Comparison of Specific Prediction Equations to Estimate Peak Oxygen Uptake in Obese Women.

The aim of the current study was to compare 2 equations to predict peak oxygen uptake (V̇O2peak) in obese women, according to their obesity class. 92 maximal cardiopulmonary exercise testing sets (CPET with initial and subsequent increments set to achieve an exercise duration between 8-12 min) were retrospectively analysed. These CPET were divided into 3 groups according to the women body mass indexes (BMI): class 1 (30 kg.m-2≤BMI<35 kg.m-2, n=22), class 2 (35 kg.m-2≤BMI<40 kg.m-2, n=36) or class 3 (BMI≥40 kg.m-2, n=34). Each participant's V̇O2peak was predicted from 2 prediction equations (from Wasserman et al.'s and Debeaumont et al.'s equations) and compared with the actual V̇O2peak. Moreover, the correlations between these values were studied, and the accuracy of the predictions was analysed. Only predicted V̇O2peak from the Debeaumont et al.'s equation was not significantly different from the actual V̇O2peak in the women in obesity class 3 (p=0.89). Moreover, significant correlation was found between these values (p<0.001, r=0.68). The bias and the 95% limits of agreement represented -3.2±34.0%. In women in obesity class 3, Debeaumont et al.'s equation may be the accurate one to predict V̇O2peak. However, the accuracy of predictions is low. Consequently, to improve this accuracy, new prediction equations for obese women are required according to the obesity class.

Phlebotomy Cycle Time Related to Phlebotomist Experience and/or Hospital Location.

BACKGROUND: Little information is available regarding expected phlebotomy cycle time (total time needed to draw a blood specimen) in inpatient settings. Examining this variable in 4 hospitals in Calgary, Alberta, Canada, we determined the distribution of phlebotomy cycle times and compared this by hospital and by phlebotomist experience. METHODS: Between April 2014 and August 2014, we observed phlebotomy timing at 4 adult acute care hospital locations. Phlebotomists were stratified into 3 experience levels: 0 to 2 years, 2 to 5 years, and more than 5 years. We observed a total of 110 different phlebotomists. RESULTS: We observed no statistical difference between experience levels (P = .07) or hospital location (P = .44) on mean phlebotomy cycle time. CONCLUSIONS: The mean (SD) phlebotomy cycle time was 259 (52) seconds per patient for normal phlebotomy procedures. If expected minimum and maximum phlebotomy times are defined as mean +/- 2 SD, the expected cycle time range is 196 to 404 seconds.

Six-week versus twelve-week antibiotic therapy for nonsurgically treated diabetic foot osteomyelitis: a multicenter open-label controlled randomized study.

OBJECTIVE: Little is known about the optimal duration of antibiotic therapy for diabetic foot osteomyelitis (DFO). This study sought to compare the effectiveness of 6 versus 12 weeks of antibiotic therapy in patients with DFO treated nonsurgically (i.e., antibiotics alone). RESEARCH DESIGN AND METHODS: This was a prospective randomized trial comparing 6- versus 12-week duration of antibiotic treatment. Remission of osteomyelitis during the monitoring period was defined as complete and persistent (>4 weeks) healing of the wound (if present initially), absence of recurrent infection at the initial site or that of adjacent rays, and no need for surgical bone resection or amputation at the end of a follow-up period of at least 12 months after completion of antibiotic treatment. RESULTS: Forty patients followed at five French general hospitals were randomized between January 2007 and January 2009, with 20 treated for 6 weeks and 20 treated for 12 weeks with antibiotics. The two groups were comparable for all variables recorded at inclusion in the study. Remission was obtained in 26 (65%) patients, with no significant differences between patients treated for 6 versus 12 weeks (12/20 vs. 14/20, respectively; P = 0.50). We did not identify any significant parameters associated with patient outcome. Fewer patients treated for 6 weeks experienced gastrointestinal adverse events related to antimicrobial therapy compared with patients treated for 12 weeks (respectively, 15 vs. 45%; P = 0.04). CONCLUSIONS: The present multicenter prospective randomized study provides data suggesting that 6-week duration of antibiotic therapy may be sufficient in patients with DFO for whom nonsurgical treatment is considered.

Coexistence of thyroid-stimulating hormone-secreting pituitary adenoma and graves' hyperthyroidism.

BACKGROUND: Coexistence of thyroid-stimulating hormone (TSH)-secreting pituitary adenoma (TSHoma) with Graves' disease has been rarely reported. We describe a female patient displaying TSHoma with Graves' disease and who presented initially with inappropriate TSH values. CASE REPORT: A 36-year-old woman presented with signs of thyrotoxicosis, small and vascular goiter and mild bilateral exophthalmos. Thyroid function tests showed hyperthyroxinemia and normal TSH values despite the use of different assays. Heterophile antibody testing result was negative. The patient underwent total right lobectomy with partial left lobectomy after 18 months of carbimazole treatment. Histology confirmed Graves' disease. Symptoms of thyrotoxicosis recurred 2 months later. Thyroid function tests showed hyperthyroxinemia and elevated TSH values. Investigations were consistent with a 10-mm TSHoma. The patient underwent a trans-sphenoidal tumor resection following preoperative lanreotide preparation. Histological examination and immunocytochemistry concluded to a pure TSH-producing tumor. There was no evidence of tumor recurrence after 18 years of follow-up. CONCLUSION: Association of TSHoma with Graves' disease should be carefully taken into account, especially when TSH values are not compatible with either the clinical history or other thyroid functions tests.

How to diagnose a lipodystrophy syndrome.

The spectrum of adipose tissue diseases ranges from obesity to lipodystrophy, and is accompanied by insulin resistance syndrome, which promotes the occurrence of type 2 diabetes, dyslipidemia and cardiovascular complications. Lipodystrophy refers to a group of rare diseases characterized by the generalized or partial absence of adipose tissue, and occurs with or without hypertrophy of adipose tissue in other sites. They are classified as being familial or acquired, and generalized or partial. The genetically determined partial forms usually occur as Dunnigan syndrome, which is a type of laminopathy that can also manifest as muscle, cardiac, neuropathic or progeroid involvement. Gene mutations encoding for PPAR-gamma, Akt2, CIDEC, perilipin and the ZMPSTE 24 enzyme are much more rare. The genetically determined generalized forms are also very rare and are linked to mutations of seipin AGPAT2, FBN1, which is accompanied by Marfan syndrome, or of BANF1, which is characterized by a progeroid syndrome without insulin resistance and with early bone complications. Glycosylation disorders are sometimes involved. Some genetically determined forms have recently been found to be due to autoinflammatory syndromes linked to a proteasome anomaly (PSMB8). They result in a lipodystrophy syndrome that occurs secondarily with fever, dermatosis and panniculitis. Then there are forms that are considered to be acquired. They may be iatrogenic (protease inhibitors in HIV patients, glucocorticosteroids, insulin, graft-versus-host disease, etc.), related to an immune system disease (sequelae of dermatopolymyositis, autoimmune polyendocrine syndromes, particularly associated with type 1 diabetes, Barraquer-Simons and Lawrence syndromes), which are promoted by anomalies of the complement system. Finally, lipomatosis is currently classified as a painful form (adiposis dolorosa or Dercum's disease) or benign symmetric multiple form, also known as Launois-Bensaude syndrome or Madelung's disease, which are sometimes related to mitochondrial DNA mutations, but are usually promoted by alcohol. In addition to the medical management of metabolic syndrome and the sometimes surgical treatment of lipodystrophy, recombinant leptin provides hope for genetically determined lipodystrophy syndromes, whereas modifications in antiretroviral treatment and tesamorelin, a GHRH analog, is effective in the metabolic syndrome of HIV patients. Other therapeutic options will undoubtedly be developed, dependent on pathophysiological advances, which today tend to classify genetically determined lipodystrophy as being related to laminopathy or to lipid droplet disorders.

Prediction of peak oxygen uptake from age and power output at RPE 15 in obese women.

The purpose of this study was to develop a simple, convenient and indirect method for predicting peak oxygen uptake (VO2peak) from a sub-maximal graded exercise test (GXT), in obese women. Thirty obese women performed GXT to volitional exhaustion. During GXT, oxygen uptake and the power at RPE 15 (VO2peak) were measured, and VO2peak was determined. Following assessment of the relationships between VO2peak and PRPE 15, age, height and mass were made available in a stepwise multiple regression analysis with VO2peak as the dependent variable. The equation to predict VO2peak was: (1 min-1) = 1.355 - 9.920e-3 x age + 8.497e-3 x PRPE 15 (r = 0.83; SEE = 0.156 l min(-1)). This study suggests that age and PRPE 15 elicited during a sub-maximal GXT provides a reasonably accurate prediction of VO2peak in obese women.

Comparison of the multiple-aliquot and batch methods of monitoring peritoneal dialysis adequacy in patients.

BACKGROUND: Effluent fluid is analyzed to determine Kt/V urea and creatinine clearance as measures of adequacy of peritoneal dialysis. To avoid the physical mixing of fluids and to minimize handling of full effluent bags, a multiple-aliquot method of sampling was developed and compared to the traditional batch method. METHODS: The batch method and the multiple-aliquot method were performed for 31 consecutive patients. Pooled fluid urea and creatinine measurements were determined for each method. PD Adequest 2.0 (Baxter Healthcare, Deerfield, IL, USA) was used to derive calculated peritoneal dialysis parameters. RESULTS: Urea dialysate levels, calculated weekly urea clearances, protein catabolic rate, and Kt/V were not statistically different (p > 0.05) between the 2 methods. Dialysate creatinine and creatinine clearance with the 2 methods were statistically distinct but the differences were not clinically important. The processing time per set of patient effluent bags was reduced from 45 to 18 minutes, handling of the bags was minimized, and error associated with inadequate mixing of pooled fluids was avoided. CONCLUSION: The multiple-aliquot method generates accurate and timely results to assess peritoneal dialysis prescription adequacy while reducing staff effort.

Prediction of peak oxygen uptake from sub-maximal ratings of perceived exertion elicited during a graded exercise test in obese women.

The purpose was to assess the validity of predicting peak oxygen uptake (.VO(2)peak) from Ratings of Perceived Exertion (RPE)< or =15, during a graded exercise test (GXT), in obese women. Forty-three obese women performed GXT to volitional exhaustion. During GXT, oxygen uptake (.VO(2)) and RPE were measured. Individual linear regressions between .VO(2) and RPE< or =15 were extrapolated to RPE 20 in order to predict .VO(2)peak. Actual and predicted .VO(2)peak were not significantly different (13.9+/-3.0 vs 14.2+/-3.3 ml kg(-1) min(-1), respectively; p=.26). The Pearson product moment correlation between actual and predicted .VO(2)peak was high (r=0.82). The 95% limits of agreement analysis on these values (bias+/-1.96SD) was -0.3+/-3.7 ml kg(-1) min(-1). Results suggested that RPE< or =15 elicited during a sub-maximal GXT provides accurate .VO(2)peak prediction. Therefore, it is not necessary to perform GXT to voluntary exhaustion to determine .VO(2)peak in obese women.

Needle puncture and transcutaneous bone biopsy cultures are inconsistent in patients with diabetes and suspected osteomyelitis of the foot.

BACKGROUND: Needle puncture has been suggested as a method for identifying bacteria in the bones in patients with diabetes with osteomyelitis of the foot. However, no studies have compared needle puncture with concomitant transcutaneous bone biopsy, which is the current standard recommended in international guidelines. METHODS: We conducted a prospective study in 2 French diabetes foot clinics. Transcutaneous bone biopsy specimens, needle puncture specimens, and swab samples were collected on the same day for each patient. RESULTS: Overall, 31 patients were included in the study from July 2006 through February 2008. Twenty-one bone biopsy specimens (67.7%), 18 needle puncture specimens (58%), and 30 swab samples (96.7%) had positive culture results. Staphylococcus aureus was the most common type of bacteria that grew from bone samples, followed by Proteus mirabilis and Morganella morganii. The mean number of bacteria types per positive sample were 1.35, 1.32, and 2.51 for bone biopsy specimens, needle puncture specimens, and swab samples, respectively. Among the 20 patients with positive bone biopsy specimens (69%), 13 had positive needle puncture samples. Overall, the correlation between microbiological results was 23.9%, with S. aureus showing the strongest correlation (46.7%). Results of cultures of bone biopsy and needle puncture specimens were identical for 10 (32.3%) of 31 patients. Bone bacteria were isolated from the needle punctures in 7 (33.3%) of the 21 patients who had positive bone biopsy specimen culture results. If the results of cultures of needle puncture specimens alone had been considered, 5 patients (16.1%) would have received unnecessary treatment, and 8 patients (38.1%) who had positive bone culture results would not have been treated at all. CONCLUSIONS: Our results suggest that needle punctures, compared with transcutaneous bone biopsies, do not identify bone bacteria reliably in patients with diabetes who have low-grade infection of the foot and suspected osteomyelitis.

Intermittent versus continuous exercise: effects of perceptually lower exercise in obese women.

INTRODUCTION: Exercise has beneficial effects on obesity and diabetes treatments. However, obese subjects do not closely adhere to training programs probably because of the monotony of the continuous exercise that is frequently proposed. To increase adherence to training programs, intermittent exercise, which is less monotonous, may be more appropriate. PURPOSE: The purposes of this study were to determine the perceptually less hard exercise (continuous vs intermittent exercise) and to analyze the impact of a training program on the basis of this exercise in obese women with and without type 2 diabetes. METHODS: Twenty type 2 diabetic obese women and 20 obese women without diabetes were recruited. In each group, 10 patients integrated a training program (i.e., training groups), whereas the remaining patients were untrained (i.e., control groups). The training groups performed a continuous exercise and an intermittent exercise to determine the perceptually less hard exercise thanks to lower ratings of perceived exertion (RPE). Then, a training program that included 32 min (3 d x wk(-1) x 10 wk(-1)) of the perceptually less hard exercise was proposed to training groups. RESULTS: RPE were significantly lower during the intermittent exercise compared to the continuous exercise in the obese women with or without diabetes (RPE = 12.3 +/- 2.3 vs 13.7 +/- 2.3 and RPE = 11.9 +/- 1.1 vs 13.2 +/- 1.6, respectively). After the training program, significant beneficial effects on the glycosylated hemoglobin (6.8 +/- 1.4% vs 6.5 +/- 1.2%), body mass (97.1 +/- 16.9 vs 95.2 +/- 16.2 kg), body mass index (37.6 +/- 6.1 vs 36.8 +/- 6.0 kg x m(-2)), and on the HR and the walked distance limit were noticed in the training groups. CONCLUSION: The obese women with or without diabetes perceived the intermittent exercise as being less hard than the continuous exercise, and a training program based on intermittent exercises produced beneficial effects on obesity and type 2 diabetes.