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Urinalysis is considered the world's oldest laboratory test. Today, many laboratories use macroscopic urinalysis as a screening tool to determine when to subject urine samples for a microscopic urinalysis and/or bacterial culture. While reflexive urine microscopy has been practiced for decades, and reflexive urine culture, more recently, evidence-based guidelines regarding optimal reflexive criteria and workflows are lacking. Standard approaches are hindered, in part, by a lack of harmonization of urinalysis and urine culture practices, heterogeneity in patient populations that are studied, and lack of provider adherence to recommended practices. This review summarizes studies that have evaluated the performance of reflexive urine microscopy and reflexive urine culture, particularly in the context of urinary tract infections. It also examines reported clinical outcomes from reflexive urinalysis interventions and their impact on antibiotic stewardship efforts. Finally, it discusses laboratory operational considerations for the implementation of reflexive algorithms. [ABSTRACT FROM AUTHOR]

Aim: Lynch Syndrome is associated with a significant risk of colorectal carcinoma (CRC) and other cancers. Universal tumor screening is a strategy to identify high-risk individuals by testing all CRC tumors for molecular features suggestive of Lynch Syndrome. Patient interest in screening and preferences for consent have been underexplored. Methods: A postal survey was administered to CRC patients in a Canadian province. Results: Most patients (81.4%) were willing to have tumors tested if universal tumor screening were available and were willing to discuss test results with family members and healthcare professionals. The majority (62.6%) preferred informed consent be obtained prior to screening. Conclusion: Patients were supportive of universal screening. They expected consent to be obtained, contrary to current practice across Canada and elsewhere. [ABSTRACT FROM AUTHOR]

We report a 37-year-old woman with uveitic phase of Vogt Koyanagi Harada disease and tonic pupil, the tonic pupil persisted after other clinical features of this syndrome had disappeared; neurological evaluation shows absent knee and arm tendon reflexes and positive cholinergic supersensitivity test with Pilocarpine 0.125% confirming the diagnosis of Holmes Adie Syndrome. [ABSTRACT FROM AUTHOR]

Objective: High-performance liquid chromatography (HPLC) has been evaluated as useful technique for detection of variant hemoglobins in newborn screening, ethnicity-based screening, and patients with abnormal hemoglobin electrophoresis. This study aimed at evaluating this technique as ‘reflex’ testing in a pediatric referral center. Methods: This study included 1317 children visiting the pediatric hospital, who underwent HPLC analysis on anticoagulated blood samples. These patients were divided into clinician-requisitioned HPLC (group A), ‘reflex’ testing for anemia (group B), and unrelated etiologies (group C). HPLC graphs were evaluated for various hemoglobins. Statistical analysis was performed for comparison between these groups for frequency of abnormal HPLC assay and various red cell parameters. Results: The frequency of abnormal HPLC assay was 22.89% in group A (125 of 546 cases), 26.89% in group B (78 of 290 cases), and 31.8% in group C (153 of 781 cases) with statistically significant difference. The most frequent variant in all three groups was thalassemia trait. Thalassemia intermedia and major, both were detected in few patients in groups B and C. Conclusion: ‘Reflex’ testing for hemoglobin variants can be undertaken for pediatric samples to enhance detection of these variants and avoid an additional venepuncture. [ABSTRACT FROM AUTHOR]

Objective. To improve the pathophysiological understanding of cardioinhibitory and vasodepressor reflex syncope, by evaluating orthostatic effects on electrical and hemodynamic variables. To unravel the pathogeneses further, we studied these effects during both the passive head-up tilt test and the active standing test. Background. The current knowledge of the compromised autonomic balance in patients with reflex syncope is limited. The orthostatic responses to head-up tilt test in cardioinhibitory and vasodepressor patients differ, suggesting different pathogeneses; however, the more physiological active standing test represents daily life situations better. Methods. We included 74 patients; 36 cardioinhibitory and 38 vasodepressor. Patients were compared with respect to vascular hemodynamics and heart rate variability during the change from supine to upright position. Resting electrolytes, brain natriuretic peptide (BNP), pro-atrial natriuretic peptide (pro-ANP), and the C-terminal of pro-vasopressin, copeptin were measured. Results. Resting systolic blood pressure was higher in cardioinhibitory (117.8 ± 15.7 mmHg) than in vasodepressor patients (109.1 ± 15.3 mmHg, p < 0.001). Changes in heart rate tended to be smaller in cardioinhibitory patients (6.7 ± 9.8vs. 10.7 ± 8.9 bpm, p = 0.056). Heart rate variability was lower and changed less in cardioinhibitory patients ( p < 0.05). Cardioinhibitory patients had higher pro-ANP levels (63.5 ± 18.8pM) compared to vasodepressor patients (54.2 ± 31.4 pM, p = 0.018). Responses during active standing were attenuated compared to head-up tilt in both groups. Conclusions. This study demonstrated that cardioinhibitory patients had higher blood pressure, attenuated hemodynamic responses, and reduced autonomic regulation compared to vasodepressor patients. Furthermore, cardioinhibitory patients showed a sympathetic predominance in their modulation of autonomic responses. Orthostatic responses induced by active standing were modest and did not sufficiently explain potential pathophysiological differences between cardioinhibitory and vasodepressor patients. [ABSTRACT FROM AUTHOR]

Context: αα-Terpineol (TPN) is a monoterpenoid alcohol present in the essential oils of several species of the Eucalyptus genus (Myrtaceae). Objective: TPN was assessed for its antinociceptive activity in rodents. Materials and methods: The antinociceptive effect of TPN was examined using the acetic acid writhing reflex, formalin, glutamate, and capsaicin-induced nociception tests. Results: TPN produced a significant ( P < 0.01 or P < 0.001) analgesic effect by reduction at the early and late phases of paw licking and reduced the writhing reflex in mice (formalin and writhing tests, respectively). In the glutamate test, all doses of TPN produced significant ( P < 0.01) nociceptive protection. When the capsaicin-induced nociception test was conducted, TPN produced dose-related inhibition of the nociceptive behavior. In addition, the results of a hot plate test showed central analgesic properties for TPN ( P < 0.01 or P < 0.001). Such results were unlikely to be provoked by motor abnormality. Conclusion: Our results suggest that TPN might represent an important tool for management and/or treatment of painful conditions. [ABSTRACT FROM AUTHOR]

Background aims. Spinal cord injury (SCI) is a medically untreatable condition for which stem cells have created hope. Pre-clinical and clinical studies have established that these cells are safe for transplantation. The dose dependency, survivability, route of administration, cell migration to injury site and effect on sensory and motor behavior in an SCI-induced paraplegic model were studied. Methods. A spinal cord contusion injury model was established in rats. Bone marrow (BM) mesenchymal stromal cells (MSC) were tagged to facilitate tracing in vivo. Two different doses (2 and 5 million cells/kg body weight) and two different routes of infusion (site of injury and lumbar puncture) were tested during and after the spinal shock period. The animals were tested post-transplantation for locomotor capacity, motor control, sensory reflex, posture and body position. Stem cell migration was observed 1 month post-transplantation in spinal cord sections. Results. The overall results demonstrated that transplantation of BM MSC significantly improved the locomotor and sensory behavior score in the experimental group compared with the sham control group, and these results were dose dependent. All the infused stem cells could be visualized at the site of injury and none was visualized at the injected site. This indicated that the cells had survived in vivo, were probably chemoattracted and had migrated to the lesion site. Conclusions. MSC transplanted with a lumbar puncture method migrate to the site of injury and are the most suitable for SCI healing. These cells demonstrate a dose-dependent effect and promote functional recovery when injected during or after the spinal shock period. [ABSTRACT FROM AUTHOR]

The Hoffmann reflex is obtained through surface electromyographic recordings, and it is one of the most common neurophysiological techniques in exercise science. Measurement and evaluation of the peak-to-peak amplitude of the Hoffmann reflex has been guided by the observation that it is a variable response that requires multiple trials to obtain a stable mean. As a result, reliability assessment of the Hoffmann reflex has thus far been limited to trial-to-trial variability or the mean of multiple trials across test days to evaluate day-to-day variability, without considering how the two dimensions of measurement interact to affect test-retest reliability. This article compares two analysis of variance models for reliability assessment of the peak-to-peak amplitude of the Hoffmann reflex: one model incorporated both days and trials, and the other used the mean of multiple trials on each test day. The intraclass correlation coefficient calculated from an analysis of variance model that incorporated both trial-to-trial and day-to-day error variances was R = .93. Using the mean of the trials for each test day as a single score resulted in a decrease in the intraclass correlation coefficient (R2,1 = .76). This study demonstrated that an analysis of variance model that accounts for both trial-to-trial and day-to-day error variances provided a higher estimate of reliability. Further, reliability estimation based on the interaction between both trials and days revealed that a schedule with additional test days had a disproportionate impact upon securing a reliable measure of Hoffmann reflex amplitude. [ABSTRACT FROM AUTHOR]

Objective: To establish the reliability of soleus H-reflex in individuals with incomplete spinal cord injury (SCI) during the standing and the swing and stance phases of overground walking. Methods: Fourteen SCI (40 ± 10 years) and eight noninjured subjects (32 ± 9 years) participated. The noninjured and SCI subjects walked at self-selected speed overground. H-reflexes in the soleus muscle (at M-wave 7%–13% maximum-M) were tested on two separate days by stimulating the tibial nerve. Intraclass correlation coefficients (two-way mixed model-ICC (1, 2)) and standard error of measurement (SEM) were calculated. Results: Relative reliability of the H-reflexes was good to excellent; intra-class correlation coefficients (ICCs) ranged from 0.64–0.91 in noninjured and SCI subjects. SEM expressed as percentage of the mean H-reflex was 13%–62% in noninjured and 12%–18% in SCI individuals. Conclusions: H-reflexes can be reliably assessed in standing and walking in post-SCI and noninjured subjects. Significance: H-reflexes can be reliably used in longitudinal studies to investigate mechanisms of recovery post-SCI. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether vegetative state patients maintain circadian rhythms. Research design: An observational study of five single cases. Methods and procedures: Five chronic vegetative state patients underwent clinical and neurological evaluations and 2-week continuous temperature measurements. Main outcomes and results: The two patients with traumatic brain injury showed well-formed circadian temperature rhythms and had more reflexive behaviours and relatively low cortical and sub-cortical atrophy, whereas the three patients from anoxic-hypoxic origin demonstrated no cycles or rhythmic behaviour. Conclusions: The presence of periods of wakefulness does not imply preserved sleep-wake cycling capacity, nor preserved circadian rhythms and it should not be taken as a distinguishing feature for the definition of the vegetative state. [ABSTRACT FROM AUTHOR]

Conclusion. Motorized head impulse rotator is an effective technique to assess peripheral vestibular function. Approximately a quarter of patients with vestibular schwannoma (VS) had preserved preoperative responses. Vestibular disability could not be predicted based on vestibulo-ocular reflex (VOR) performance during motion stimuli, or in the caloric test. Objectives. To explore motorized head impulse rotator for evaluation of angular horizontal VOR in patients with VS, and to compare these responses to those of the caloric test and the symptoms. Patients and methods. We prospectively recorded head and eye position during unpredictable motorized head impulses in 38 patients with VS. We calculated gain and asymmetry of VOR (mean±95% CI), and the results were compared to those of the caloric test and a questionnaire regarding dizziness, hearing and quality of life. Results. The VOR during motorized impulses was abnormal in 71% of patients. Asymmetry in gain correlated significantly (p<0.001) with unilateral weakness in the caloric test. Preoperative gain was significantly lowered to 0.83±0.08 on the ipsilateral side compared to 0.98±0.06 on the contralateral side. Postoperative gain on the operated side of 0.53±0.05 was significantly different from preoperative gain (p<0.001). Findings in vestibular tests did not correlate with subjective sensation of dizziness. [ABSTRACT FROM AUTHOR]

Conclusion. The otolithic organs of patients with vestibular drop attack (VDA) secondary to Meniere's disease were damaged but the damage was not complete. In other words, the otolithic functions of patients with VDA were unstable. Objective. To evaluate otolithic function using vestibular evoked myogenic potential (VEMP) in patients with VDA secondary to Meniere's disease. Patients and methods. Clinical records of three patients with VDA secondary to Meniere's disease were reviewed with special reference to VEMP testing. Results. The three patients were classified as stage II or III Meniere's disease. A long-term follow-up of VEMP in two patients showed reversible changes of VEMP reflexes, and VEMP testing with glycerol administration in two patients revealed the recovery of VEMP responses after taking glycerol, and the existence of saccular endolymphatic hydrops. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate if the magnitude of the soleus H-reflex is different depending on the method employed to measure its size (peak-to-peak amplitude vs. area). In this study, 13 healthy human subjects participated, while the soleus H-reflex was induced via conventional methods. In the first experiment, the soleus H-reflex was recorded via two monopolar electrodes and was evoked at least at eight different stimulation intensities in respect to the recovery curve of the H-reflex and at three different inter-stimulus intervals (ISIs) (8, 5, and 2&ThickSpace;s). The ISI refers to the time delay between the single pulses delivered to the posterior tibial nerve within a single trial. In the second experiment, the effects of common peroneal nerve (CPN) stimulation at short (2–4&ThickSpace;ms) and at long (60–120&ThickSpace;ms) conditioning test (C-T) intervals on the soleus H-reflex elicited every 5&ThickSpace;s were established. Control and conditioned reflexes were recorded via a single differential bipolar electrode. In both experiments, H-reflexes were quantified by measuring their size as peak-to-peak amplitude and as area under the full-wave rectified waveform. The reflex responses recorded through two monopolar electrodes across stimulation intensities and ISIs measured as peak-to-peak amplitude had larger values than measured as area. In contrast, the magnitude of the reflexes, conditioned by CPN stimulation at either short or long C-T intervals and recorded via a single differential electrode, were not significantly different when measured as peak-to-peak amplitude or as area. Our findings indicate that monopolar recordings yield different reflex sizes depending on the method employed to measure the reflex size, and that the H-reflex measured as area might detect better the homosynaptic reflex depression. The lack of observing such differences with bipolar recordings might be related to changes of the reflex shape at a given stimulus intensity due to inhibitory inputs. The implications of our findings are discussed in respect to human reflex studies. [ABSTRACT FROM AUTHOR]

Conclusion The results of this study show that R- prelingually cochlear-implanted children are not optimal candidates for cochlear implantation. However, if this group are implanted, other rehabilitation methods should be incorporated into their rehabilitation program in order to achieve better results and maximize the efficacy of their prosthesis.Objective To demonstrate that the blink reflex or auropalpebral reflex evaluation can be used as a prognostic factor for the assessment of auditory and speech perception levels in prelingually cochlear-implanted children.Material and methods In an observational, analytical, prospective study conducted at a single cochlear implant rehabilitation center in 85 prelingually cochlear-implanted children, the presence or absence of the blink reflex (BR) was evaluated and the results of auditory and speech perception tests were compared between reflex-positive (R+) and reflex-negative (R-) patients. To obtain the BR, four electrodes were applied in both the Nucleus and MED-EL systems and then stimulated by means of current levels higher than the previously detected most comfortable level of the patient until the reflex appeared. Auditory and speech perception levels were measured using the vowels-confusion test and the categorization of auditory perception scale. Results The mean results of auditory and speech perception tests were significantly higher in R+ compared to R- patients. [ABSTRACT FROM AUTHOR]

The purpose of this study was to quantify changes in Renshaw cell activity from supine to standing and determine the relationship between these changes and changes in the soleus H-reflex. Ten young subjects were tested using an indirect measure of Renshaw cell activity. Twelve test and twelve conditioned H-reflexes were collected during both supine and standing conditions. All subjects significantly increased Renshaw cell activity from supine to standing. Furthermore, there was a significant correlation between the changes in H-reflex and Renshaw cell activity. As the co-contraction requirement of the system increased, Renshaw cell activity also increased. [ABSTRACT FROM AUTHOR]

The Hoffmann (H) reflex and motor (M) response were studied in sole us and gastrocnemius during voluntary contraction in eight male volunteers. Aims: To determine if the strength of spindle input to the muscles is the same. To assess if the M response size changes during contraction. Results: The size of the maximum M response (M max) changed during contraction in each subject. Hence, all H reflex measurements were normalized to the M max at each level of contraction for each subject. The largest HIM max was bigger in sole us than gastrocnemius at every contraction level. The overall largest HIM max for soleus (97%) and gastrocnemius (55%) were achieved at 40 and 100% maximum voluntary contraction (MVC), respectively. Conclusion: Soleus receives greater spindle feedback than the gastrocnemius both at rest and during voluntary contraction. [ABSTRACT FROM AUTHOR]

Despite the fact that vertigo is the most apparent complaint at the onset of Ménière's disease, standard vestibular examination seldom shows vestibular function loss in the early phase. In this study, three relatively advanced diagnostic tests (passive high frequency head shaking, passive head impulse test and sidewards linear acceleration) were applied to trace vestibular function loss in the early phase in 25 patients with possible Ménière's disease (American Academy of Otolaryngology-Head and Neck Surgery 1995 criteria); one test (passive high frequency head shaking) was also conducted in 20 chronic definite Ménière's disease patients. Head movements were induced by a head shaker and whole-body linear translation by a motor-driven linear slit. Eye movements were detected by electro-oculography (head shaking) and the scleral coil technique (impulse test and linear translation). Standard vestibular examination showed no vestibular function loss in the early phase patient group. In contrast, 17 out of 25 patients (68%) showed a phase lag upon head shaking that was 1-2° larger than the 95% confidence interval in healthy subjects; the remaining 8 patients showed a normal phase lag. Gain was normal in all 25 patients. In the chronic patient group, standard vestibular examination was abnormal (calorics) in 16 out of 20 patients (60%) and 18 out of 20 (90%) showed an abnormal phase on passive head shaking. In 11 of the 25 early phase patients (44%), an increased latency was observed in the response to a passive head impulse to one side. The side to which the abnormal latency occurred did not correspond to the documented or reported side of the hearing loss in 2 out of the 11 patients. The amplitude of ocular counter rolling induced by sidewards sinusoidal translation was reduced in 17 out of the 25 early phase Ménière's disease patients, of whom 6 showed a normal head impulse and head shaking test. Our findings indicate that vestibular function loss occurs in Ménière's disease patients within 9 months of the first vertigo attack. Also, the results support the hypothesis that, at least in some patients, function loss in the statolith system might precede function loss in the horizontal canals. [ABSTRACT FROM AUTHOR]

Examines the theoretical views regarding the appearance and disappearance of primitive reflexes and discusses their implications for therapeutic interventions. Traditional, transitional and systems view on primitive reflexes; Disappearance of primitive reflexes by biochemical reasons; Use of the dynamic systems approach providing insights for intervention.