Effect of Pharmacologic Stress Test Results on Outcomes in Obese versus Nonobese Subjects Referred for Stress Perfusion Echocardiography

2016 ◽  
Vol 29 (9) ◽  
pp. 899-906 ◽  
Author(s):  
Nicola Gaibazzi ◽  
Valentina Lorenzoni ◽  
Claudio Reverberi ◽  
Juefei Wu ◽  
Feng Xie ◽  
...  
Keyword(s):  
Stress Test ◽  
Pharmacologic Stress ◽  
Stress Perfusion ◽  
Test Results

scholarly journals Clinical judgement in chest pain: a case report 

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Mishita Goel ◽  
Shubhkarman Dhillon ◽  
Sarwan Kumar ◽  
Vesna Tegeltija
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Tobacco Use ◽  
Stress Test ◽  
Artery Bypass ◽  
Pretest Probability ◽  
Clinical Judgement ◽  
Test Results ◽  
Cardiac Stress ◽  
History Of

Abstract Background Cardiac stress testing is a validated diagnostic tool to assess symptomatic patients with intermediate pretest probability of coronary artery disease (CAD). However, in some cases, the cardiac stress test may provide inconclusive results and the decision for further workup typically depends on the clinical judgement of the physician. These decisions can greatly affect patient outcomes. Case presentation We present an interesting case of a 54-year-old Caucasian male with history of tobacco use and gastroesophageal reflux disease (GERD) who presented with atypical chest pain. He had an asymptomatic electrocardiogram (EKG) stress test with intermediate probability of ischemia. Further workup with coronary computed tomography angiography (CCTA) and cardiac catheterization revealed multivessel CAD requiring a bypass surgery. In this case, the patient only had a history of tobacco use but no other significant comorbidities. He was clinically stable during his hospital stay and his testing was anticipated to be negative. However to complete workup, cardiology recommended anatomical testing with CCTA given the indeterminate EKG stress test results but the results of significant stenosis were surprising with the patient eventually requiring coronary artery bypass grafting (CABG). Conclusion As a result of the availability of multiple noninvasive diagnostic tests with almost similar sensitivities for CAD, physicians often face this dilemma of choosing the right test for optimal evaluation of chest pain in patients with intermediate pretest probability of CAD. Optimal test selection requires an individualized patient approach. Our experience with this case emphasizes the role of history taking, clinical judgement, and the risk/benefit ratio in deciding further workup when faced with inconclusive stress test results. Physicians should have a lower threshold for further workup of patients with inconclusive or even negative stress test results because of the diagnostic limitations of the test. Instead, utilizing a different, anatomical test may be more valuable. Specifically, the case established the usefulness of CCTA in cases such as this where other CAD diagnostic testing is indeterminate.

scholarly journals Limiting the Pitch Count in Youth Baseball Pitchers Decreases Elbow Pain

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712198910
Author(s):  
Tetsuya Matsuura ◽  
Yuki Takata ◽  
Toshiyuki Iwame ◽  
Jyoji Iwase ◽  
Kenji Yokoyama ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Stress Test ◽  
Daily Maximum ◽  
Test Results ◽  
Level Of Evidence ◽  
Valgus Stress ◽  
Radiographic Images ◽  
Elbow Pain ◽  
Youth Baseball ◽  
Baseball Pitchers

Background: Reducing the number of pitches thrown is regarded as the most effective way to prevent throwing injuries in youth baseball pitchers. However, few studies have compared the effectiveness of limiting the pitch count versus the limiting the number of innings pitched in terms of elbow injuries. Hypothesis: We hypothesized that, compared with inning limits, pitch count limits would lead to greater decreases in elbow pain, range of motion deficits, positive moving valgus stress test results, and the risk of capitellar osteochondritis dissecans (OCD). Study Design: Cohort study; Level of evidence, 3. Methods: This study retrospectively reviewed baseball pitchers aged 8 to 12 years in 2017 and 2018. Inning and pitch count limits in games were set to a daily maximum of 7 innings in 2017 and 70 pitches in 2018. Elbow pain, range of motion, and moving valgus stress test results were evaluated. The presence of capitellar OCD was assessed on ultrasonographic and radiographic images. Results: A total of 352 pitchers in 2017 and 367 pitchers in 2018 participated. The mean pitch count per game was lower in the pitch count limit (CL) group (52.5 ± 16.0) than in the inning limit (IL) group (98.2 ± 19.5) ( P < .001). Compared with the IL group, the CL group had significantly lower rates of elbow pain (40.9% vs 31.9%, respectively; P = .01) and reduced flexion (19.0% vs 10.6%, respectively; P = .001). Multivariate analysis revealed a significant association between elbow pain and age in both the IL and the CL groups ( P < .0001 and P = .02, respectively) and between OCD and elbow pain in the CL group ( P = .04). Conclusion: A pitch count limit of ≤70 pitches per day for baseball pitchers ≤12 years could be more protective against elbow pain and reduced flexion than a limit of ≤7 innings per day, but it may not be effective for reducing the risk of capitellar OCD.

A 300°C High Reliability HALT/HAST Screening/Sorting Procedure for Ceramic Capacitors

2018 ◽  
Vol 2018 (HiTEC) ◽  
pp. 000129-000137 ◽  
Author(s):  
Harold L. Snyder
Keyword(s):  
High Reliability ◽  
Stress Test ◽  
Electrical Current ◽  
Accelerated Life Test ◽  
Test Results ◽  
Electrical Model ◽  
Current Leakage ◽  
Ceramic Capacitor ◽  
Ceramic Capacitors ◽  
Before And After

Abstract A highly accelerated life test (HALT) and highly accelerated stress test (HAST) procedure for ceramic capacitors developed by the author in the mid 1980's to early 1990's, and published in 1994, consists of a 400 Volt biased six (6) hour stress sort at 150°C (423K), a methanol current leakage test that located mechanical and structural cracks, a visual inspection at ten times (10×) magnification, and a capacitance and dissipation measurement before and after the test. In over thirty (30) years of use, there has never been a user reported in-circuit failure in industrial, military, and aerospace application at temperatures as high as 500°C (773K). However, reviewing user feedback, two concerns with the original sorting procedure are the stress is performed at 150°C (423K), and the lack of a more detailed ceramic capacitor electrical model. To address the first, the low aging temperature, the stress temperature was increased from 150°C to 300°C, in order to age ceramic solid state crystal mineral phases that may change with temperature. The test results for X7R and NP0/COG multilayer ceramic capacitors (MLCC) at 300°C, are compared to the test results using the original HALT/HAST procedure at 150°C. Differences between X7R/NP0/COG and porcelain capacitors are discussed when applicable. Further, a more detailed ceramic capacitor electrical model that represents the physical and electrical characteristics of the ceramic capacitors is presented, including the electrical current leakage effects with temperature, and the carbonized residue effects from the manufacturing process.

scholarly journals A Pharmacologic “Stress Test” for Assessing Select Antioxidant Defenses in Patients with CKD

2020 ◽  
Vol 15 (5) ◽  
pp. 633-642 ◽  
Author(s):  
Richard A. Zager ◽  
Ali C.M. Johnson ◽  
Alvaro Guillem ◽  
Jeff Keyser ◽  
Bhupinder Singh
Keyword(s):  
Kidney Disease ◽  
Healthy Volunteers ◽  
Stress Test ◽  
Oxidant Stress ◽  
Pharmacologic Stress ◽  
Antioxidant Defenses ◽  
Heme Oxygenase 1 ◽  
High Dose ◽  
Clinical Trial Registry ◽  
Antioxidant Proteins

Background and objectivesOxidative stress is a hallmark and mediator of CKD. Diminished antioxidant defenses are thought to be partly responsible. However, there is currently no way to prospectively assess antioxidant defenses in humans. Tin protoporphyrin (SnPP) induces mild, transient oxidant stress in mice, triggering increased expression of select antioxidant proteins (e.g., heme oxygenase 1 [HO-1], NAD[P]H dehydrogenase [quinone] 1 [NQO1], ferritin, p21). Hence, we tested the hypothesis that SnPP can also variably increase these proteins in humans and can thus serve as a pharmacologic “stress test” for gauging gene responsiveness and antioxidant reserves.Design, setting, participants, & measurementsA total of 18 healthy volunteers and 24 participants with stage 3 CKD (n=12; eGFR 30–59 ml/min per 1.73 m2) or stage 4 CKD (n=12; eGFR 15–29 ml/min per 1.73 m2) were injected once with SnPP (9, 27, or 90 mg). Plasma and/or urinary antioxidant proteins were measured at baseline and for up to 4 days post-SnPP dosing. Kidney safety was gauged by serial measurements of BUN, creatinine, eGFR, albuminuria, and four urinary AKI biomarkers (kidney injury molecule 1, neutrophil gelatinase-associated lipocalin, cystatin C, and N-acetyl glucosaminidase).ResultsPlasma HO-1, ferritin, p21, and NQO1 were all elevated at baseline in CKD participants. Plasma HO-1 and urine NQO1 levels each inversely correlated with eGFR (r=−0.85 to −0.95). All four proteins manifested statistically significant dose- and time-dependent elevations after SnPP injection. However, marked intersubject differences were observed. p21 responses to high-dose SnPP and HO-1 responses to low-dose SnPP were significantly suppressed in participants with CKD versus healthy volunteers. SnPP was well tolerated by all participants, and no evidence of nephrotoxicity was observed.ConclusionsSnPP can be safely administered and, after its injection, the resulting changes in plasma HO-1, NQO1, ferritin, and p21 concentrations can provide information as to antioxidant gene responsiveness/reserves in subjects with and without kidney disease.Clinical Trial registry name and registration numberA Study with RBT-1, in Healthy Volunteers and Subjects with Stage 3–4 Chronic Kidney Disease, NCT0363002 and NCT03893799

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