A systematic review of the literature examining the diagnostic efficacy of measurement of fractionated plasma free metanephrines in the biochemical diagnosis of pheochromocytoma

BACKGROUND: Fractionated plasma metanephrine measurements are commonly used in biochemical testing in search of pheochromocytoma. METHODS: We aimed to critically appraise the diagnostic efficacy of fractionated plasma free metanephrine measurements in detecting pheochromocytoma. Nine electronic databases, meeting abstracts, and the Science Citation Index were searched and supplemented with previously unpublished data. Methodologic and reporting quality was independently assessed by two endocrinologists using a checklist developed by the Standards for Reporting of Diagnostic Studies Accuracy Group and data were independently abstracted. RESULTS: Limitations in methodologic quality were noted in all studies. In all subjects (including those with genetic predisposition): the sensitivities for detection of pheochromocytoma were 96%-100% (95% CI ranged from 82% to 100%), whereas the specificities were 85%-100% (95% CI ranged from 78% to 100%). Statistical heterogeneity was noted upon pooling positive likelihood ratios when those with predisposition to disease were included (p < 0.001). However, upon pooling the positive or negative likelihood ratios for patients with sporadic pheochromocytoma (n = 191) or those at risk for sporadic pheochromocytoma (n = 718), no statistical heterogeneity was noted (p = 0.4). For sporadic subjects, the pooled positive likelihood ratio was 5.77 (95% CI = 4.90, 6.81) and the pooled negative likelihood ratio was 0.02 (95% CI = 0.01, 0.07). CONCLUSION: Negative plasma fractionated free metanephrine measurements are effective in ruling out pheochromocytoma. However, a positive test result only moderately increases suspicion of disease, particularly when screening for sporadic pheochromocytoma.     

Hypohydration effects on skeletal muscle performance and metabolism: a 31P-MRS study

The purpose of this study was to determinewhether hypohydration reduces skeletal muscle endurance and whetherincreased H⁺ andP_i might contribute to performancedegradation. Ten physically active volunteers (age 21-40 yr)performed supine single-leg, knee-extension exercise to exhaustion in a1.5-T whole body magnetic resonance spectroscopy (MRS) system wheneuhydrated and when hypohydrated (4% body wt).³¹P spectra were collected at arate of one per second at rest, exercise, and recovery, and weregrouped and averaged to represent 10-s intervals. The desired hydrationlevel was achieved by having the subjects perform 2-3 h ofexercise in a warm room (40°C dry bulb, 20% relative humidity)with or without fluid replacement 3-8 h before the experiment.Time to fatigue was reduced (P < 0.05) by 15% when the subjects were hypohydrated [213 ± 12 vs. 251 ± 15 (SE) s]. Muscle strength was generally notaffected by hypohydration. Muscle pH andP_i/-ATP ratio were similarduring exercise and at exhaustion, regardless of hydration state. The time constants for phosphocreatine recovery were also similar betweentrials. In summary, moderate hypohydration reduces muscle endurance,and neither H⁺ norP_i concentration appears to berelated to these reductions.

     

Impact of muscle injury and accompanying inflammatory response on thermoregulation during exercise in the heat.

This study examined whether muscle injury and the accompanying inflammatory responses alter thermoregulation during subsequent exercise-heat stress. Sixteen subjects performed 50 min of treadmill exercise (45-50% maximal O(2) consumption) in a hot room (40 degrees C, 20% relative humidity) before and at select times after eccentric upper body (UBE) and/or eccentric lower body (LBE) exercise. In experiment 1, eight subjects performed treadmill exercise before and 6, 25, and 30 h after UBE and then 6, 25, and 30 h after LBE. In experiment 2, eight subjects performed treadmill exercise before and 2, 7, and 26 h after LBE only. UBE and LBE produced marked soreness and significantly elevated creatine kinase levels (P < 0.05), but only LBE increased (P < 0.05) interleukin-6 levels. In experiment 1, core temperatures before and during exercise-heat stress were similar for control and after UBE, but some evidence for higher core temperatures was found after LBE. In experiment 2, core temperatures during exercise-heat stress were 0.2-0.3 degrees C (P < 0.05) above control values at 2 and 7 h after LBE. The added thermal strain after LBE (P < 0.05) was associated with higher metabolic rate (r = 0.70 and 0.68 at 2 and 6-7 h, respectively) but was not related (P > 0.05) to muscle soreness (r = 0.47 at 6-7 h), plasma interleukin-6 (r = 0.35 at 6-7 h), or peak creatine kinase levels (r = 0.22). Local sweating responses (threshold core temperature and slope) were not altered by UBE or LBE. The results suggest that profuse muscle injury can increase body core temperature during exercise-heat stress and that the added heat storage cannot be attributed solely to increased heat production.     

Biological and analytical variation of the human sweating response: implications for study design and analysis

Appropriate quantification of analytical and biological variation of thermoregulatory sweating has important practical utility for research design and statistical analysis. We sought to examine contributors to variability in local forearm sweating rate (SR) and sweating onset (SO) and to evaluate the potential for using bilateral measurements. Two women and eight men (26 ± 9 yr; 79 ± 12 kg) completed 5 days of heat acclimation and walked (1.8 l/min VO(2)) on three occasions for 30 min in 40°C, 20% RH, while local SR and SO were measured. Local SR measures among days were not different (2.14 ± 0.72 vs. 2.02 ± 0.79 vs. 2.31 ± 0.72 mg·cm(2)·min(-1), P = 0.19) nor was SO (10.47 ± 2.54 vs. 10.04 ± 2.97 vs. 9.87 ± 3.44 min P = 0.82). Bilateral SR (2.14 ± 0.72 vs. 2.16 ± 0.71 mg·cm(2)·min(-1), P = 0.56) and SO (10.47 ± 2.54 vs. 10.83 ± 2.48 min, P = 0.09) were similar and differences were ≤ 1 SD of day-to-day differences for a single forearm. Analytical imprecision (CV(a)), within (CV(i))-, and between (CV(g))-subjects' coefficient of variation for local SR were 2.4%, 22.3%, and 56.4%, respectively, and were 0%, 9.6%, and 41%, respectively, for SO. We conclude: 1) technologically, sweat capsules contribute negligibly to sweat measurement variation; 2) bilateral measures of SR and SO appear interchangeable; 3) when studying potential factors affecting sweating, changes in SO afford a more favorable signal-to-noise ratio vs. changes in SR. These findings provide a quantitative basis for study design and optimization of power/sample size analysis in the evaluation of thermoregulatory sweating.     

Mating types in Paramecium and a molecular approach to their determination

Mating types are expressed in ciliates for the duration of the mature period of their clonal cycle. During cell conjugation the reciprocal fertilization of complementary mating types takes place. Models of mating type determination in the Paramecium aurelia species complex based on classical genetics are reviewed including molecular aspects of the studies.     

Methyl Jasmonate Increases the Tropane Alkaloid Scopolamine and Reduces Natural Herbivory in Brugmansia suaveolens: Is Scopolamine Responsible for Plant Resistance?

The tropane alkaloid (TA) scopolamine is suggested to protect Brugmansia suaveolens (Solanaceae) against herbivorous insects. To test this prediction in a natural environment, scopolamine was induced by methyl jasmonate (MJ) in potted plants which were left 10?days in the field. MJ-treated plants increased their scopolamine concentration in leaves and herbivory decreased. These findings suggest a cause?Ceffect relationship. However, experiments in laboratory showed that scopolamine affect differently the performance of the specialist larvae of the ithomiine butterfly Placidina euryanassa (C. Felder & R. Felder) and the generalist fall armyworm Spodoptera frugiperda (J. E. Smith): the specialist that sequester this TA from B. suaveolens leaves was not negatively affected, but the generalist was. Therefore, scopolamine probably acts only against insects that are not adapted to TAs. Other compounds that are MJ elicited may also play a role in plant resistance against herbivory by generalist and specialist insects, and deserve future investigations.     

An interdisciplinary knowledge translation intervention in long-term care: Study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial

ABSTRACT: BACKGROUND: Knowledge translation (KT) research in long-term care (LTC) is still in its early stages. This protocol describes the evaluation of a multifaceted, interdisciplinary KT intervention aimed at integrating evidence-based osteoporosis and fracture prevention strategies into LTC care processes. Methods and design The Vitamin D and Osteoporosis Study (ViDOS) is underway in 40 LTC homes (n = 21 intervention, n = 19 control) across Ontario, Canada. The primary objectives of this study are to assess the feasibility of delivering the KT intervention, and clinically, to increase the percent of LTC residents prescribed [greater than or equal to]800 IU of vitamin D daily. Eligibility criteria are LTC homes that are serviced by our partner pharmacy provider and have more than one prescribing physician. The target audience within each LTC home is the Professional Advisory Committee (PAC), an interdisciplinary team who meets quarterly. The key elements of the intervention are three interactive educational sessions led by an expert opinion leader, action planning using a quality improvement cycle, audit and feedback reports, nominated internal champions, and reminders/point-of-care tools. Control homes do not receive any intervention, however both intervention and control homes received educational materials as part of the Ontario Osteoporosis Strategy. Primary outcomes are feasibility measures (recruitment, retention, attendance at educational sessions, action plan items identified and initiated, internal champions identified, performance reports provided and reviewed), and vitamin D ([greater than or equal to]800 IU/daily) prescribing at 6 and 12 months. Secondary outcomes include the proportion of residents prescribed calcium supplements and osteoporosis medications, and falls and fractures. Qualitative methods will examine the experience of the LTC team with the KT intervention. Homes are centrally randomized to intervention and control groups in blocks of variable size using a computer generated allocation sequence. Randomization is stratified by home size and profit/nonprofit status. Prescribing data retrieval and analysis are performed by blinded personnel. DISCUSSION: Our study will contribute to an improved understanding of the feasibility and acceptability of a multifaceted intervention aimed at translating knowledge to LTC practitioners. Lessons learned from this study will be valuable in guiding future research and understanding the complexities of translating knowledge in LTC. Trial registration ClinicalTrials.gov NCT01398527.     

Sexual imprinting on a novel trait in the dimorphic zebra finch: sexes differ

We investigated the effect of a novel trait, a red feather on the forehead, on sexual imprinting in the dimorphic zebra finch, Taeniopygia guttata. Parents reared young in one of four imprinting groups: (1) both parents adorned with the red feather; (2) the father only adorned; (3) the mother only adorned; (4) both parents unadorned. After the young matured, we tested their preference for adorned and unadorned conspecifics of the opposite sex in simultaneous double-choice tests. Females but not males sexually imprinted on the red feather when their parents or father were adorned. In further tests, females that had sexually imprinted on the red feather did not generalize from the learned preference for a red feather to a preference for an orange or blue feather. Neither males nor females reared by unadorned parents showed a latent preference for potential mates adorned with a red, orange, or blue feather. Our results show that in the dimorphic zebra finch, only females sexually imprint on a novel trait. Sexual imprinting can support the evolution of novel male traits and would enhance the dimorphism in this species.Copyright 2003 The Association for the Study of Animal Behaviour. Published by Elsevier Science Ltd. All rights reserved.