Peak vertical jump power estimations in youths and young adults

The purpose of this study was to develop and validate a regression equation to estimate peak power (PP) using a large sample of athletic youths and young adults. Anthropometric and vertical jump ground reaction forces were collected from 460 male volunteers (age: 12-24 years). Of these 460 volunteers, a stratified random sample of 45 subjects representing 3 different age groups (12-15 years [n = 15], 16-18 years [n = 15], and 19-24 years [n = 15]) was selected as a validation sample. Data from the remaining 415 subjects were used to develop a new equation ("Novel") to estimate PP using age, body mass (BM), and vertical jump height (VJH) via backward stepwise regression. Independently, age (r = 0.57), BM (r = 0.83), and VJ (r = 0.65) were significantly (p < 0.05) correlated with PP. However, age did not significantly (p = 0.53) contribute to the final prediction equation (Novel): PP (watts) = 63.6 × VJH (centimeters) + 42.7 × BM (kilograms) - 1,846.5 (r = 0.96; standard error of the estimate = 250.7 W). For each age group, there were no differences between actual PP (overall group mean ± SD: 3,244 ± 991 W) and PP estimated using Novel (3,253 ± 1,037 W). Conversely, other previously published equations produced PP estimates that were significantly different than actual PP. The large sample size used in this study (n = 415) likely explains the greater accuracy of the reported Novel equation compared with previously developed equations (n = 17-161). Although this Novel equation can accurately estimate PP values for a group of subjects, between-subject comparisons estimating PP using Novel or any other previously published equations should be interpreted with caution because of large intersubject error (± >600 W) associated with predictions.     

Computerized analysis of the acetylcholinesterase distribution in the rabbit hippocampal region

Summary The distribution of acetylcholinesterase (AChE) was analysed in the hippocampal region of the rabbit, employing computerized optical densitometry (COD). AChE was demonstrated histochemically according to a modification of the copper thiocholine method, and computerized analysis was performed on a selected section with the use of a graphic operating processor, resulting in images with pixel values ranging between 0 and 255, measuring 512 × 512 pixels. Examples of the densitometric analysis include presentation of pixel values in single points, in profiles through selected areas and in slicing procedures. The results of the densitometric analysis basically agreed with the subjective visual impression of different staining intensities in the sections and corresponding photomicrographs. However, the densitometric analysis provided an objective and more exact expression of the relative AChE content of the different subfields and layers of the hippocampal region. In particular, zones with the same enzyme content as well as zones differing only minimally in activity can be recognized easily and unequivocally. In view of this, the promising future uses of COD are considered briefly.     

Field Evaluation of Two Rapid Diagnostic Tests for Neisseria meningitidis Serogroup A during the 2006 Outbreak in Niger

The Pastorex^® (BioRad) rapid agglutination test is one of the main rapid diagnostic tests (RDTs) for meningococcal disease currently in use in the “meningitis belt”. Earlier evaluations, performed after heating and centrifugation of cerebrospinal fluid (CSF) samples, under good laboratory conditions, showed high sensitivity and specificity. However, during an epidemic, the test may be used without prior sample preparation. Recently a new, easy-to-use dipstick RDT for meningococcal disease detection on CSF was developed by the Centre de Recherche Médicale et Sanitaire in Niger and the Pasteur Institute in France. We estimate diagnostic accuracy in the field during the 2006 outbreak of Neisseria meningitidis serogroup A in Maradi, Niger, for the dipstick RDT and Pastorex^® on unprepared CSF, (a) by comparing each test''s sensitivity and specificity with previously reported values; and (b) by comparing results for each test on paired samples, using McNemar''s test. We also (c) estimate diagnostic accuracy of the dipstick RDT on diluted whole blood. We tested unprepared CSF and diluted whole blood from 126 patients with suspected meningococcal disease presenting at four health posts. (a) Pastorex^® sensitivity (69%; 95%CI 57–79) was significantly lower than found previously for prepared CSF samples [87% (81–91); or 88% (85–91)], as was specificity [81% (95%CI 68–91) vs 93% (90–95); or 93% (87–96)]. Sensitivity of the dipstick RDT [89% (95%CI 80–95)] was similar to previously reported values for ideal laboratory conditions [89% (84–93) and 94% (90–96)]. Specificity, at 62% (95%CI 48–75), was significantly lower than found previously [94% (92–96) and 97% (94–99)]. (b) McNemar''s test for the dipstick RDT vs Pastorex^® was statistically significant (p<0.001). (c) The dipstick RDT did not perform satisfactorily on diluted whole blood (sensitivity 73%; specificity 57%).Sensitivity and specificity of Pastorex^® without prior CSF preparation were poorer than previously reported results from prepared samples; therefore we caution against using this test during an epidemic if sample preparation is not possible. For the dipstick RDT, sensitivity was similar to, while specificity was not as high as previously reported during a more stable context. Further studies are needed to evaluate its field performance, especially for different populations and other serogroups.     

The reliability and reproducibility of foot type measurements using a mirrored foot photo box and digital photography compared to caliper measurements

The height of the medial longitudinal arch (MLA) is thought to be a predisposing factor to various lower extremity injuries. Discrepancy exists as to whether MLA height plays a role in injury prevention. The purpose of this study was to determine the intertester and intratester reliability, and the validity of the mirrored foot photo box (MFPB) and caliper measurements to radiographic measurements. METHODS: Thirty subjects with equal numbers of men and women were recruited. Both feet were tested (n=60) in a 90% weight bearing stance. A set of anatomic landmarks were palpated, marked, and measured using a caliper, MFPB, and radiographs. The protocol was completed by two testers on 2 days approximately 1 week apart. Intertester and intratester reliability were determined using the intraclass correlation coefficient (ICC)(2,k) and the ICC(2,1), respectively. Validity of both measurement techniques to radiographic measurements was determined using the ICC(2,k). RESULTS: The intertester reliability ranged from 0.991 to 0.577, while the intratester reliability ranged from 0.994 to 0.527, with first metatarsal angle being the only variable with poor reliability. Most variables demonstrated acceptable validity between the MFPB and the caliper measurements, and acceptable validity between the MFPB and calipers compared to radiographic measurements. The MFPB took 51.3+/-19.6s per foot while the caliper measurements averaged 227.4+/-68.9s to complete the measurements. DISCUSSION: The MFPB is as reliable as the caliper measurements, and offers better intertester reliability. Both the caliper and MFPB measurements demonstrated acceptable validity to radiographic measurements and testing time was reduced when using the MFPB compared to calipers.     

Combining rapid diagnostic tests to estimate primary and post-primary dengue immune status at the point of care

BackgroundCharacterising dengue virus (DENV) infection history at the point of care is challenging as it relies on intensive laboratory techniques. We investigated how combining different rapid diagnostic tests (RDTs) can be used to accurately determine the primary and post-primary DENV immune status of reporting patients during diagnosis.Methods and findingsSerum from cross-sectional surveys of acute suspected dengue patients in Indonesia (N:200) and Vietnam (N: 1,217) were assayed using dengue laboratory assays and RDTs. Using logistic regression modelling, we determined the probability of being DENV NS1, IgM and IgG RDT positive according to corresponding laboratory viremia, IgM and IgG ELISA metrics. Laboratory test thresholds for RDT positivity/negativity were calculated using Youden’s J index and were utilized to estimate the RDT outcomes in patients from the Philippines, where only data for viremia, IgM and IgG were available (N:28,326). Lastly, the probabilities of being primary or post-primary according to every outcome using all RDTs, by day of fever, were calculated. Combining NS1, IgM and IgG RDTs captured 94.6% (52/55) and 95.4% (104/109) of laboratory-confirmed primary and post-primary DENV cases, respectively, during the first 5 days of fever. Laboratory test predicted, and actual, RDT outcomes had high agreement (79.5% (159/200)). Among patients from the Philippines, different combinations of estimated RDT outcomes were indicative of post-primary and primary immune status. Overall, IgG RDT positive results were confirmatory of post-primary infections. In contrast, IgG RDT negative results were suggestive of both primary and post-primary infections on days 1–2 of fever, yet were confirmatory of primary infections on days 3–5 of fever.ConclusionWe demonstrate how the primary and post-primary DENV immune status of reporting patients can be estimated at the point of care by combining NS1, IgM and IgG RDTs and considering the days since symptoms onset. This framework has the potential to strengthen surveillance operations and dengue prognosis, particularly in low resource settings.     

Dental histology: study of aging processes in root dentine

The amount of sclerotic root dentine increases with age, proceeding from the apex towards the crown. There are obvious optical changes in the tissue, which becomes translucent (dentine is normally opaque). Therefore, the sclerosis of root dentine could be a reliable indicator of age in anthropological studies of human remains. We studied the histological aspects of sclerotic dentine in longitudinal thin sections (70-140 microns) of undecalcified premolars, cut in the bucco-lingual plane. To quantify the sclerosis and to construct a reference standard, we sectioned 85 premolars from subjects of known age (70 from odontological extractions and 15 from a university collection). Another 10 teeth from medieval subjects were studied to assess the applicability of the method to ancient skeletal collections. The technique consists of embedding the tooth in a polyester resin (cold method), sectioning it with a diamond blade microtome. Qualitative analysis was performed with polarized light microscopy and measurements were made with a quote 2D x,y viewer and on digital images. The sclerotic root dentine was quantified with both linear and surface area parameters in order to assess the correlation with age. The quality of the sections was sufficient for the clear discernment and quantification of the sclerotic dentine. Indeed, the technique allowed us to obtain good results with a considerable saving of time and money compared with other dental histological techniques. The best correlation with age was obtained from the surface area parameter, particularly after exclusion of the cementum and pulp chamber. To produce comparable data from similar studies, we advise the use of cold resins, as used here, and digital computerized analyzers because of their accuracy, precision and quickness. The qualitative analysis of the ancient teeth indications that this dental aging techniques can be applied to both recent and ancient dental tissues.     

Intra and intersession reliability of balance measures during one-leg standing in young adults

A study was designed to investigate the intra and intersession reliability during 1-leg standing recorded from a computerized balance platform. Thirty-nine healthy young men (n = 17, age range: 20-30 years) and women (n = 22, age range: 21-28 years) performed 3 testing sessions, with the second session 30 minutes (intrasession comparison) and the third session 1 week (intersession comparison) after the initial testing session. Within each testing session, participants completed 3 trials of 1-leg standing with their dominant leg. Reliability statistics were calculated using the mean of all 3 trials during each session for 6 balance measures (i.e., total displacements of the center of pressure [CoP], the CoP displacements in mediolateral and anterior-posterior directions, and the CoP speed and CoP area and their SD). Test-retest reliability was examined calculating both, intraclass correlation coefficient (ICC) with 95% confidence interval (95% CI) and Bland-Altman plots. In both sexes and irrespective of balance measure, ICC values were ≥0.75 except for 1 parameter in men. This indicates an excellent intra and intersession reliability. Bland-Altman plots confirmed these findings by showing that only 1 or 2 (4.5-11.8%) of the data points were beyond the 95% CI. Practitioners and clinicians are provided with a posturographic test setup that proved to be reliable. Researchers can use these data to identify the range in which the true value of a subject's score lies and estimate a priori sample sizes.     

Efficiency of Household Reactive Case Detection for Malaria in Rural Southern Zambia: Simulations Based on Cross-Sectional Surveys from Two Epidemiological Settings

Background

Case detection and treatment are critical to malaria control and elimination as infected individuals who do not seek medical care can serve as persistent reservoirs for transmission.

Methods

Household malaria surveys were conducted in two study areas within Southern Province, Zambia in 2007 and 2008. Cross-sectional surveys were conducted approximately five times throughout the year in each of the two study areas. During study visits, adults and caretakers of children were administered a questionnaire and a blood sample was obtained for a rapid diagnostic test (RDT) for malaria. These data were used to estimate the proportions of individuals with malaria potentially identified through passive case detection at health care facilities and those potentially identified through reactive case finding. Simulations were performed to extrapolate data from sampled to non-sampled households. Radii of increasing size surrounding households with an index case were examined to determine the proportion of households with an infected individual that would be identified through reactive case detection.

Results

In the 2007 high transmission setting, with a parasite prevalence of 23%, screening neighboring households within 500 meters of an index case could have identified 89% of all households with an RDT positive resident and 90% of all RDT positive individuals. In the 2008 low transmission setting, with a parasite prevalence of 8%, screening neighboring households within 500 meters of a household with an index case could have identified 77% of all households with an RDT positive resident and 76% of all RDT positive individuals.

Conclusions

Testing and treating individuals residing within a defined radius from an index case has the potential to be an effective strategy to identify and treat a large proportion of infected individuals who do not seek medical care, although the efficiency of this strategy is likely to decrease with declining parasite prevalence.     

Expected long-term survival of older patients diagnosed with non-Hodgkin lymphoma in 2008-2012

Background: New therapeutic options have led to substantial increases in survival expectations of patients with non-Hodgkin lymphoma (NHL) in recent years. In contrast to many malignancies, survival in older patients has improved in NHL at a rate similar to that in younger patients. In the past, the impact of innovations on long-term survival of NHL patients on the population level has been disclosed only with substantial delay. Methods: We employ a novel model-based projection method to estimate survival expectations of NHL patients age 60+ diagnosed in 2008–2012. Preliminary empirical evaluation of the method using historical data indicates excellent performance in projection of age specific and overall 5- and 10-year relative survival. Results: Overall 5- and 10-year survival projections for 2008–2012 were 67.5% and 56.9%, respectively, 8.2 percentage units (% units) and 15.2% units, respectively, higher than the most recent survival estimates available from traditional cohort analysis. Projected survival decreased with age, ranging from 79.1% for patients age 60–64 to 54.3% for patients age 80+. Projected survival estimates for diffuse large B-cell lymphoma and follicular lymphoma were 59% and 84.9%, respectively. Survival estimates by model-based projection were substantially higher than available cohort estimates for all age groups including 80+, each specific morphology examined, nodal and extranodal disease, and both genders. Conclusions: Patients over 60 diagnosed with NHL in 2008–2012 have much higher long-term survival expectations than suggested by previously available survival statistics.     

Field Application of SD Bioline Malaria Ag Pf/Pan Rapid Diagnostic Test for Malaria in Greece

Greece, a malaria-free country since 1974, has experienced re-emergence of Plasmodium vivax autochthonous malaria cases in some agriculture areas over the last three years. In early 2012, an integrated control programme (MALWEST Project) was launched in order to prevent re-establishment of the disease. In the context of this project, the rapid diagnostic tests (RDT) of SD Bioline Malaria Ag Pf/Pan that detects hrp-2 and pan-LDH antigens were used. The aim of this study was to assess the field application of the RDT for the P. vivax diagnosis in comparison to light microscopy and polymerase chain reaction (PCR). A total of 955 samples were tested with all three diagnostic tools. Agreement of RDT against microscopy and PCR for the diagnosis of P. vivax was satisfactory (K value: 0.849 and 0.976, respectively). The sensitivity, specificity and positive predictive value of RDT against PCR was 95.6% (95% C.I.: 84.8-99.3), 100% (95% C.I.: 99.6-100.0) and 100% (95% CI: 91.7-100.0) respectively, while the sensitivity, specificity and positive predictive value of RDT against microscopic examination was 97.4% (95% C.I.: 86.1-99.6), 99.4% (95% C.I.: 98.6-99.8) and 86.1% (95% CI: 72.1-94.7), respectively. Our results indicate that RDT performed satisfactory in a non-endemic country and therefore is recommended for malaria diagnosis, especially in areas where health professionals lack experience on light microscopy.     

Effects of malaria volunteer training on coverage and timeliness of diagnosis: a cluster randomized controlled trial in Myanmar

ABSTRACT: BACKGROUND: The use of community volunteers is expected to improve access to accurate diagnosis and timely treatment of malaria, using rapid diagnostic test (RDT) and artemisinin-based combination therapy (ACT). However, empirical data from the field are still limited. The aim of this study was to assess whether training village volunteers on the use of Paracheck-Pf(R) RDT and ACT (artemether-lumefantrine (AL)) for Plasmodium falciparum and presumptive treatment with chloroquine for Plasmodium vivax had an effect on the coverage of timely diagnosis and treatment and on mortality in malaria-endemic villages without health staff in Myanmar. METHODS: The study was designed as a cluster randomized controlled trial with a cross-sectional survey at baseline, a monthly visit for six months following the intervention (village volunteers trained and equipped with Paracheck-Pf(R)) and an endline survey at six months follow-up. Survey data were supplemented by the analysis of logbooks and field-based verbal autopsies. Villages with midwives (MW) in post were used as a third comparison group in the endline survey. Intention-to-treat analysis was used. RESULTS: Of 38 villages selected, 21 were randomly assigned to the intervention (two villages failed to participate) and 17 to the comparison group. The two groups had comparable baseline statistics. The blood tests provided by volunteers every month declined over time from 279 tests to 41 but not in MW group in 18 villages (from 326 to 180). In the endline survey, among interviewed subjects (268 intervention, 287 in comparison, 313 in MW), the coverage of RDT was low in all groups (14.9%, SE 2.4% in intervention; 5.7%, SE 1.7% in comparison; 21.4%, SE 2.6% in MW) although the intervention (OR 3.2, 95% CI 1.5-6.7) and MW (OR 5.4, 95% CI 2.6-11.0) were more likely to receive a blood test. Mean (SE) of blood tests after onset of fever in days was delayed (intervention 3.6 (0.3); comparison 4.8 (1.3); MW 3.2 (0.4)). Malaria mortality rates per 100,000 populations in a year were not significantly different (intervention 130 SE 37; comparison 119 SE 34; MW 50 SE 18). None of the dead cases had consulted volunteers. CONCLUSIONS: The results show that implementing volunteer programmes to improve the coverage of accurate and timely diagnosis with RDT and early treatment may be beneficial but the timeliness of detection and sustainability must be improved.     

Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image.

A single abdominal cross-sectional computerized axial tomography and magnetic resonance image is often obtained in studies examining adipose tissue (AT) distribution. An abdominal image might also provide additional useful information on total body skeletal muscle (SM) and AT volumes with related physiological insights. We therefore investigated the relationships between abdominal SM and AT areas from single images and total body component volumes in a large and diverse sample of healthy adult subjects. Total body SM and AT volumes were derived by whole body multislice magnetic resonance imaging in 123 men [age (mean +/- SD) of 41.6 +/- 15.8 yr; body mass index of 25.9 +/- 3.4 kg/m(2)] and 205 women (age of 47.8 +/- 18.7 yr; body mass index of 26.7 +/- 5.6 kg/m(2)). Single abdominal SM and AT slice areas were highly correlated with total body SM (r = 0.71-0.92; r = 0.90 at L(4)-L(5) intervertebral space) and AT (r = 0.84-0.96; r = 0.94 at L(4)-L(5) intervertebral space) volumes, respectively. R(2) increased by only 5.7-6.1% for SM and 2.7-4.4% for AT with the inclusion of subject sex, age, ethnicity, scanning position, body mass index, and waist circumference in the model. The developed SM and AT models were validated in an additional 49 subjects. To achieve equivalent power to a study measuring total body SM or AT volumes, a study using a single abdominal image would require 17-24% more subjects for SM and 6-12% more subjects for AT. Measurement of a single abdominal image can thus provide estimates of total body SM and AT for group studies of healthy adults.     

Optimal Caliper Width for Propensity Score Matching of Three Treatment Groups: A Monte Carlo Study

Propensity score matching is a method to reduce bias in non-randomized and observational studies. Propensity score matching is mainly applied to two treatment groups rather than multiple treatment groups, because some key issues affecting its application to multiple treatment groups remain unsolved, such as the matching distance, the assessment of balance in baseline variables, and the choice of optimal caliper width. The primary objective of this study was to compare propensity score matching methods using different calipers and to choose the optimal caliper width for use with three treatment groups. The authors used caliper widths from 0.1 to 0.8 of the pooled standard deviation of the logit of the propensity score, in increments of 0.1. The balance in baseline variables was assessed by standardized difference. The matching ratio, relative bias, and mean squared error (MSE) of the estimate between groups in different propensity score-matched samples were also reported. The results of Monte Carlo simulations indicate that matching using a caliper width of 0.2 of the pooled standard deviation of the logit of the propensity score affords superior performance in the estimation of treatment effects. This study provides practical solutions for the application of propensity score matching of three treatment groups.     

Muscle mass during childhood--relationship to skeletal development

Bone densitometric data often are difficult to interpret in children and adolescents because of large inter- and intraindividual variations in bone size. Here, we propose a functional approach to bone densitometry that addresses two questions: Is bone strength normally adapted to the largest physiological loads, that is, muscle force? Is muscle force adequate for body size? To implement this approach, forearm muscle cross-sectional area (CSA) and bone mineral content (BMC) of the radial diaphysis were measured in 349 healthy subjects from 6 to 19 years of age (183 girls), using peripheral quantitative computed tomography (pQCT). This functional approach to pediatric bone densitometric data should be adaptable to a variety of densitometric techniques.     

Increased use of malaria rapid diagnostic tests improves targeting of anti-malarial treatment in rural Tanzania: implications for nationwide rollout of malaria rapid diagnostic tests

ABSTRACT: BACKGROUND: The World Health Organization recommends parasitological confirmation of all malaria cases. Tanzania is implementing a phased rollout of malaria rapid diagnostic tests (RDTs) for routine use in all levels of care as one strategy to increase parasitological confirmation of malaria diagnosis. This study was carried out to evaluated artemisinin combination therapy (ACT) prescribing patterns in febrile patients with and without uncomplicated malaria in one pre-RDT implementation and one post-RDT implementation area. METHODS: A cross-sectional health facility surveys was conducted during high and low malaria transmission seasons in 2010 in both areas. Clinical information and a reference blood film on all patients presenting for an initial illness consultation were collected. Malaria was defined as a history of fever in the past 48 hours and microscopically confirmed parasitaemia. Routine diagnostic testing was defined as RDT or microscopy ordered by the health worker and performed at the health facility as part of the health worker-patient consultation. Correct diagnostic testing was defined as febrile patient tested with RDT or microscopy. Over-testing was defined as a febrile patient tested with RDT or microscopy. Correct treatment was defined as patient with malaria prescribed ACT. Over-treatment was defined as patient without malaria prescribed ACT. RESULTS: A total of 1,247 febrile patients (627 from pre-implementation area and 620 from post-implementation area) were included in the analysis. In the post-RDT implementation area, 80.9% (95% CI, 68.2-89.3) of patients with malaria received recommended treatment with ACT compared to 70.3% (95% CI, 54.7-82.2) of patients in the pre-RDT implementation area. Correct treatment was significantly higher in the post-implementation area during high transmission season (85.9% (95%CI, 72.0-93.6) compared to 58.3% (95%CI, 39.4-75.1) in pre-implementation area (p=0.01). Over-treatment with ACT of patients without malaria was less common in the post-RDT implementation area (20.9%; 95% CI, 14.7-28.8) compared to the pre-RDT implementation area (45.8%; 95% CI, 37.2-54.6) (p<0.01) in high transmission. The odds of overtreatment was significantly lower in post- RDT area (adjusted Odds Ratio (OR: 95%CI) 0.57(0.36-0.89); and much higher with clinical diagnosis adjusted OR (95%CI) 2.24(1.37-3.67) CONCLUSION: Implementation of RDTs increased use of RDTs for parasitological confirmation and reduced over-treatment with ACT during high malaria transmission season in one area in Tanzania. Continued monitoring of the national RDT rollout will be needed to assess whether these changes in case management practices will be replicated in other areas and sustained over time. Additional measures (such as refresher trainings, closer supervisions, etc) may be needed to improve ACT targeting during low transmission seasons.     

Estimation of skeletal muscle mass by bioelectrical impedance analysis.

The purpose of this study was to develop and cross-validate predictive equations for estimating skeletal muscle (SM) mass using bioelectrical impedance analysis (BIA). Whole body SM mass, determined by magnetic resonance imaging, was compared with BIA measurements in a multiethnic sample of 388 men and women, aged 18-86 yr, at two different laboratories. Within each laboratory, equations for predicting SM mass from BIA measurements were derived using the data of the Caucasian subjects. These equations were then applied to the Caucasian subjects from the other laboratory to cross-validate the BIA method. Because the equations cross-validated (i.e., were not different), the data from both laboratories were pooled to generate the final regression equation SM mass (kg) = [(Ht²/ R x 0.401) + (gender x 3.825) + (age x -0. 071)] + 5.102 where Ht is height in centimeters; R is BIA resistance in ohms; for gender, men = 1 and women = 0; and age is in years. The r(2) and SE of estimate of the regression equation were 0.86 and 2.7 kg (9%), respectively. The Caucasian-derived equation was applicable to Hispanics and African-Americans, but it underestimated SM mass in Asians. These results suggest that the BIA equation provides valid estimates of SM mass in healthy adults varying in age and adiposity.     

Improvement of in vivo genotoxicity assessment: combination of acute tests and integration into standard toxicity testing

A working group convened at the 2009 5th IWGT to discuss possibilities for improving in vivo genotoxicity assessment by investigating possible links to standard toxicity testing. The working group considered: (1) combination of acute micronucleus (MN) and Comet assays into a single study, (2) integration of MN assays into repeated-dose toxicity (RDT) studies, (3) integration of Comet assays into RDT studies, and (4) requirements for the top dose when integrating genotoxicity measurements into RDT studies. The working group reviewed current requirements for in vivo genotoxicity testing of different chemical product classes and identified opportunities for combination and integration of genotoxicity endpoints for each class. The combination of the acute in vivo MN and Comet assays was considered by the working group to represent a technically feasible and scientifically acceptable alternative to conducting independent assays. Two combination protocols, consisting of either a 3- or a 4-treament protocol, were considered equally acceptable. As the integration of MN assays into RDT studies had already been discussed in detail in previous IWGT meetings, the working group focussed on factors that could affect the results of the integrated MN assay, such as the possible effects of repeated bleeding and the need for early harvests. The working group reached the consensus that repeated bleeding at reasonable volumes is not a critical confounding factor for the MN assay in rats older than 9 weeks of age and that rats bled for toxicokinetic investigations or for other routine toxicological purposes can be used for MN analysis. The working group considered the available data as insufficient to conclude that there is a need for an early sampling point for MN analysis in RDT studies, in addition to the routine determination at terminal sacrifice. Specific scenarios were identified where an additional early sampling can have advantages, e.g., for compounds that exert toxic effects on hematopoiesis, including some aneugens. For the integration of Comet assays into RDT studies, the working group reached the consensus that, based upon the limited amount of data available, integration is scientifically acceptable and that the liver Comet assay can complement the MN assay in blood or bone marrow in detecting in vivo genotoxins. Practical issues need to be considered when conducting an integrated Comet assay study. Freezing of tissue samples for later Comet assay analysis could alleviate logistical problems. However, the working group concluded that freezing of tissue samples can presently not be recommended for routine use, although it was noted that results from some laboratories look promising. Another discussion topic centred around the question as to whether tissue toxicity, which is more likely observed in RDT than in acute toxicity studies, would affect the results of the Comet assay. Based on the available data from in vivo studies, the working group concluded that there are no clear examples where cytotoxicity, by itself, generates increases or decreases in DNA migration. The working group identified the need for a refined guidance on the use and interpretation of cytotoxicity methods used in the Comet assay, as the different methods used generally lead to inconsistent conclusions. Since top doses in RDT studies often are limited by toxicity that occurs only after several doses, the working group discussed whether the sensitivity of integrated genotoxicity studies is reduced under these circumstances. For compounds for which in vitro genotoxicity studies yielded negative results, the working group reached the consensus that integration of in vivo genotoxicity endpoints (typically the MN assay) into RDT studies is generally acceptable. If in vitro genotoxicity results are unavailable or positive, consensus was reached that the maximum tolerated dose (MTD) is acceptable as the top dose in RDT studies in many cases, such as when the RDT study MTD or exposure is close (50% or greater) to an acute study MTD or exposure. Finally, the group agreed that exceptions to this general rule might be acceptable, for example when human exposure is lower than the preclinical exposure by a large margin.     

False Positivity of Non-Targeted Infections in Malaria Rapid Diagnostic Tests: The Case of Human African Trypanosomiasis

Background

In endemic settings, diagnosis of malaria increasingly relies on the use of rapid diagnostic tests (RDTs). False positivity of such RDTs is poorly documented, although it is especially relevant in those infections that resemble malaria, such as human African trypanosomiasis (HAT). We therefore examined specificity of malaria RDT products among patients infected with Trypanosoma brucei gambiense.

Methodology/Principal Findings

Blood samples of 117 HAT patients and 117 matched non-HAT controls were prospectively collected in the Democratic Republic of the Congo. Reference malaria diagnosis was based on real-time PCR. Ten commonly used malaria RDT products were assessed including three two-band and seven three-band products, targeting HRP-2, Pf-pLDH and/or pan-pLDH antigens. Rheumatoid factor was determined in PCR negative subjects. Specificity of the 10 malaria RDT products varied between 79.5 and 100% in HAT-negative controls and between 11.3 and 98.8% in HAT patients. For seven RDT products, specificity was significantly lower in HAT patients compared to controls. False positive reactions in HAT were mainly observed for pan-pLDH test lines (specificities between 13.8 and 97.5%), but also occurred frequently for the HRP-2 test line (specificities between 67.9 and 98.8%). The Pf-pLDH test line was not affected by false-positive lines in HAT patients (specificities between 97.5 and 100%). False positivity was not associated to rheumatoid factor, detected in 7.6% of controls and 1.2% of HAT patients.

Conclusions/Significance

Specificity of some malaria RDT products in HAT was surprisingly low, and constitutes a risk for misdiagnosis of a fatal but treatable infection. Our results show the importance to assess RDT specificity in non-targeted infections when evaluating diagnostic tests.     

Age determination in human adults by dental histology

Dentine root transparency (RDT) has been measured on 70 histological sections of teeth from 46 individuals of known sex and age. In order to obtain the estimates of individual chronological age, Bang & Ramm (1970) equations have been applied to the value obtained by the measurements. Using the percentage ratio hx100/H (after Lemendin & Cambray 1981)--were h is the extension of the root transparency zone (in mm) and H is the total root length (in mm), some regression functions have been elaborated. The error of the age estimates obtained following Bang & Ramm was quite high in percentage, being comprised between +/- 5 years only in 21.13% of the cases.     

Ultrasonic and skinfold caliper measures of subcutaneous adipose tissue thickness in elderly men and women

Ultrasonic and skinfold caliper measures of subcutaneous adipose tissue were taken in a sample of elderly men and women, 65 to 99 years of age with an A-mode Ithaco Body Composition Meter and a Holtain skinfold caliper. For most of the measurements, standard deviations for the ultrasonic measurements were three or more times larger than corresponding caliper measurements. Also, mean absolute interobserver errors for the ultrasonic measurements were considerably larger than those for skinfold calipers. At best, the interobserver reliability for the ultrasound machine was 68% while the poorest reliability for the skinfold caliper was 88%. In the form tested, the Ithaco Body Composition Meter is not as accurate for measuring subcutaneous adipose tissue thickness in the elderly as a Holtain skinfold caliper.