUSIONS

Within the ranges measured, VAI did not influence the end points of the study.

Management of retrohepatic venous injuries with atrial caval shunts

Retrohepatic inferior vena caval injuries resulting from blunt or penetrating abdominal trauma are rare but devastating events that remain formidable challenges to even the most experienced Level I trauma center team members. Prepackaged atrial caval shunts have improved emergency medical treatments, and prior planning and coordination by perioperative nurses allow for rapid response by surgical team members. These efforts provide an optimal level of care required to increase patient survival. This article provides a general overview of abdominal trauma and retrohepatic inferior vena caval injuries and a proactive plan to meet the needs of patients with these injuries.

Versatile approach to encoding combinatorial organic syntheses using chemically robust secondary amine tags

Encoded combinatorial organic synthesis has recently emerged as a powerful tool for the discovery of biologically active compounds from complex chemical libraries. This report describes a new encoding methodology that uses chemically robust secondary amines as tags. These amines are incorporated into an N-[(dialkylcarbamoyl)methyl]glycine-coding oligomer through simple chemistry that is compatible with a wide range of polymer-supported transformations useful in combinatorial synthesis. In the decoding process acidic hydrolysis of the tagging polymer regenerates the secondary amines, which after dansylation are resolved and detected at sub-picomole levels by reversed-phase HPLC. The versatility of this strategy is demonstrated here by encoded syntheses of members of several representative heterocyclic compound classes, including beta-lactams, 4-thiazolidinones, and pyrrolidines.

Comparison of low-pressure versus standard-pressure fixation Carpentier-Edwards bioprosthesis

Intermediate-phase clinical results of 51 low-pressure (LP) and 234 standard-pressure (SP) fixation porcine Carpentier-Edwards (CE) valves implanted between 1977 and 1991 were compared for valve-related events. Group similarities included New York Heart Association functional class, ejection fraction, and sex. Patients with SP valves were younger (mean age, 58 versus 68 years; p = 0.0001). There were 20 in-hospital deaths (8.6%) in the SP valve group and 5 (9.8%) in the LP valve group (p = 0.79). Follow-up was 99%, with a mean of 104 months in the SP valve group versus 55 months in the SP valve group (p = 0.0001). The actuarial survival rate was 48.2% and 22.3% at 10 and 15 years, respectively, in the SP valve group and 34.1% at 10 years in the LP valve group (p = 0.42). Freedom from events at 5, 10, and 15 years in the SP valve group and at 5 years in the LP valve group was as follows: for late valve-related events, 86.3%, 51.4% and 20.2%, respectively, in the SP valve group versus 85% in the LP valve group (p = 0.44); for valve-related death, 96.4%, 93.6%, and 87.3% in the SP valve group versus 100% in the LP valve group (p = 0.20); for structural valve failure, 96%, 68%, and 35% in the SP valve group versus 100% in the LP valve group (p = 0.09); and for reoperation, 95%, 61%, and 30% in the SP valve group versus 92% in the LP valve group (p = 0.82). In conclusion, this study revealed no significant statistical difference between LP and SP valves. In the LP valve group, structural valve failure/valve-related death was not observed, perhaps indicating a more favorable result. Absolute verification of this trend awaits long-term follow-up.

Energy cost of wearing chemical protective clothing during progressive treadmill walking

While chemical protective (CP) clothing is known to adversely affect physical performance, few data exist regarding the physiological response of wearing US military CP clothing during incremental, dynamic exercise. To quantify the effects of CP clothing on energy cost and to test the hypothesis that the mask contributes little to this effect, oxygen uptake (VO2) and ventilation (VE) were determined in 14 male soldiers who walked on a treadmill at 1.56 m.s-1 for 20 min each at 0, 5, and 10% grades in three clothing conditions: BDU (battledress uniform only), MASK (BDU + M-17 protective mask), and CP clothing (MASK + overgarment, gloves and boots). In BDU's, exercise intensities expressed as %VO2max were 29, 42, and 59% at the three grades, respectively. VO2 was significantly (p < 0.01) greater at all grades (range 13 to 18%) in CP clothing compared to BDU. However, no differences in VO2 were seen between BDU and MASK at any level of exercise. VE was significantly higher at the two highest grades in CP clothing compared to BDU but when expressed relative to VO2 (VE/VO2) was significantly lower at 0% and 5% grades but not at 10%. In the MASK condition, VE was significantly lower at the 10% grade and VE/VO2 was significantly lower at all grades compared to BDU. The results show that despite the mask induced hypoventilation, VO2 is unaffected at exercise intensities up to 60% of VO2max.(ABSTRACT TRUNCATED AT 250 WORDS)

Social facilitation and inhibition of emotional expression and communication

Does the presence of others facilitate or inhibit emotional expression? Female "senders" (n = 45) viewed 12 emotionally loaded slides either alone or with another sender while responses were secretly videotaped. In Study 1, 14 "receivers" guessed the type of slide viewed by dyads more accurately (eta = .366). In Study 2, 42 receivers viewed 10 senders with friends, 10 with strangers, and 10 alone. One dyad member was covered so that only 1 sender was visible. Analysis revealed significant effects of condition (alone, friend, or stranger; eta = .456), slide type (sexual, scenic, unpleasant, or unusual; eta = .325), and the Condition x Slide Type interaction (eta = .350). Strangers had overall inhibitory effects on communication accuracy, whereas friends had facilitative effects on some slides and inhibitory effects on others. Thus, both social facilitation and inhibition of expression occurred on the basis of the emotional stimulus and personal relationship involved.

Social facilitation and inhibition of emotional expression and communication

Does the presence of others facilitate or inhibit emotional expression? Female "senders" (n = 45) viewed 12 emotionally loaded slides either alone or with another sender while responses were secretly videotaped. In Study 1, 14 "receivers" guessed the type of slide viewed by dyads more accurately (eta = .366). In Study 2, 42 receivers viewed 10 senders with friends, 10 with strangers, and 10 alone. One dyad member was covered so that only 1 sender was visible. Analysis revealed significant effects of condition (alone, friend, or stranger; eta = .456), slide type (sexual, scenic, unpleasant, or unusual; eta = .325), and the Condition x Slide Type interaction (eta = .350). Strangers had overall inhibitory effects on communication accuracy, whereas friends had facilitative effects on some slides and inhibitory effects on others. Thus, both social facilitation and inhibition of expression occurred on the basis of the emotional stimulus and personal relationship involved.

Pulse voltammetry at microcylinder electrodes

Microcylindrical electrodes are easier to construct and maintain than microdisk electrodes. In the normal-pulse mode, ranges of time parameters and electrode sizes can be found such that depletion of reactant is unimportant and the response to the analysis pulse is predicted by theory for planar conditions. Similarly, ranges of parameters are found for reverse-pulse voltammetry such that the potential-dependent response can be treated as a sequence of individual double-pulse responses. Cylindrical diffusion and convection act to replenish reactant quickly near the electrode and thus permit overall experiment times in the range of seconds. For square-wave voltammetry the shape and position of the net current response are independent of the extent of cylindrical diffusion.

A rapid method for standardization of the gated radionuclide left ventricular ejection fraction

Radionuclide ventriculography has become the standard method for serially evaluating left ventricular ejection fraction (EF). The "gold standard" for evaluating EF is the contrast ventriculogram, which uses mathematical models to arrive at the volumes used to calculate EF. These models are subject to possible error. This paper reports the standardization of volume measurements of a digital angiographic camera system using a series of cardiac phantoms and the correlation of measurement of the EF of a series of patients whose EF was determined by digital angiography and radionuclide ventriculography.

Five cases of Thermopsis poisoning

Various Thermopsis species are found in the foothills and plains of the Rocky Mountains. There are no reported cases of human ingestion to Thermopsis reported in the literature. We report 5 cases of ingestion of seeds or flowers where the primary symptoms were nausea, vomiting and headache of several hours duration. As few as 6 seeds produced symptoms. The common names used by parents when calling the poison center could have easily lead to misidentification and a careful history and subsequent professional identification were required to ascertain the actual plant involved.

Fibroblast stimulation in schistosomiasis. VII. Egg granulomas secrete factors that stimulate collagen and fibronectin synthesis

Tissue fibrosis in schistosomiasis is largely responsible for the important morbidity that results from infection with the trematode worms, Schistosoma. Neither the migrating larval forms (cercariae) nor the intravascular adult worms appear to incite pathological responses that are important in chronic schistosomiasis. On the other hand, eggs deposited in tissue incite chronic granulomatous inflammatory responses that are the hallmark of infection and precede the onset of adjacent tissue fibrosis. We previously reported that products of the egg granulomas can stimulate a number of relevant responses in fibroblast cultures that in vivo would be expected to promote tissue fibrosis. We report here that the granulomas secrete factors that in vitro can stimulate collagen and fibronectin synthesis in fibroblasts. We determined that activity stimulating collagen synthesis is congruent to 10 Kd (gel filtration) with a pI of congruent to 5.5 (isoelectric focusing); additional activity is also detected in some other fractions (congruent to Kd; pI approximately 7.0). In contrast, the activity stimulating fibronectin synthesis was congruent to 22 Kd with a pI of 5.5. Activity was also present in fractions of 50 Kd with pI of approximately 7.5. Fibroblasts grown in granuloma supernatant-containing medium contained greater steady-state levels of specific mRNA coding for type I procollagen and fibronectin compared with cells cultured in unsupplemented medium. These observations support the hypothesis that biologically active molecules secreted by granuloma cells are instrumental in the initiation of tissue fibrosis in schistosomiasis.

Fibroblast stimulation in schistosomiasis. VII. Egg granulomas secrete factors that stimulate collagen and fibronectin synthesis

Tissue fibrosis in schistosomiasis is largely responsible for the important morbidity that results from infection with the trematode worms, Schistosoma. Neither the migrating larval forms (cercariae) nor the intravascular adult worms appear to incite pathological responses that are important in chronic schistosomiasis. On the other hand, eggs deposited in tissue incite chronic granulomatous inflammatory responses that are the hallmark of infection and precede the onset of adjacent tissue fibrosis. We previously reported that products of the egg granulomas can stimulate a number of relevant responses in fibroblast cultures that in vivo would be expected to promote tissue fibrosis. We report here that the granulomas secrete factors that in vitro can stimulate collagen and fibronectin synthesis in fibroblasts. We determined that activity stimulating collagen synthesis is congruent to 10 Kd (gel filtration) with a pI of congruent to 5.5 (isoelectric focusing); additional activity is also detected in some other fractions (congruent to Kd; pI approximately 7.0). In contrast, the activity stimulating fibronectin synthesis was congruent to 22 Kd with a pI of 5.5. Activity was also present in fractions of 50 Kd with pI of approximately 7.5. Fibroblasts grown in granuloma supernatant-containing medium contained greater steady-state levels of specific mRNA coding for type I procollagen and fibronectin compared with cells cultured in unsupplemented medium. These observations support the hypothesis that biologically active molecules secreted by granuloma cells are instrumental in the initiation of tissue fibrosis in schistosomiasis.

Comparative anaerobic power of men and women

The purpose of this study was to determine the differences in anaerobic power (AnP) between men and women and the contribution of anthropometric variables in accounting for these differences. There were 18 female and 19 male subjects who performed the 30-s Wingate test where power outputs in watts are expressed as mean power (MP, the mean for 30 s) and peak power (PP, the highest 5-s interval). Thigh volume (TV), lean body mass (LBM) and body weight (BW) were used as anthropometric variables. Absolute AnP of men was 35% and 40% higher (p less than 0.001) than that of women for PP and MP, respectively. These differences decreased to 10% and 17% for PP and MP when expressed relative to kg LBM. Anthropometric variables explained less than 50% of the variation in PP and MP for men, while in women, TV accounted for 66% and 71% of the variation in PP and MP, respectively. When the data were combined, TV, BW, and LBM explained 48%, 74%, and 79% of variation in MP and 53%, 71%, and 76% in PP, respectively. These data show that gender differences in indices of AnP are similar to those reported for muscular strength and aerobic power. Additionally, a larger portion of the between gender variation compared to the within gender variation in AnP can be accounted for by anthropometric variables.

Oral intake of phosphorus can determine the serum concentration of 1,25-dihydroxyvitamin D by determining its production rate in humans

Changes in the oral intake of phosphorus could induce the reported changes in the serum concentration of 1,25-dihydroxyvitamin D (1,25-(OH)2D) by inducing changes in its production rate (PR) or metabolic clearance rate (MCR), or both. To investigate these possibilities, we employed the constant infusion equilibrium technique to measure the PR and MCR of 1,25-(OH)2D in six healthy men in whom the oral intake of phosphorus was initially maintained at 1,500 mg/70 kg body weight per d for 9 d, then restricted to 500 mg/d (coupled with oral administration of aluminum hydroxide) for 10 d, and then supplemented to 3,000 mg/d for 10 d. With phosphorus restriction, the serum concentration of 1,25-(OH)2D increased by 80% from a mean of 38 +/- 3 to 68 +/- 6 pg/ml, P less than 0.001; the PR increased from 1.8 +/- 0.2 to 3.8 +/- 0.6 micrograms/d, P less than 0.005; the MCR did not change significantly. The fasting serum concentration of phosphorus decreased from 3.5 +/- 0.2 to 2.6 +/- 0.2 mg/dl, P less than 0.01. With phosphorus supplementation, the serum concentration of 1,25-(OH)2D decreased abruptly, reaching a nadir within 2 to 4 d; after 10 d of supplementation, the mean concentration of 27 +/- 4 pg/ml was lower by 29%, P less than 0.01, than the value measured when phosphorus intake was normal. The PR decreased to 1.3 +/- 0.2 micrograms/d, P less than 0.05; the MCR did not change significantly. The fasting serum concentration of phosphorus increased significantly, but only initially. These data demonstrate that in healthy men, reductions and increases in the oral intake of phosphorus can induce rapidly occurring, large, inverse, and persisting changes in the serum concentration of 1,25-(OH)2D. Changes in the PR of 1,25-(OH)2D account entirely for the phosphorus-induced changes in serum concentration of this hormone.

Maximal power outputs during the Wingate anaerobic test

The purpose of this study was to determine the resistance loads which elicit maximal values of power output (PO) during performance of the Wingate test (WT). Nineteen male subjects (mean age, 25.1 yrs; mean VO2 max, 3.52 l/min) performed multiple WTs in a random order at resistances ranging from 3.23 to 6.76 joules/pedal rev/kg BW. Tests were carried out on a Monark cycle ergometer modified to permit instantaneous application of resistance. Revolutions were determined by a computer interfaced frequency counter. The mean resistances eliciting the highest peak power (PP) and mean power (MP) outputs were 5.65 and 5.53 joules/pedal rev/kg BW, respectively (average of 5.59 joules/pedal rev/kg BW). Both PP and MP were significantly higher (15.5% and 13.0%, respectively) using a resistance load of 5.59 compared to the Wingate setting of 4.41 joules/pedal rev/kg BW. The test-retest reliability for PP and MP ranged between 0.91 and 0.93 at both resistance loads. Body weight and thigh volume did not significantly estimate the individual resistances eliciting maximal POs. The data suggest that resistance be assigned according to the subjects BW but consideration be given to increasing the resistance from that presently used in various laboratories.