Response In Healthy Patients Research Articles

Do question phrasing and long wavelength cone sensitivity influence red cap test responses in healthy patients?

This study investigates the influence of question phrasing and long wavelength cone sensitivity on red cap test responses in healthy patients. A chart review of 230 adult patients assessed responses to two different phrasings of the red cap test. Phrasing 1 asked the patient to describe the left eye relative to the right while Phrasing 2 asked the patient to name the brighter eye and provided an option for the patient to report no difference. Long wavelength cone thresholds were measured using the Konan CCT. Across both phrasings, 33 % of patients reported red saturation asymmetry, with a significant difference in positive responses between the two phrasings (43.6 % for Phrasing 1 vs. 11.3 % for Phrasing 2, (χ2 = 121.694, p <.001). No significant interocular differences in long wavelength cone sensitivity were found in those patients with a positive red cap response. Phrasing contributes to the high false positive rate of the red cap test reported in healthy patients.

This issue of Acta Feb 2021

This issue of Acta Feb 2021

Effect of preoperative topical nepafenac 0.1% on inflammatory response after uncomplicated cataract surgery in healthy subjects.

To determine the effect of preoperative topical Nepafenac administration on anterior chamber flare after uneventful cataract surgery in healthy subjects. Prospective randomized clinical trial. Seventy-three eyes of 73 healthy patients undergoing routine cataract surgery were randomized to receive (group A) topical nepafenac (1mg/ml) or not to receive (group B) 1 drop 3 times per day for 3days before surgery. All eyes received the same postoperative anti-inflammatory therapy. Clinical outcome parameters such as best corrected visual acuity, intraocular pressure, retinal central foveal thickness and aqueous flare were recorded preoperatively, 1, 15, 30 and 60days after surgery. Three patients were excluded for poor compliance, and three patients were excluded or developing pseudophakic macular oedema during the follow-up. Both groups were comparable for age, gender, and showed similar BCVA, intraocular pressure and central macular thickness values preoperatively and during the entire follow-up (p>0.01). Aqueous flare values showed a statistically increase in both groups respect to preoperative values through follow-up evaluations (p<0.01), while values were significantly lower in group A than in group B 30days after surgery (p<0.01). Preoperative administration of topical Nepafenac reduces the inflammatory response in healthy patients undergoing uncomplicated cataract surgery one month after surgery respect to non-treated group.

Local application of enamel matrix derivative prevents acute systemic inflammation after periodontal regenerative surgery: A randomized controlled clinical trial.

The aim of this study was to compare surgical treatment of periodontal intra-bony defects (IBD) with or without the adjunct of enamel matrix derivative (EMD) in terms of acute-phase responses in healthy patients. Thirty-eight periodontitis-affected subjects, one IDB each, were randomized to minimally invasive periodontal surgery (MIS) with or without EMD. Periodontal parameters were recorded at baseline and 6-months. Blood samples were collected at baseline, 1, 7 and 180days after treatment. At 24hr, the group treated MIS with EMD showed lower values of C-reactive protein (CRP; p<.01) as no inflammatory perturbation was noticed. Conversely, MIS group resulted in an acute inflammatory response at 24hr (p<.05) that regressed to its baseline values at day 7. The EMD group showed a higher number of cases without residual BOP or PPD≥5mm 6months after surgery (p<.05), and post-surgical gingival recession was lower (p<.05). The adjunctive application of EMD during surgical treatment resulted in a minor increase in serum CRP 24-hr after surgery. These findings suggest a possible systemic anti-inflammatory effect of EMD. Within its limitations, this pilot trial confirmed better clinical periodontal outcomes in the EMD group. NCT03590093.

Characterizing the Acute Phase Response in Healthy Patients Following Total Joint Arthroplasty: Predictable and Consistent

BackgroundDuring surgery, trauma to musculoskeletal tissue induces a systemic reaction known as the acute phase response (APR). When excessive or prolonged, the APR has been implicated as an underlying cause of surgical complications. The purpose of this study was to determine the typical APR following total joint arthroplasty in a healthy population defined by the Charlson Comorbidity Index (CCI). MethodsThis retrospective study identified 180 healthy patients (CCI < 2) who underwent total joint arthroplasty by a single surgeon for primary osteoarthritis from 2013 to 2015. Serial measurements of C-reactive protein (CRP) and fibrinogen were obtained preoperative, perioperative, and at 2 and 6 weeks postoperative. ResultsPostoperative CRP peaked during the inpatient period and returned to baseline by 2 weeks. Fibrinogen peaked after CRP and returned to baseline by 6 weeks. Elevated preoperative CRP correlated with a more robust postoperative APR for both total hip arthroplasty and total knee arthroplasty, suggesting that a patient's preoperative inflammatory state correlates with the magnitude of the postoperative APR. ConclusionMeasurement of preoperative acute phase reactants may provide an objective means to predict a patient's risk of postoperative dysregulation of the APR and complications.

Which hemodynamic parameter predicts nitroglycerin-potentiated head-up tilt test response?

The aim of our study was to identify the early hemodynamic predictors of head-up tilt test (HUTT) outcome in healthy patients with recurrent unexplained syncope. The study involved 95 patients (mean age 38 ± 15; 42 male) who were referred for the evaluation of the syncopal episodes from October 2012 to May 2013. According to the nitroglycerin-potentiated diagnostic tilt test response, the study population was divided into two groups: HUTT+ Group (61 patients, mean age 37 ± 10; 27 male) and HUTT- Group (34 patients, mean age 38 ± 11; 15 male) with no tilt-induced syncope. Finger arterial blood pressure (BP) was recorded during tilt testing. Left ventricular stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR) were computed from the pressure pulsations. After nitroglycerin administration, the HUTT+ Group showed a significant increase in heart rate (92.0 ± 7.3 beats/min vs 68.9 ± 8.7 beats/min, P < 0.0001), with well-maintained systolic BP (111.6 ± 14.1 mm Hg vs 108.8 ± 11.5 mm Hg; P = 0.332) and diastolic BP (66.1 ± 8.5 mm Hg vs 63.1 ± 6.9 mm Hg; P = 0.0913); a significant decrease in SV (53.9 ± 8.0 mL vs 78.6 ± 8.2 mL; P < 0.0001) and CO (4.0 ± 0.5 L/min vs 5.8 ± 1.0 L/min; P < 0.001), and a significant increase in TPR (1.3 ± 0.3 U vs 0.9 ± 0.2 U, P < 0.0011). We tested three hemodynamic parameters (SV, CO, and TPR) as predictors of positive tilt test response with receiver-operating characteristic curve analysis. Our results show that, 2 minutes after nitroglycerin administration, a statistically significant decrease of SV values (<67 mL) strongly predicts (area under the curve, 0.985; P < 0.0001) the HUTT-positive response in healthy patients with recurrent unexplained syncope.

Contrast sensitivity perimetry tests along the cardinal directions in color space: Correlation with the properties of the neural mechanisms mediating detection of spatio-temporal patterns

It is well-known the advantages of measuring chromatic and achromatic contrast sensitivity for detecting pathologies. But these measurements are rarely used in clinical practice, due the complexity of the measurements and the examinator specialization. In fact, there is not a complete characterization of the response of the visual pathways to achromatic and chromatic spatio-temporal frequency stimuli. We have designed a new experimental device that facilitates these measurements and allow us to characterize the visual response in healthy patients. In this paper, we evaluated the responses of the visual pathways in healthy patients.

Postprandial impairment of flow-mediated dilation and elevated methylglyoxal after simple but not complex carbohydrate consumption in dogs

Hyperglycemia produces oxidative stress, which may impair endothelial function. Methylglyoxal, a reactive intermediate metabolite of glucose, is known to cause oxidative stress and is produced when excess carbohydrate is consumed in diabetic patients, but postprandial responses in healthy patients are unknown. We hypothesize that methylglyoxal levels will cause impaired endothelial function via increased oxidative stress after consuming a high glycemic index meal in healthy animals. Normal-weight laboratory beagles (n = 6) were used in a crossover study that tested postprandial responses of 4 complex carbohydrate sources (barley, corn, peas, rice) vs a simple carbohydrate (glucose). Blood samples were taken prefeeding and at timed intervals after feeding to measure serum glucose, insulin, nitrotyrosine, and methylglyoxal. Flow-mediated dilation (FMD), cardiac function (echocardiography), and blood pressure measurements were determined before and 60 minutes after feeding. The mean (±SEM) glycemic indices of the complex carbohydrate sources were 29 ± 5 for peas, 47 ± 10 for corn, 51 ± 7 for barley, and 55 ± 6 for rice. Postprandial FMD was lowest in the glucose group and significantly different from both the corn group and the FMD value for all complex carbohydrates combined. Methylglyoxal was significantly elevated at 60 minutes postprandial after glucose compared with the other carbohydrate sources. No significant effects of carbohydrate source were observed for blood pressure, nitrotyrosine, or echocardiographic variables. The novel finding of this study was that methylglyoxal levels increased after a single feeding of simple carbohydrate and may be linked to the observed postprandial decrease in endothelial function. Thus, consuming low-glycemic-index foods may protect the cardiovascular system by reducing oxidative stress.

Comparison of the Effects of Etomidate, Propofol, and Thiopental on Respiratory Resistance after Tracheal Intubation

Tracheal intubation frequently results in reversible bronchoconstriction. Propofol has been reported to minimize this response in healthy patients and in asthma patients, but may be unsuitable for hemodynamically unstable patients for whom etomidate may be preferable. The current study examined respiratory resistance after tracheal intubation after induction with either thiopental, etomidate, or propofol. A supratherapeutic dose of etomidate was used to test the hypothesis that the bronchoconstrictive response could be minimized by deep intravenous anesthesia. Seventy-seven studies were conducted in 75 patients. Anesthesia was induced with either 2.5 mg/kg propofol, 0.4 mg/kg etomidate, or 5 mg/kg thiopental. Respiratory resistance was measured at 2 min after induction. Respiratory resistance at 2 min was 8.1 +/- 3.4 cmH2O.1(-1).s (mean +/- SD) for patients receiving propofol versus 11.3 +/- 5.3 for patients receiving etomidate and 12.3 +/- 7.9 for patients receiving thiopental (P < or = 0.05 for propofol vs. either etomidate or thiopental). Respiratory resistance after tracheal intubation is lower after induction with propofol than after induction with thiopental or after induction with high-dose etomidate.