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[Return to digest index] --------------------------------------------- This is a special digest of Co-Cure Research & Medical posts only Problems? Write to mailto:firstname.lastname@example.org E-Mail mailto:Co-Cure-HMCemail@example.com to unsubscribe --------------------------------------------- ---------------------------------------------------------------------- Date: Tue, 30 Jan 2007 15:08:07 -0500 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: Computerized cuff pressure algometry: A new method to assess deep-tissue hypersensitivity in fibromyalgia Computerized cuff pressure algometry: A new method to assess deep-tissue hypersensitivity in fibromyalgia. Pain. 2007 Jan 24; [Epub ahead of print] Jespersen A, Dreyer L, Kendall S, Graven-Nielsen T, Arendt-Nielsen L, liddal H, Danneskiold-Samsoe B. The Parker Institute, Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark. PMID: 17257757 The aim of this study was to evaluate the use of computerized cuff pressure algometry (CPA) in fibromyalgia (FM) and to correlate deep-tissue sensitivity assessed by CPA with other disease markers of FM. Forty-eight women with FM and 16 healthy age-matched women were included. A computer-controlled, pneumatic tourniquet cuff was placed over the gastrocnemius muscle. The cuff was inflated, and the subject rated the pain intensity continuously on an electronic Visual Analogue Scale (VAS). The subject stopped the inflation at the pressure-pain tolerance and the corresponding VAS-score was determined (pressure-pain limit). The pressure at which VAS firstly exceeded 0 was defined as the pressure-pain threshold. Other disease markers (FM only): Isokinetic knee muscle strength, tenderpoint-count, myalgic score, Beck Depression Inventory, and Fibromyalgia Impact Questionnaire. Student's T-test was used to compare pressure-pain threshold and pressure-pain tolerance and the Mann-Whitney test to compare pressure-pain limit. Pearson's correlation was used to detect linear relationships. Pressure-pain threshold and pressure-pain tolerance assessed by CPA were significantly lower in FM compared to healthy controls. There was no difference in pressure-pain limit. CPA-parameters were significantly correlated to isokinetic muscle strength where more hypersensitivity resulted in lower strength. Pressure-pain threshold and pressure-pain tolerance assessed by CPA were significantly lower in patients with FM indicating muscle hyperalgesia. CPA was associated with knee muscle strength but not with measures thought to be influenced by psychological distress and mood. [Return to top] ------------------------------ Date: Tue, 30 Jan 2007 17:07:49 -0500 From: "Alan Gurwitt, M.D. <agurcp verizon.net> via Co-Cure Moderator" Subject: RES: Unreliable findings of depression in CFS Apparently it is necessary to remind ourselves of the following: Any report of research data that refers to finding the presence of depression and/or increased anxiety in CFS patients that does not make clear whether those symptoms are pre-illness or post-illness onset findings is seriously flawed. The occurrence of depression and anxiety after onset is common and is both reactive (that is, a psychological consequence of having such a dreadful medical illness) and biological (as evidenced by new brain imaging techniques). Furthermore the depression in post-onset CFS is different from the major depressive disorder in non-CFS patients. The failure to distinguish between the two, easily done, has plagued research conclusions and led to highly biased findings and attitudes in the past. Failure to make such distinction, although less common now, continues to plague us. It is totally unacceptable. Alan Gurwitt, M.D. [Return to top] ------------------------------ Date: Wed, 31 Jan 2007 11:52:00 -0500 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: Possible joint origin of restless leg syndrome (RLS) and migraine Possible joint origin of restless leg syndrome (RLS) and migraine. Med Hypotheses. 2007 Jan 25; [Epub ahead of print] Sabayan B, Bagheri M, Borhani Haghighi A. Student Research Committee, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. PMID: 17258401 Sleep disorders have been described in migraine patients. Among sleep disorders RLS has been reported in up to one-third of migraineurs. Adverse effects of anti migraine therapy by dopamine antagonists can not fully explain this association. Therefore we present the hypothesis that RLS and migraine may have a joint origin. The hypothesis is supported by: (1) the same genetic origin for migraine without aura and RLS in single Italian family on chromosome 14q21; this gene codes survival motor neuron-interacting protein 1 (SIP1) which can play role in both diseases. (2) Correlation of both RLS and migraine with fibromyalgia. (3) Alteration of cortical excitability in both migraine and RLS. [Return to top] ------------------------------ Date: Wed, 31 Jan 2007 11:51:13 -0500 From: Fred Springfield <fredspringfield VERIZON.NET> Subject: RES: Diagnosis and treatment of metal-induced side-effects Diagnosis and treatment of metal-induced side-effects. Journal: Neuro Endocrinol Lett. 2006 Dec 29;27(Suppl1) [Epub ahead of print] Authors: Stejskal VD, Hudecek R, Stejskal J, Sterzl I. Affiliation: Department of Immunology and Microbiology, 1st Medical Faculty, Charles University Prague, Czech Republic. NLM Citation: PMID: 17261999 Environmental factors are recognized as a cause of the increasing frequency of allergic and autoimmune diseases. In addition to external pollutants, metal ions released from dental restorations or from other body implants might trigger inflammation in susceptible subjects. In humans, genes governing metal-induced inflammation/autoimmunity are not yet known. In clinical praxis, metal-sensitive patients will present various symptoms raging from oral mucosal changes and skin disease to excessive fatigue and autoimmune diseases. One has to rely on the phenotypic markers of metal susceptibility. Such biomarkers might be certain detoxification enzymes but also the presence of metal-specific memory cells in the blood. With the increasing use of metal implants in medicine and dentistry, it is important to have a proper tool for the diagnosis of metal allergy in susceptible subjects. After nickel, gold is now the second most common sensitizer. Depending on the genetic phenotype, metal-sensitive patients will present symptoms ranging from contact allergy to autoimmune disease and chronic fatigue syndrome (CFS). In addition to patch test, an in vitro blood test, an optimized commercially available lymphocyte transformation test (MELISA(R)) is used in this study for the diagnosis of metal allergy. Both tests were used for the diagnosis of metal allergy in selected group of 17 patients who suffered from clinical metal sensitivity in addition to other health problems. The concordance of the two tests was good but LTT detected more metal allergies than patch test. The replacement of incompatible dental restorative metals (RID) resulted in long term health improvement in the majority of patients. We postulate that in vivo metal ions will activate T-cells starting systemic inflammation which, through cytokines affect the brain and hypothalamus-pituitary-adrenal (HPA) axis. The treatment and rehabilitation of metal sensitive patients is based on a firm understanding and recognition of individual susceptibility. RID has to be done under strict precaution and according to standard working protocol. If performed properly, this treatment can result in decreased systemic inflammation and improved health in sensitized patients. [Return to top] ------------------------------ Date: Wed, 31 Jan 2007 15:28:21 -0800 From: "Rich Van Konynenburg.................via Co-Cure moderators" Subject: RES: cancer breakthough moderator's note: although this is off-topic for Co-Cure, it may be of interest to patients. It was sent by a frequent contributor, Rich Van Konynenburg, Ph.D. Any questions, replies or comments should go to him at richvank@AOL.COM -------------------- I want to let you know about what appears to me to be a major breakthrough in research on cancer treatment. I'm not selling anything, and I was not involved with the research, but I think it's very exciting! I hope you won't think I've parted company with my sanity when I tell you this. I'm referring to work recently published by researchers at the University of Alberta in Canada. The full paper can be found at the following site: http://www.depmed.ualberta.ca/dca/cancer_cell.pdf I'm not exaggerating when I call this a major breakthrough. Briefly, these researchers have found that a relatively simple, non-patentable substance, namely dichloroacetate, which has been used in the past to control lactic acidosis in children with mitochondrial disease, is able to knock out a variety of types of cancer cells without causing systemic problems. They have demonstrated this by experiments in three types of human cancer cell cultures and in mice. This substance works by blocking the enzyme pyruvate dehydrogenase kinase, causing pyruvate to be converted to acetyl Co-A and be fed into the Krebs cycle, instead of being reduced to lactic acid as normally occurs in cancer cells, and thus forcing the cancer cells to change their metabolism from glycolysis to oxidative phosphorylation, like normal cells. As a result of this change, they are able to cause these cells to undergo apoptosis and die, rather than being immortal as cancer cells are. In the mice, they put this substance in their driinkinig water, and they began to see effects on their cancer within one week! Because it operates on a feature that is common to all cancer cells (as shown by Otto Warburg in 1930, for which he won the Nobel prize), this substance promises to be a universal treatment for all types of cancers. Because it is nonpatentable, it should be relatively inexpensive. This also means that non-pharma money will have to be found for the phase II and III clinical trials, and they've started a fund for that. Because there is already a history of using this substance in humans to treat lactic acidosis in mitochondrial disease, it is already known that the side effects are mnimal. I am fairly familiar with the biochemistry of the intermediary metabolism, and I can tell you that the paper looks good to me. I would invite comments from others on this. If this is what it looks like to me, the ramifications are huge to society, the economy, the cancer industry, and to all of us as individuals. I think this will make it even more imperative that we figure out what to do for Alzheimer's, because the average life expectancy is going to jump. When futurists used to talk about the possibility of "a cure for cancer" being found, I always thought they were nuts! I don't think so anymore. Rich Van Konynenburg, Ph.D. [Return to top] ------------------------------ Date: Fri, 2 Feb 2007 12:14:18 -0500 From: Fred Springfield <fredspringfield VERIZON.NET> Subject: RES: Hypocapnia is a biological marker for orthostatic intolerance in some patients with chronic fatigue syndrome Hypocapnia is a biological marker for orthostatic intolerance in some patients with chronic fatigue syndrome. Journal: Dyn Med. 2007 Jan 30;6(1):2 [Epub ahead of print] Authors: Natelson BH, Intriligator R, Cherniack NS, Chandler HK, Stewart JM. NLM Citation: PMID: 17263876 ABSTRACT: Context: Patients with chronic fatigue syndrome and those with orthostatic intolerance share many symptoms, yet questions exist as to whether CFS patients have physiological evidence of orthostatic intolerance. OBJECTIVE: To determine if some CFS patients have increased rates of orthostatic hypotension, hypertension, tachycardia, or hypocapnia relative to age-matched controls. DESIGN: Assess blood pressure, heart rate, respiratory rate, end tidal CO2 and visual analog scales for orthostatic symptoms when supine and when standing for 8 minutes without moving legs. Setting: Referral practice and research center. Participants: 60 women and 15 men with CFS and 36 women and 4 men serving as age matched controls with analyses confined to 62 patients and 35 controls showing either normal orthostatic testing or a physiological abnormal test. Main Outcome Measures: Orthostatic tachycardia; orthostatic hypotension; orthostatic hypertension; orthostatic hypocapnia or combinations thereof. RESULTS: CFS patients had higher rates of abnormal tests than controls (53% vs 20%, p < .002), but rates of orthostatic tachycardia, orthostatic hypotension, and orthostatic hypertension did not differ significantly between patients and controls (11.3% vs 5.7%, 6.5% vs 2.9%, 19.4% vs 11.4%, respectively). In contrast, rates of orthostatic hypocapnia were significantly higher in CFS than in controls (20.6% vs 2.9%, p < .02). This CFS group reported significantly more feelings of illness and shortness of breath than either controls or CFS patients with normal physiological tests. CONCLUSIONS: A substantial number of CFS patients have orthostatic intolerance in the form of orthostatic hypocapnia. This allows subgrouping of patients with CFS and thus reduces patient pool heterogeneity engendered by use of a clinical case definition. [Note: This is an Open Access article. The provisional PDF is available free of charge at http://www.dynamic-med.com/content/pdf/1476-5918-6-2.pdf The fully formatted version will be available within a few weeks.] [Return to top] ------------------------------ Date: Fri, 2 Feb 2007 15:17:55 -0500 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: The frequency and characteristics of chronic widespread pain in general practice: a case-control study The frequency and characteristics of chronic widespread pain in general practice: a case-control study. Br J Gen Pract. 2007 Feb;57(535):109-15. Rohrbeck J, Jordan K, Croft P. Primary Care Musculoskeletal Research Centre, Keele University, Keele. PMID: 17263927 BACKGROUND: Chronic widespread pain is common in the community but is not often diagnosed in primary care. One explanation may be that widespread pain is presented and treated in primary care as multiple episodes of regional pain. AIM: To determine whether patients who consult with multiple regional pain syndromes have characteristics consistent with chronic widespread pain. Design of study: Case-control study. SETTING: One general practice in North Staffordshire, UK. METHOD: Participants were 148 cases who consulted regularly with different musculoskeletal pains over 5 years, and 524 controls who had not consulted for musculoskeletal pain during the same period. A postal questionnaire survey and medical record review were undertaken. RESULTS: Cases with musculoskeletal pain reported more health problems and higher levels of fatigue than controls, and significantly worse general health and greater sleep disturbance (odds ratios 3.3. and 3.1, respectively). They generally reported more severe symptoms and consulted more frequently for a range of problems, but this was not explained by a general propensity to consult. CONCLUSION: Patients who consult in primary care with multiple regional pain syndromes have similar characteristics to those associated with chronic widespread pain and fibromyalgia. Recognising the need for general approaches to pain management, rather than treating each syndrome as a regional problem of pain, may improve the outcome in such patients. [Return to top] ------------------------------ Date: Sat, 3 Feb 2007 15:20:09 -0500 From: Fred Springfield <fredspringfield VERIZON.NET> Subject: RES: Continuous measurement of BRSI in chronic fatigue syndrome [This is dated, but it just hit PubMed.] Continuous measurement of BRSI in chronic fatigue syndrome. Journal: Conf Proc IEEE Eng Med Biol Soc. 2004;2:906-8 Authors: Donnelly D, Rockland RH, Reisman S, Quigley KS. Affiliation: New Jersey Inst. of Technol., Newark, NJ, USA. NLM Citation: PMID: 17271825 This paper discusses the development of a system to measure continuous cardiac baroreceptor measurement during a 45-minute 70-degree head-up tilt (HUT) of five groups of subjects suffering the following: chronic fatigue syndrome (CFS), CFS with fibromyalgia (CFS-FM), CFS with postural orthostatic tachycardia syndrome (CFS-POTS), controls with POTS (CON-POTS), and controls (CON). The duration of the test was 56-minutes, which included a five-minute supine baseline, a 45-minute HUT and a six-minute recovery period. The system was developed in LabView, and can provide a comparative time analyses of weighted BRSI averages. Baroreflex effectiveness index (BEI) was also investigated over the course of lags 0, 1 and 2 as well as an assessment of overall BEI performance between groups. [Return to top] ------------------------------ Date: Sat, 3 Feb 2007 20:24:18 -0500 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: Use of complementary and alternative medicine providers by fibromyalgia patients under insurance coverage Use of complementary and alternative medicine providers by fibromyalgia patients under insurance coverage. Arthritis Rheum. 2007 Jan 31;57(1):71-76 [Epub ahead of print] Lind BK, Lafferty WE, Tyree PT, Diehr PK, Grembowski DE. University of Washington, Seattle, and Boise State University, Boise, Idaho. PMID: 17266066 OBJECTIVE: To quantify how visits and expenditures differ between insured patients with fibromyalgia syndrome (FMS) who visit complementary and alternative medicine (CAM) providers compared with patients with FMS who do not. Patients with FMS were also compared with an age- and sex-matched comparison group without FMS. METHODS: Calendar year 2002 claims data from 2 large insurers in Washington state were analyzed for provider type (CAM versus conventional), patient comorbid medical conditions, number of visits, and expenditures. RESULTS: Use of CAM by patients with FMS was 2.5 times higher than in the comparison group without FMS (56% versus 21%). Patients with FMS who used CAM had more health care visits than patients with FMS not using CAM (34 versus 23; P < 0.001); however, CAM users had similar expenditures to nonusers among patients with FMS ($4,638 versus $4,728; not significant), because expenditure per CAM visit is lower than expenditure per conventional visit. Patients with FMS who used CAM also had heavier overall disease burdens than those not using CAM. CONCLUSION: With insurance coverage, a majority of patients with FMS will visit CAM providers. The sickest patients use more CAM, leading to an increased number of health care visits. However, CAM use is not associated with higher overall expenditures. Until a cure for FMS is found, CAM providers may offer an economic alternative for patients with FMS seeking symptomatic relief. [Return to top] ------------------------------ Date: Sat, 3 Feb 2007 20:28:26 -0500 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: Results of a randomized clinical trial Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: Results of a randomized clinical trial. Arthritis Rheum. 2007 Jan 31;57(1):77-85 [Epub ahead of print] Sephton SE, Salmon P, Weissbecker I, Ulmer C, Floyd A, Hoover K, Studts JL. University of Louisville and James Graham Brown Cancer Center, Louisville, Kentucky. PMID: 17266067 OBJECTIVE: Depressive symptoms are common among patients with fibromyalgia, and behavioral intervention has been recommended as a major treatment component for this illness. The objective of this study was to test the effects of the Mindfulness-Based Stress Reduction (MBSR) intervention on depressive symptoms in patients with fibromyalgia. METHODS: This randomized controlled trial examined effects of the 8-week MBSR intervention on depressive symptoms in 91 women with fibromyalgia who were randomly assigned to treatment (n = 51) or a waiting-list control group (n = 40). Eligible patients were at least 18 years old, willing to participate in a weekly group, and able to provide physician verification of a fibromyalgia diagnosis. Of 166 eligible participants who responded to local television news publicizing, 49 did not appear for a scheduled intake, 24 enrolled but did not provide baseline data, and 2 were excluded due to severe mental illness, leaving 91 participants. The sample averaged 48 years of age and had 14.7 years of education. The typical participant was white, married, and employed. Patients randomly assigned to treatment received MBSR. Eight weekly 2.5-hour sessions were led by a licensed clinical psychologist with mindfulness training. Somatic and cognitive symptoms of depression were assessed using the Beck Depression Inventory administered at baseline, immediately postprogram, and at followup 2 months after the conclusion of the intervention. RESULTS: Change in depressive symptoms was assessed using slopes analyses of intervention effects over time. Depressive symptoms improved significantly in treatment versus control participants over the 3 assessments. CONCLUSION: This meditation-based intervention alleviated depressive symptoms among patients with fibromyalgia. [Return to top] ------------------------------ Date: Sun, 4 Feb 2007 15:11:47 -0500 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: Sleep disordered breathing concomitant with fibromyalgia syndrome Sleep disordered breathing concomitant with fibromyalgia syndrome. [Article in English, Portuguese] J Bras Pneumol. 2006 Jul-Aug;32(4):333-8. Germanowicz D, Lumertz MS, Martinez D, Margarites AF. Federacao de Estabelecimento de Ensino Superior, Novo Hamburgo, Rio Grande do Sul, Brazil. firstname.lastname@example.org PMID: 17268733 OBJECTIVE: To identify fibromyalgia syndrome in patients with sleep disordered breathing. METHOD: We studied 50 patients seeking treatment at a sleep disorder clinic for snoring, apnea and excessive daytime sleepiness. Sleep disordered breathing was diagnosed through the use of polysomnography. To diagnose fibromyalgia syndrome, patients were evaluated in accordance with the criteria established by the American College of Rheumatology. RESULTS: Of the 50 patients, 32 were male. The mean (+/- standard deviation) age of the group was 50 ± 12 years. The mean body mass index was 29.7 ± 5.6 kg/m(2). The mean apnea-hypopnea index was 36 ± 29 attacks of apnea or hypopnea per hour of sleep. Of the 18 women and 32 men evaluated, 9 and 2, respectively, met the American College of Rheumatology criteria for fibromyalgia syndrome. CONCLUSION: Considering the fact that the prevalence of fibromyalgia syndrome in the general population is 0.5% for men and 3.4% for women, the more than ten-fold higher proportion of fibromyalgia cases seen in this sample supports the hypothesis that there is an association between sleep disordered breathing and fibromyalgia syndrome. [Return to top] ------------------------------ Date: Sun, 4 Feb 2007 15:15:32 -0500 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: Exploring the role of sleep and coping in quality of life in fibromyalgia Exploring the role of sleep and coping in quality of life in fibromyalgia. J Psychosom Res. 2007 Feb;62(2):145-51. Theadom A, Cropley M, Humphrey KL. Department of Clinical Health Psychology, Riverside Center, Hillingdon Hospital, Middlesex, United Kingdom; Department of Psychology, School of Human Sciences, University of Surrey, Guildford, Surrey, United Kingdom. PMID: 17270572 OBJECTIVE: The objective of this study was to explore the effect of sleep and coping on health-related quality of life in fibromyalgia syndrome (FMS). METHODS: Patients diagnosed with FMS (N=101) completed the Positive and Negative Affect Schedule, the Pittsburgh Sleep Quality Index, the COPE, and the Medical Outcomes Study-Short-Form Health Survey for the previous month. RESULTS: Poor sleep quality was reported by 99% of participants. Sleep quality was significantly predictive of pain, fatigue, and social functioning in patients with FMS. Active coping, planning, acceptance, and seeking instrumental and emotional social support were not predictive of health outcomes in FMS. However, the use of restraint coping was predictive of poorer physical functioning. CONCLUSION: Sleep quality has significant implications for health-related quality of life in FMS. The use of coping strategies contributed little to the models' ability to predict health outcomes in FMS. Interventions designed to improve sleep quality may help to improve health-related quality of life for patients with FMS. [Return to top] ------------------------------ Date: Sun, 4 Feb 2007 15:18:45 -0500 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: Beliefs about sleep in disorders characterized by sleep and mood disturbance Beliefs about sleep in disorders characterized by sleep and mood disturbance. J Psychosom Res. 2007 Feb;62(2):179-88. Carney CE, Edinger JD, Manber R, Garson C, Segal ZV. Duke Insomnia and Sleep Research Program, Duke University Medical Center, Durham, NC, USA. PMID: 17270576 OBJECTIVES: Maladaptive sleep beliefs play an important role in primary insomnia, but their role in other disorders with concomitant sleep disruption has rarely been explored. Thus, this study investigated the link between insomnia and sleep beliefs in five groups (N=422): primary insomnia (PI), good sleepers (GS), fibromyalgia (FM), major depressive disorder (MDD), and Community Sleep Clinic patients with comorbid insomnia and mood disturbance (CSC). METHOD: Groups were compared on the Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16) scale. RESULTS: Unlike the GS group, the MDD, FM, and CSC groups had elevated DBAS-16 scores that were similar to, or more pathological than, those of primary insomnia sufferers. Only some of the differences were removed after controlling for depression. CONCLUSION: Like primary insomnia patients, other sleep-disturbed patient groups have problematic sleep beliefs. Depression was not sufficient to account for all elevations in beliefs. The presence of maladaptive sleep beliefs in these patients suggests that belief-targeted treatment might be helpful in alleviating sleep complaints. [Return to top] ------------------------------ Date: Mon, 5 Feb 2007 12:20:05 -0500 From: "Bernice A. Melsky" <bernicemelsky@VERIZON.NET> Subject: RES: Myofascial trigger points in early life Myofascial trigger points in early life. Arch Phys Med Rehabil. 2007 Feb;88(2):251-4. Kao MJ, Han TI, Kuan TS, Hsieh YL, Su BH, Hong CZ. Department of Physical Medicine & Rehabilitation, Taipei City Hospital, Taipei, Taiwan; Department of Rehabilitation Medicine, College of Medicine, China Medical University, Taichung, Taiwan. PMID: 17270525 OBJECTIVE: To determine whether latent myofascial trigger points (MTPs) can be identified in healthy infants and in healthy adult subjects. DESIGN: Blind comparison. SETTING: Ambulatory. PARTICIPANTS: A convenience sample of 60 healthy adults and 60 infants (age range, 0-12mo). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: An algometer was used to measure the pressure pain threshold (PPT) on 3 different sites, including a midpoint (assumed to be the MTP site) in the brachioradialis muscle. RESULTS: The mean PPT values at the MTP site were significantly lower than the other sites in the adult muscles. However, no significant differences in PPT values among these 3 sites were found in the infants. Taut bands were found in all the adult muscles but none in the infants. CONCLUSIONS: In the adult subjects, the midpoint of brachioradialis muscle was significantly more irritable than other sites and the midpoint was probably a latent MTP. However, in the infants younger than 1 year old, such a phenomenon could not be observed in this study. It is very likely that the latent MTPs might not exist in early life, but develop in later life. 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