178 THE VARIABILITY IN MAXIMAL STRESS TEST RESULTS IN HEALTHY ELDERLY MALES USING THREE MINUTE, ONE MINUTE, AND RAMP STAGE PROTOCOLS

1990 ◽  
Vol 22 (2) ◽  
pp. S30
Author(s):  
C. E. Shaw ◽  
K. Gorman ◽  
I. Pina ◽  
J. Posner
2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Mishita Goel ◽  
Shubhkarman Dhillon ◽  
Sarwan Kumar ◽  
Vesna Tegeltija

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.


2021 ◽  
Vol 9 (3) ◽  
pp. 232596712198910
Author(s):  
Tetsuya Matsuura ◽  
Yuki Takata ◽  
Toshiyuki Iwame ◽  
Jyoji Iwase ◽  
Kenji Yokoyama ◽  
...  

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.


2018 ◽  
Vol 2018 (HiTEC) ◽  
pp. 000129-000137 ◽  
Author(s):  
Harold L. Snyder

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.


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

1998 ◽  
Vol 83 (5) ◽  
pp. 1756-1761 ◽  
Author(s):  
Brigitte M. Kudielka ◽  
Juliane Hellhammer ◽  
Dirk H. Hellhammer ◽  
Oliver T. Wolf ◽  
Karl-Martin Pirke ◽  
...  

Evidence from animal as well as human studies has suggested that significant sex differences exist in hypothalamus-pituitary-adrenal axis (HPA) activity. As gonadal steroids could be important modulators of HPA sex differences, stress responses were investigated in subjects of advanced age after dehydroepiandrosterone (DHEA) or placebo treatment. After a 2-week treatment with 50 mg DHEA daily or placebo, 75 men and women (mean age, 67.6 yr) were exposed to the Trier Social Stress Test (TSST). The TSST is a brief psychosocial stress that consists of a free speech and mental arithmetic task in front of an audience. The results show that the TSST induced significant increases in ACTH, salivary free cortisol, total plasma cortisol, norepinephrine, and heart rates (all P &lt; 0.0001) as well as decreased positive affect in the elderly (P = 0.0009). Men showed larger stress responses in ACTH (P = 0.004), salivary free cortisol (P = 0.044), and plasma total cortisol (P = 0.076) compared to women. No sex differences were observed in norepinephrine, epinephrine, or heart rate responses. In contrast to ACTH and cortisol response differences, women reported that they were significantly more stressed by the TSST than men (P = 0.0051). Women treated with DHEA showed ACTH stress responses similar to those of men, but significantly enhanced compared to those of women taking placebos (P &lt; 0.009). No other stress response differences emerged between DHEA and placebo groups. Finally, DHEA treatment did not result in an improvement of subjective well-being. We conclude that elderly men show larger HPA responses than women to psychosocial stress, as studied in the TSST. Estrogen effects on hypothalamic CRF-producing neurons might be responsible for these sex differences.


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