Intersubject Coefficient Of Variation Research Articles

Inter- and intra-subject variability in gabapentin absorption and absolute bioavailability

Gabapentin (GBP) is a non-metabolized, non-plasma protein bound, renally excreted antiepileptic drug that is actively absorbed via the system L amino acid transporter. Previous studies have demonstrated that gabapentin displays dose-dependent absorption. Objectives: These studies were conducted to determine inter- and intra-subject variability of gabapentin absorption. Two prospective clinical studies in healthy adult volunteers were conducted. Coefficient of variation ( CV) was used to express variability of gabapentin absorption. Methods: Study A: 400-mg single dose, randomized, cross-over study to assess bioavailability of four different gabapentin formulations ( n=20, 9 males, 11 females; mean age and weight 41 years, 75.1 kg). Plasma was serially collected up to 48 h and bioavailability (F) calculated post-dose to determine concentration-time curves ( AUC). All four formulations were bioequivalent, thus repeated measures analysis was performed to assess inter-and intra-subject variability. Study B: 600-mg single dose study ( n=50, 15 males, 35 females; mean age and weight 31.1 years, 72.7 kg) was conducted to determine inter-subject variability in gabapentin F. Urine was collected over 48 h and bioavailability (F) calculated. Urine and plasma gabapentin concentrations were measured by HPLC-UV. Results: Study A: Overall mean ( CV) of GBP AUC values was 34.1±24 ug/h per ml. Inter-subject CV for AUC was 22.5% and intra-subject CV was 12.1%. Study B: Overall mean (SD) GBP F was 49.3±13.6%. Inter-subject CV of F was 27.6%. Discussion: The inter-subject variability in gabapentin absorption is substantially less than that of the inter-subject variability. This indicates that one would expect a wide range in gabapentin absorption between subjects; however, a much smaller variability within a subject. The within subject variability of gabapentin is small enough that plasma drug monitoring may be used to assess gabapentin absorption for a given subject and the benefit of dose individualization.

Measurement of physiotherapists' ability to reliably generate vibration amplitudes and pressures using a tuning fork

Summary Vibratory sensibility testing has been identified as a useful clinical test for establishing patients' neural status. Clinically, however, vibratory sensibility testing is rarely used, which may be a consequence of the suggested subjectivity and unreliability of the clinical tests available. This study investigated the intertester and intratester reliability of nine physiotherapists using the tuning fork as a method of producing a vibratory stimulus. Subjects had not used the tuning fork previously in clinical practice. The relationship between amplitude production, pressure application and time transference when striking the tuning fork were established. Pressure application when using the tuning fork was shown to be reliable, with a mean intrasubject correlation coefficient (ICC) of 0.88, and a mean intersubject coefficient of variation 14%. Amplitude production, however, was less satisfactory with a mean ICC of 0.5%. The results revealed evidence of a relationship between transfer time and amplitude ( P = 0.07). In addition, variation in pressure was shown to have no relationship with amplitude production ( P = 0.34). In conclusion, the findings of this study suggest that subjects are reliable in the application of pressure when using the tuning fork. However, they are unable to reproduce reliable amplitude measurements. This finding may therefore limit the use of the tuning fork as a method of establishing patients' vibratory sensibility.

A longitudinal assessment of hormonal and physical alterations during normal puberty in boys. III. The neuroendocrine growth hormone axis during late prepuberty.

Cross-sectional studies demonstrating that physiological GH secretion varies widely among normally and slowly growing children as well as adults have created uncertainty over the definition of normal GH secretion. Furthermore, recent data indicate that the pattern of GH released under identical physiological conditions may be unique for each individual, and suggest that normality may be an individually defined condition. To investigate and develop further this concept and to avoid the confounding effects of fluctuating gonadal steroid hormone levels, we chose as a model normally growing prepubertal boys and performed a longitudinal assessment of spontaneous GH release characteristics (36 24-h GH secretion studies in 9 boys over 9-19 months). Assessment of serum GH pulse characteristics was accomplished using the Cluster pulse detection algorithm. Characteristics of underlying pituitary GH secretory events were estimated by multiple parameter deconvolution analysis. Approximate entropy was used to quantify the serial regularity or orderliness of GH release over 24 h. Among the group data, mean 24-h GH concentrations spanned a range of more than 4-fold (1.6-7.0 micrograms/L). The intersubject coefficient of variation (CV) was 41%. In contrast, values from individuals exhibited much less variability, not only for mean 24-h GH level (CV = 25 +/- 4%; P = < 0.02), but also for all assessed component GH pulse properties (P < 0.01) vs. intersubject values). Similarly, the estimated daily GH production rate, the calculated GH half-lives, and all parameters of GH secretory events varied much less for intraindividual compared to interindividual values. The sizes of the serum GH pulses gave rise to the greatest differences in overall serum GH level among individuals, as demonstrated by the large within-subject CV (50%). The most constant pulse characteristic among subjects was that of 24-h GH pulse frequency (intersubject CV = 30%). Approximate entropy estimates disclosed high within-subject consistency (mean CV = 15%). Several aspects of GH secretion and serum concentrations varied inversely with the subject's mean age-adjusted body mass index, including the 24-h GH production rate (r = -0.67; P < 0.05), the GH secretory burst amplitude (r = -0.73; P = 0.026), the mean serum GH pulse amplitude (r = -0.79; P = 0.011), and the sum of the GH pulse amplitudes (r = -0.66; P = 0.05). By contrast, no consistent pattern of increase or decrease in serum GH concentrations with advancing age was detectable during the prepubertal period. These data suggest that during prepuberty, 1) individual boys regulate daily GH secretion within relatively confined limits characteristic for that individual, much narrower than the range present in the larger population; 2) differences in mean 24-h GH levels among normally growing prepubertal boys arise primarily from differences in GH pulse size; 3) differences in body composition, as indicated by the body mass index, may influence the GH secretion range characteristic of each individual; and 4) there is no consistent change in mean 24-h GH concentrations or the orderliness (approximate entropy) of the GH release process ever time during late prepuberty as the onset of puberty approaches.

Use of [11C]Aminocyclohexanecarboxylate for the Measurement of Amino Acid Uptake and Distribution Volume in Human Brain

A quantitative positron emission tomographic (PET) method to measure amino acid blood-brain barrier (BBB) transport rate and tissue distribution volume (DV) has been developed using 11C-labeled aminocyclohexanecarboxylate (ACHC), a nonmetabolized amino acid analogue. Dynamic PET data were acquired as a series of 15 scans covering a total of 60 min and analyzed by means of a two-compartment, two-parameter model. Functional images were calculated for the amino acid transport rate constants across the BBB and the amino acid DV in the brain. Results show [11C]ACHC to have an influx rate constant in gray matter of approximately 0.03-0.04 ml g-1 min-1, indicating a single-pass extraction fraction of approximately 5-7%. The intersubject coefficient of variation was approximately 15% while intrasubject variability of repeat scans was only slightly greater than 5%. Studies were performed in 15 young normal volunteer control subjects, 5 elderly controls, 7 patients with probable Alzheimer's disease, and one patient with phenylketonuria. Results indicate that [11C]-ACHC will serve as the basis of a method for measuring amino acid transport rate and DV in the normal and pathological human brain.

Variability of Tracheobronchial Clearance in Healthy Non-Smoking Subjects

Tracheobronchial clearance was measured twice in 10 healthy non-smoking volunteers to evaluate inter- and intrasubject variability, using a radio-aerosol technique (5 microns 99mTc-labelled polystyrene particles). By means of two detectors radioactivity in the lungs was measured at regular intervals for 6 h and once more 24 h after inhalation. The decrease in radioactivity after correction for background activity, isotope decay and 24-hour retention was assumed to reflect tracheobronchial clearance. Among other parameters to quantitate the results of these tests, the area under the retention curve up to 6 h after inhalation (AUC-6) was calculated. The intersubject coefficient of variation (COV) using the AUC-6 was 31%. The intrasubject COV of the AUC-6 was 11%. These results compare favourably with those reported by others using different techniques. It is concluded that the intrasubject variability of tracheobronchial clearance as measured by this technique is small.

Variability and reproducibility in the measurement of tracheobronchial clearance in healthy subjects and patients with different obstructive lung diseases

The purpose of this study was to establish the inter- and intra-subject/patient variability of tracheobronchial clearance, measured for 6 h, using a radioaerosol technique. Inter-subject variability was evaluated in five groups: 33 healthy non-smokers (NS); 19 asymptomatic smokers (S); 40 asthmatics (A); 27 chronic bronchitics (CB) and 12 bronchiectatics (B). Intra-subject variability was evaluated in 16 A and 27 CB who were studied twice. The inter-subject/patient coefficient of variation (CoV) of tracheobronchial clearance was 13% for NS and 28-39% for the remaining four groups. The intra-patient CoV was about half of the inter-patient CoV. Inter-subject CoV (for A and CB) appeared to be independent of initial tracheobronchial deposition of radioaerosol and frequency of cough. We were also able to estimate the approximate number of patients required for a crossover study in order to avoid statistical, type II errors when investigating the effect of a drug or of a therapeutic intervention on tracheobronchial clearance.

Partial forced expiratory flow-volume curves in young children during ketamine anesthesia.

Maximal flows at functional residual capacity (VmaxFRC) from partial forced expiratory flow-volume (PEFV) curves were obtained in 14 normal preschool children (8 boys, 6 girls) of average age 44 mo, under general anesthesia before elective surgery. PEFV curves were generated from end inspiration by rapid compression of the chest wall with an inflatable jacket. VmaxFRC, expressed in milliliter per second, correlated linearly with height, weight, age, and FRC in milliliter and milliliters per kilogram. The best correlation of VmaxFRC (ml/s) was to height to the power of 2.47, which agrees with the results predicted by wave-speed theory. Mean FRC-corrected VmaxFRC was 2.42 +/- 0.50 (SD) FRC's/s with no significant difference between boys (2.35 FRC's/s) and girls (2.51 FRC's/s). There was no correlation between lung-size corrected VmaxFRC and height, weight, or age, but it tended to decrease with increasing FRC. The intersubject variability for VmaxFRC was reduced by normalizing for FRC, and was significantly better than that reported for awake children. This can be attributed to the greater control over volume history and more reliable maximal flow generation during anesthesia. The intrasubject coefficient of variation (CV) for VmaxFRC was 12.2%, and the intersubject CV was 20.0%. The difference may represent the variability due to dysanapsis. It is concluded that dysanapsis is not a prominent factor in children of this age group. In addition, the similarity of the regression equation for VmaxFRC vs. height to that of FRC vs. height supports the concept of equidimensional growth of the airways and lung parenchyma.