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• The introduction of a national CF newborn screening programme results in a significant decrease in the number of sweat tests performed. • Monitoring of CFTR modulator therapy is a new indication for sweat testing, an emerging trend that should be reflected in sweat test reports to ensure accurate interpretation. • Quantity not sufficient rates remain a challenge, particularly when testing very young infants. • Variations in sweat testing practices are observed across different centres. Greater alignment of best practice techniques across centres could improve the overall quality of the service. The sweat test has been the "gold standard" diagnostic test for cystic fibrosis for more than 40 years. We hypothesized that there would be a change in the pattern of sweat testing in Ireland since the introduction of cystic fibrosis newborn screening in 2011, when practices were last reviewed. This is a follow up survey looking at sweat testing numbers and practices. A national survey compiled data on sweat collection, conductivity and sweat chloride testing in all hospitals previously identified as performing sweat tests. All 13 centres in Ireland performing sweat testing in 2018 responded to the survey (100% return rate). Our results indicate that 1007 sweat tests were performed in 2018 compared to 2555 in 2011, equating to a 61% reduction. Seven out of 13 centres are performing less than 50 sweat tests per year. Nine out of 13 centres (69%) had a sweat test failure rate greater than the recommended allowable rate of ≤ 10%. We detected a trend of sweat testing in patients with an existing diagnosis of CF who had commenced cystic fibrosis transmembrane conductance regulator (CFTR) modulators. There has been a significant reduction in the number of sweat tests performed in Ireland since the introduction of newborn screening for CF. There remains a lack of standardisation in many aspects of the service ranging from sample collection to reporting of results. We have identified a new trend of sweat testing in the cystic fibrosis transmembrane conductance regulator modulator era. [ABSTRACT FROM AUTHOR]

Context: There is interest in including recommendations for the replacement of the sodium lost in sweat in individualized hydration plans for athletes. Purpose: Although the regional absorbent-patch method provides a practical approach to measuring sweat sodium losses in field conditions, there is a need to understand the variability of estimates associated with this technique. Methods: Sweat samples were collected from the forearms, chest, scapula, and thigh of 12 cyclists during 2 standardized cycling time trials in the heat and 2 in temperate conditions. Single measure analysis of sodium concentration was conducted immediately by ion-selective electrodes (ISE). A subset of 30 samples was frozen for reanalysis of sodium concentration using ISE, flame photometry (FP), and conductivity (SC). Results: Sweat samples collected in hot conditions produced higher sweat sodium concentrations than those from the temperate environment (P = .0032). A significant difference (P = .0048) in estimates of sweat sodium concentration was evident when calculated from the forearm average (mean ± 95% CL; 64 ±12 mmol/L) compared with using a 4-site equation (70 ± 12 mmol/L). There was a high correlation between the values produced using different analytical techniques (r2 = .95), but mean values were different between treatments (frozen FP, frozen SC > immediate ISE > frozen ISE; P < .0001). Conclusion: Whole-body sweat sodium concentration estimates differed depending on the number of sites included in the calculation. Environmental testing conditions should be considered in the interpretation of results. The impact of sample freezing and subsequent analytical technique was small but statistically significant. Nevertheless, when undertaken using a standardized protocol, the regional absorbent-patch method appears to be a relatively robust field test. [ABSTRACT FROM AUTHOR]

A new method for the determination of chloride anions in sweat is described. The novelty of the method relies on the different photochemical response of silver ions and silver chloride crystals when exposed to UV light. Silver ions undergo an intense colorimetric transition from colorless to dark grey-brown due to the formation of nanosized Ag while AgCl exhibits a less intense color change from white to slightly grey. The analytical signal is obtained as mean grey value of color intensity on the paper surface and is expressed as the absolute difference between the signal of the blank (i.e., in absence of chloride) and the sample (i.e., in the presence of chloride). The method is simple to perform (addition of sample, incubation in the absence of light, irradiation, and offline measurement in a flatbed scanner), does not require any special signal processing steps (the color intensity is directly measured from a constant window on the paper surface without any imager processing) and is performed with minimum sample volume (2 μL). The method operates within a large chloride concentration range (10–140 mM) with good detection limits (2.7 mM chloride), satisfactory recoveries (95.2–108.7%), and reproducibility (

Background Athletes commonly consume insufficient fluid and electrolytes just prior to, or during training and competition. Unlike non-athletes or athletes who do not engage in frequent rigorous and prolonged training sessions, “hard trainers” may require additional sodium and better benefit from a hydration plan tailored to their individual physiology. The purpose of this randomized cross-over study was to determine whether a hydration plan based off of an athlete’s sweat rate and sodium loss improves anaerobic and neurocognitive performance during a moderate to hard training session as well as heart rate recovery from this session. Methods Collegiate athletes who were injury free and could exercise at ≥ 75% of their maximum heart rate for a minimum of 45 min were recruited for this randomized, cross-over study. After completing a questionnaire assessing hydration habits, participants were randomized either to a prescription hydration plan (PHP), which considered sweat rate and sodium loss or instructed to follow their normal ad libitum hydration habits (NHP) during training. Attention and awareness, as well as lower body anaerobic power (standing long jump) were assessed immediately before and after a moderate to hard training session of ≥ 45 min. Heart rate recovery was also measured. After a washout period of 7 days, the PHP group repeated the training bout with their normal hydration routine, while the NHP group were provided with a PHP plan and were assessed as previously described. Results Fifteen athletes from three different sports, aged 20 ± 0.85 years, participated in this study. Most participants reported feeling somewhat or very dehydrated after a typical training session. Compared to their NHP, participants following a PHP jumped 4.53 ± 3.80 in. farther, tracked moving objects 0.36 ± 0.60 m/second faster, and exhibited a faster heart rate recovery following a moderate to hard training session of 45–120 min in duration. Conclusion A tailored hydration plan, based on an athlete’s fluid and sodium loss has the potential to improve anaerobic power, attention and awareness, and heart rate recovery time.

Objective: The aim of this study was to report a method that quantifies axon reflex sweating from individual sweat glands with nanoliter precision. Measurement of the axon reflex is generally expressed as a single variable (e.g., the flare area or total sweat volume). High-definition videography enables precise measurement of sweating from single, axon reflex-stimulated sweat glands (SGs).Methods: The sudomotor axon reflex was activated in healthy subjects and subjects with peripheral neuropathy by iontophoresis of 10% acetylcholine. Sweating was simultaneously imaged for 5 min in a 2.5-cm2 area of iodine-coated skin to one side of the stimulus, using a customized high-resolution camera with starch-coated transparent tape over a rigid viewing screen. A second video then imaged the directly stimulated sweating. The indirect sweat response was quantified in terms of sweat gland number and distance from the stimulation site (radius), sweat rate per gland, and total sweat.Results: Fifty-two healthy control and twenty subjects with neuropathy underwent testing at the foot, calf, thigh, and hand. Normal ranges were calculated for SG density, mean sweat rate per SG, and total sweat volume. Neuropathy subjects demonstrated reduced sweating, and values differed between body sites.Interpretation: The described method precisely measures the total and individual sweat output of hundreds of SGs in response to a standard, axon reflex-mediated stimulus, and quantifies alterations in axon reflex sweating seen in peripheral neuropathy. [ABSTRACT FROM AUTHOR]

Background: Athletes commonly consume insufficient fluid and electrolytes just prior to, or during training and competition. Unlike non-athletes or athletes who do not engage in frequent rigorous and prolonged training sessions, "hard trainers" may require additional sodium and better benefit from a hydration plan tailored to their individual physiology. The purpose of this randomized cross-over study was to determine whether a hydration plan based off of an athlete's sweat rate and sodium loss improves anaerobic and neurocognitive performance during a moderate to hard training session as well as heart rate recovery from this session. Methods: Collegiate athletes who were injury free and could exercise at ≥ 75% of their maximum heart rate for a minimum of 45 min were recruited for this randomized, cross-over study. After completing a questionnaire assessing hydration habits, participants were randomized either to a prescription hydration plan (PHP), which considered sweat rate and sodium loss or instructed to follow their normal ad libitum hydration habits (NHP) during training. Attention and awareness, as well as lower body anaerobic power (standing long jump) were assessed immediately before and after a moderate to hard training session of ≥ 45 min. Heart rate recovery was also measured. After a washout period of 7 days, the PHP group repeated the training bout with their normal hydration routine, while the NHP group were provided with a PHP plan and were assessed as previously described. Results: Fifteen athletes from three different sports, aged 20 ± 0.85 years, participated in this study. Most participants reported feeling somewhat or very dehydrated after a typical training session. Compared to their NHP, participants following a PHP jumped 4.53 ± 3.80 in. farther, tracked moving objects 0.36 ± 0.60 m/second faster, and exhibited a faster heart rate recovery following a moderate to hard training session of 45–120 min in duration. Conclusion: A tailored hydration plan, based on an athlete's fluid and sodium loss has the potential to improve anaerobic power, attention and awareness, and heart rate recovery time. [ABSTRACT FROM AUTHOR]

Background: There are several complementary Englishlanguage guidelines for the performance of the sweat chloride test. These guidelines also incorporate information for the collection of conductivity samples. However, recommendations for the measurement and reporting of sweat conductivity are less clear than for sweat chloride. The aim of the study was to develop an understanding of the testing and reporting practices of sweat conductivity in Australasian laboratories. Methods: A survey specifically directed at conductivity testing was sent to the 12 laboratories registered with the Royal College of Pathologists of Australasia Quality Assurance Programs. Results: Nine (75%) laboratories participated in the survey, seven of whom used Wescor Macroduct® for collecting sweat and the Wescor SWEAT · CHEK™ for conductivity testing, and the remaining two used the Wescor Nanoduct®. There was considerable variation in frequency and staffing for this test. Likewise, criteria about which patients it was inappropriate to test, definitions of adequate collection sweat rate, cutoffs and actions recommended on the basis of the result showed variations between laboratories. Conclusions: Variations in sweat conductivity testing and reporting reflect many of the same issues that were revealed in sweat chloride test audits and have the potential to lead to uncertainty about the result and the proper action in response to the result. We recommend that sweat testing guidelines should include clearer statements about the use of sweat conductivity. [ABSTRACT FROM AUTHOR]

• Statistical optimum strategy was an effective tool for optimization of process parameters. • Sweat collection materials proved to be a very useful complementary tool for physicians and health care professionals. • Cosmetic pads and swabs can be used interchangeably with Drugwipe5A for drug testing in sweat. Sweat analysis can yield valuable information in forensic investigations, diagnosis and treatment. The purpose of this study was to develop a validated gas chromatography–mass spectrometric method for the detection of illegal substances in sweat after optimizing the method by chemometric approach. This study also investigated the effectiveness of alternative sweat-collecting materials. Plackett-Burman screening design was employed to determine the effect of seven process factors on this new method. Then, central composite design (CCD) was used to optimize the method. The method was validated according to the international guidelines. The effectiveness of alternative sweat-collecting materials (cosmetic pads and swabs) was compared with a commercially available collecting device (DrugWipe5A). Sample pH, ultrasonic bath time, and liquid–liquid extraction (LLE) shaking time were determined as the most significantly effective three parameters with the Plackett– Burman screening design. The validation procedure was successfully performed after optimizing this method. The comparison study demonstrated that cosmetic pads, swabs, and DrugWipe5A can be used interchangeably. Our results suggested that the statistical optimum strategy was an effective tool for the optimization of process parameters. Combined with the sensitivity and selectivity of our method, the analysis of sweat collection materials proved to be a useful tool for physicians and health care professionals. [ABSTRACT FROM AUTHOR]

Introduction: Cystic Fibrosis (CF) is an autosomal recessive disorder and the incidence of this disease is undermined in Northern India. The distinguishable salty character of the sweat belonging to individuals suffering from CF makes sweat chloride estimation essential for diagnosis of CF disease. Aim: The aim of this prospective study was to elucidate the relationship of sweat chloride levels with clinical features and pattern of CF. Materials and Methods: A total of 182 patients, with clinical features of CF were included in this study for quantitative measurement of sweat chloride. Sweat stimulation and collection involved pilocarpine iontophoresis based on the Gibson and Cooks methodology. The quantitative estimation of chloride was done by Schales and Schales method with some modifications. Cystic Fibrosis Trans Membrane Conductance Regulator (CFTR) mutation status was recorded in case of patients with borderline sweat chloride levels to correlate the results and for follow-up. Results: Out of 182 patients having clinical features consistent with CF, borderline and elevated sweat chloride levels were present in 9 (5%) and 41 (22.5%) subjects respectively. Elevated sweat chloride levels were significantly associated with wheeze, Failure To Thrive (FTT), history of CF in Siblings, product of Consanguineous Marriage (CM), digital clubbing and steatorrhoea on univariate analysis. On multivariate analysis only wheeze, FTT and steatorrhoea were found to be significantly associated with elevated sweat chloride levels (p

Introduction: Sweat test has a diagnostic role in evaluation of cystic fibrosis. Its performance includes sweat stimulation, collection and analysis. All listed may be sources of inconsistencies in everyday practice. The aim of this study was an evaluation of external quality assessment (EQA) of sweat chloride measurement including sweat test performance in medical biochemistry laboratories in Croatia. Materials and methods: EQA for sweat chloride measurement was provided by Croatian Centre for Quality Assessment in Laboratory Medicine (CROQALM) in five consecutive exercises to medical biochemistry laboratories (MBL) that offered sweat testing. A questionnaire regarding all phases of testing was mailed to involved MBL (N = 10). Survey results were compared to current guidelines for sweat test performance. Results: Reported results of EQA in 2015 exercises showed coefficients of variation (CV) from 28.9%, 29.0% to 35.3%, respectively. An introduction of uniform sweat chloride measurement protocol resulted in CV of 15.5% and 14.7% reported in following two exercises in 2016. All MBL included in this study replied to the questionnaire. Results reported by MBL indicated: lack of patient information policy (7/10), use of unacceptable electrodes (6/9), misuse of minimum of acceptable sweat weight (6/9), lack of internal quality assessment (5/9) and recommended reference ranges (5/9 and 4/9). Agreements to guidelines were found in approach to unsuitable patients (9/10) and sweat collection (8/9). Conclusion: Presented results indicate major weak points of current practice in sweat test performance in Croatian MBL and stress the need for its standardization on a national level. [ABSTRACT FROM AUTHOR]

Introduction: Cystic Fibrosis (CF) is an autosomal recessive disorder and the incidence of this disease is undermined in this region (Northern India). The distinguishable salty character of the sweat belonging to individuals suffering from CF makes sweat chloride estimation essential for diagnosis of CF disease. Aim: The aim of this prospective study was to elucidate the relationship of sweat chloride levels with clinical features and pattern of CF and hence to get an idea about the real scenario of this disease in this region. Materials and Methods: A total of 182 patients, with clinical features of CF were included in this study for quantitative measurement of sweat chloride. Sweat stimulation and collection involved pilocarpine iontophoresis based on the Gibson and Cooks methodology. The quantitative estimation of chloride was done by Schales and Schales method with some modifications. Cystic Fibrosis Trans Membrane Conductance Regulator (CFTR)` mutation status was recorded in case of patients with borderline sweat chloride levels to correlate the results and for follow-up. Results: Out of 182 patients having clinical features consistent with CF, borderline and elevated sweat chloride levels were present in 09 (05%) and 41 (22.5%) subjects respectively. Elevated sweat chloride levels were significantly associated with wheeze, Failure To Thrive (FTT), history of CF in Siblings, product of Consanguineous Marriage (CM), digital clubbing and steatorrhoea on univariate analysis. On multivariate analysis only wheeze, FTT and steatorrhoea were found to be significantly associated with elevated sweat chloride levels (p<0.05). Among the 09 borderline cases 06 cases were positive for at least two CFTR mutations and rest of the 03 cases were not having any mutation in CFTR gene. Conclusion: The scenario of CF is not known in Kashmir valley. The diagnosis is often delayed and the disease is advanced in most patients at the time of diagnosis. Sweat testing is a gold standard for diagnosis of CF patients as genetic mutation profile being heterozygous and unlikely to become diagnostic test. [ABSTRACT FROM AUTHOR]

The purpose of this study was to establish normative data for regional sweat sodium concentration ([Na+]) and whole-body sweating rate in athletes. Data from 506 athletes (367 adults, 139 youth; 404 male, 102 female) were compiled from observational athlete testing for a retrospective analysis. The participants were skill/team-sport (including American football, baseball, basketball, soccer and tennis) and endurance (including cycling, running and triathlon) athletes exercising in cool to hot environmental conditions (15–50°C) during training or competition in the laboratory or field. A standardised regional absorbent patch technique was used to determine sweat [Na+] on the dorsal mid-forearm. Whole-body sweat [Na+] was predicted using a published regression equation (y = 0.57x+11.05). Whole-body sweating rate was calculated from pre- to post-exercise change in body mass, corrected for fluid/food intake (ad libitum) and urine output. Data are expressed as mean ± SD (range). Forearm sweat [Na+] and predicted whole-body sweat [Na+] were 43.6 ± 18.2 (12.6–104.8) mmol · L–1and 35.9 ± 10.4 (18.2–70.8) mmol · L–1, respectively. Absolute and relative whole-body sweating rates were 1.21 ± 0.68 (0.26–5.73) L · h–1and 15.3 ± 6.8 (3.3–69.7) ml · kg–1 · h–1, respectively. This retrospective analysis provides normative data for athletes’ forearm and predicted whole-body sweat [Na+] as well as absolute and relative whole-body sweating rate across a range of sports and environmental conditions. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: No study has correlated thermoregulatory sweat testing (TST) with histopathologic study of sweat glands (SGs) and SG nerve fibers (SGNFs). Methods: We studied 10 neuropathy patients in whom anhidrosis was found by TST and 10 matched controls. Skin biopsies were taken from both anhidrotic and sweating skin and immunohistochemical staining was done for nerves and basement membrane. For each biopsy, total tissue volume, total SG volume, and total SGNF length were measured. SGNF length per biopsy volume, SG volume per biopsy volume (SG%), and SGNF length per SG volume were calculated. Results: SGNF length per biopsy volume was reduced in anhidrotic site biopsies of patients compared with controls. SG% was decreased and SGNF length per SG volume increased in patients compared with controls. Conclusions: The results suggest a concomitant loss of SG volume and SGNF length in neuropathy, with greater loss of SGNFs in anhidrotic skin, possibly exceeding collateral reinnervation. Muscle Nerve 50: 528-534, 2014 [ABSTRACT FROM AUTHOR]

Background Conventional methods of sweat testing are time consuming and have many steps that can and do lead to errors. This study compares conventional sweat testing to a new quantitative method, the CF Quantum® (CFQT) sweat test. This study tests the diagnostic accuracy and analytic validity of the CFQT. Methods Previously diagnosed CF patients and patients who required a sweat test for clinical indications were invited to have the CFQT test performed. Both conventional sweat testing and the CFQT were performed bilaterally on the same day. Pairs of data from each test are plotted as a correlation graph and Bland–Altman plot. Sensitivity and specificity were calculated as well as the means and coefficient of variation by test and by extremity. After completing the study, subjects or their parents were asked for their preference of the CFQT and conventional sweat testing. Results The correlation coefficient between the CFQT and conventional sweat testing was 0.98 (95% confidence interval: 0.97–0.99). The sensitivity and specificity of the CFQT in diagnosing CF was 100% (95% confidence interval: 94–100%) and 96% (95% confidence interval: 89–99%), respectively. In one center in this three center multicenter study, there were higher sweat chloride values in patients with CF and also more tests that were invalid due to discrepant values between the two extremities. The percentage of invalid tests was higher in the CFQT method (16.5%) compared to conventional sweat testing (3.8%) (p < 0.001). In the post-test questionnaire, 88% of subjects/parents preferred the CFQT test. Conclusions The CFQT is a fast and simple method of quantitative sweat chloride determination. This technology requires further refinement to improve the analytic accuracy at higher sweat chloride values and to decrease the number of invalid tests. [ABSTRACT FROM AUTHOR]

Collection of sweat via pilocarpine iontophoresis is commonly used to diagnose cystic fibrosis ( CF), with thousands of tests performed each day. The main source of resistance to the passage of pilocarpine ions to the sweat glands is the electrical resistance of the stratum corneum. It was hypothesized that pretreating the skin with 0·5 mm-long microneedles would significantly decrease this resistance, thus increasing pilocarpine's permeation into the skin. Improved permeation should result in significantly reduced time to sweat initiation, time to collection of a clinically meaningful amount of sweat, and increased total amount of sweat produced in 15 min. Subjects ( n = 12) had two 5 cm2 areas on the forearm measured, marked and randomized to experimental (microneedles + iontophoresis) or control (iontophoresis alone). Microneedle pretreatment was conducted using a 35-needle microneedle stamp in a manner that 20 applications completely covered the 5 cm2 treatment area. This was repeated five times for a total of 100 applications. Both experimental and control sites were placed under iontophoresis (1·5 mA) for 5 min. Microneedle pretreatment significantly decreased mean skin resistance (260 ± 27 kΩ versus 160 ± 19 kΩ, P = 0·006), while significantly increasing mean sweat rate (0·76 ± 0·35 versus 0·54 ± 0·19 μl cm2 min−1, P = 0·007). No significant difference was found concerning pain ( P = 0·059), number of active sweat glands ( P = 0·627) or the osmolality of the collected sweat ( P = 0·636). The results of this study suggest that microneedle pretreatment prior to pilocarpine iontophoresis significantly increases sweat production. Such results have the potential to improve the methodology currently used to diagnose cystic fibrosis and, more broadly, to administer drugs via the skin. [ABSTRACT FROM AUTHOR]

In this review of thermoregulatory function in health and disease, we review the basic mechanisms controlling skin blood flow of the hairy and glabrous skin and illustrate the major differences in blood flow to glabrous skin, which is, in essence, sympathetically mediated, while hairy skin is dependent upon neuropeptidergic signals, nitric oxide, and prostaglandin, among others. Laser Doppler methods of quantification of blood flow-in response to iontophoresis of acetylcholine or heat-and nociceptor-mediated blood flow have relatively uniformly demonstrated an impaired capacity to increase blood flow to the skin in diabetes and in its forerunners, prediabetes and the metabolic syndrome. This reduced capacity is likely to be a significant contributor to the development of foot ulcerations and amputations in diabetes, and means of increasing blood flow are clearly needed. Understanding the pathogenic mechanisms is likely to provide a means of identifying a valuable therapeutic target. Thermoregulatory control of sweating is intimately linked to the autonomic nervous system via sympathetic C fibers, and sweat glands are richly endowed with a neuropeptidergic innervation. Sweating disturbances are prevalent in diabetes and its precursors, and quantification of sweating may be useful as an index of diagnosis of somatic and, probably, autonomic dysfunction. Moreover, quantifying this disturbance in sweating by various methods may be useful in identifying the risk of progression from prediabetes to diabetes, as well as responses to therapeutic intervention. We now have the technological power to take advantage of this physiological arrangement to better understand, monitor, and treat disorders of small nerve fibers and the somatic and autonomic nervous system (ANS). Newer methods of sudomotor function testing are rapid, noninvasive, not technically demanding, and accessible to the outpatient clinic. Whether the potential applications are screening for diabetes, following poorly controlled diabetes subjects during alteration of their treatment regimen, or simply monitoring somatic and autonomic function throughout the course of treatment, sudorimetry can be an invaluable tool for today's clinicians. [ABSTRACT FROM AUTHOR]

Atomoxetine (ATX) is a selective norepinephrine reuptake inhibitor approved since 2002 for the treatment of attention deficit hyperactivity disorder (ADHD) in children, adolescents, and adults as an alternative treatment to methylphenidate. Within the framework of a project evaluating the use of alternative biological matrices for therapeutic monitoring of psychoactive drugs in paediatric and non-paediatric individuals, the excretion of ATX and its principal metabolites has been recently studied in oral fluid and hair. The aim of this study was to describe the excretion profile of ATX and its metabolites 4-hydroxyatomoxetine (4-OH-ATX) and N-desmethylatomoxetine (N-des-ATX) in sweat following the administration of different dosage regimens (60, 40, 35, and 18 mg/day) of ATX to six paediatric patients. Sweat patches were applied to the back of each participant and removed at timed intervals. ATX and its metabolites were measured in patches using a previously validated liquid chromatography-tandem mass spectrometric (LC-MS/MS) method. Independently from the administered dose, ATX appeared in the sweat patches 1 h post administration and reached its maximum concentration generally at 24 h. Peak ATX concentrations ranged between 2.31 and 40.4 ng/patch and did not correlate with the administered drug dose, or with body surface area. Total ATX excreted in sweat ranged between 0.008 and 0.121 mg, corresponding to 0.02 and 0.3% of the administered drug. Neither 4-OH-ATX, nor N-des-ATX was detected in either of the collected sweat patches. Measuring ATX in sweat patches can provide information on cumulative drug use from patch application until removal. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The sweat test remains the current diagnostic gold standard for CF disease. Many CF testing centres have switched from the Gibson and Cooke to the Macroduct®. Since the validity and sensitivity of Macroduct® has not been tested in patients with intermediate sweat chloride concentrations, we compared both methods simultaneously including subjects expected to have intermediate results. Design and methods: We prospectively evaluated controls, obligate heterozygotes, patients with CF and with an uncertain diagnosis of CF (congenital absence of the vas deferens, pancreatitis and sinopulmonary disease). Results: We assessed 82 subjects (3.7–60.1 years); 14 healthy controls, 7 obligate heterozygotes, 20 CF (15 pancreatic insufficient, 5 pancreatic sufficient), and 41 with unproven diagnosis. Mean test difference was close to 0 (95% CI±20 mmol/L) and test values were highly correlated (r =0.93, p ≤0.0001). Discrepancies between the two testing methods occurred in 22% of subjects. Conclusion: Sweat chloride measured by Macroduct® highly correlates with Gibson and Cooke for concentrations in all ranges, including the intermediate range. This study reveals the limitations of sweat testing for excluding a diagnosis of CF since 38% of subjects had intermediate range results. [Copyright &y& Elsevier]

Sudomotor dysfunction is common in many subtypes of neuropathy but is one of the earliest detectable neurophysiologic abnormalities in distal small fiber neuropathy. Clinical assessments of sudomotor function include thermoregulatory sweat testing (TST), quantitative sudomotor axon reflex testing (QSART), silicone impressions, the sympathetic skin response (SSR), the acetylcholine sweat-spot test and quantitative direct and indirect axon reflex testing (QDIRT). These testing techniques, when used in combination, can detect and localize pre- and postganglionic lesions, can provide early diagnosis of sudomotor dysfunction and can monitor disease progression or disease recovery. In this article, we describe many of the common clinical tests available for evaluation of sudomotor function with focus on the testing methodology and limitations while providing concrete examples of test results. [ABSTRACT FROM AUTHOR]

Cystic fibrosis (CF) is an autosomal recessive disease caused by mutations in the CF transmembrane conductance regulator (CFTR) gene that results in abnormal viscous mucoid secretions in multiple organs and whose main clinical features are pancreatic insufficiency and chronic endobronchial infection. Although it was initially defined and diagnosed based on clinical features and sweat chloride measurement, an in vivo method of assessing CFTR function, the discovery of the CFTR gene in 1989 revealed a broad spectrum of CF phenotypes associated with specific CFTR gene mutations. In this article, we will review the indications for sweat testing, alternative techniques to diagnose CF, and the approach to patients with an ambiguous or indeterminate diagnosis of CF. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: : The goal of this study was to examine the ability of the current Canadian CF center network to conduct sweat testing, with a particular focus on testing in infants less than 3 months old. Methods: : Surveys were sent to the 37 CF centers in Canada supported by the Canadian CF Foundation, and results were interpreted with respect to their ability to obtain adequate sweat volumes in children less than 3 months and potential factors influencing these results. Results: : Ten centers that care for adult patients referred patients to their local pediatric CF center for sweat testing; the remaining 27 centers conducted sweat tests and 26 responded. Insufficient sweat volume results in children &#60;3 months occurred in a median of 18.3% of tests. The corresponding proportion for the remaining population was 4.5% (P &#60; 0.001). 15 of 19 centers had an incidence of >5% of insufficient tests in children &#60;3 months of age, and 9 of 19 had an incidence of &#60;20% in this age group. Six of 19 had an incidence of >5% of insufficient sweat volumes in older children and adults. Conclusions: : Standardization of testing procedures is required to reduce the rates of insufficient sweat volumes in both infants less than 3 months old and children >3 months old. This will decrease the need for repeat testing and delay in diagnosis. [Copyright &y& Elsevier]

A new method for the determination of chloride anions in sweat is described. The novelty of the method relies on the different photochemical response of silver ions and silver chloride crystals when exposed to UV light. Silver ions undergo an intense colorimetric transition from colorless to dark grey-brown due to the formation of nanosized Ag while AgCl exhibits a less intense color change from white to slightly grey. The analytical signal is obtained as mean grey value of color intensity on the paper surface and is expressed as the absolute difference between the signal of the blank (i.e., in absence of chloride) and the sample (i.e., in the presence of chloride). The method is simple to perform (addition of sample, incubation in the absence of light, irradiation, and offline measurement in a flatbed scanner), does not require any special signal processing steps (the color intensity is directly measured from a constant window on the paper surface without any imager processing) and is performed with minimum sample volume (2 μL). The method operates within a large chloride concentration range (10–140 mM) with good detection limits (2.7 mM chloride), satisfactory recoveries (95.2–108.7%), and reproducibility (<9%). Based on these data the method could serve as a potential tool for the diagnosis of cystic fibrosis through the determination of chloride in human sweat. [ABSTRACT FROM AUTHOR]

Non-invasive wearable biosensors provide an efficient way of continuously quantifying a person's biochemical parameters, and are highly valuable for predicting human physiological status and flagging risks and illness. Commercial wearable sensors are available for tracking a user's physical activities, but few could monitor user's health conditions through sweat analysis. Electronic textile (e-textile) biosensors enable new applications in this scenario because of its high flexibility/wearability, low cost, high level of electronic integration, and unobtrusiveness. However, challenges in developing e-textile sweat biosensors remain in the production of textile-based biosensing materials, skin interfacing design, and embedded data acquisition/transmission. Here, we propose a novel wearable electrochemical sweat biosensor based on conductive threads decorated with zinc-oxide nanowires (ZnO NWs) and apply it to detecting lactate and sodium in perspiration during physical exercise. The sweat biosensor is fully integrated with signal readout and data communication circuits in a wearable headband and is capable of monitoring human sweat accurately and wirelessly. We achieved the detection of lactate and sodium in linear ranges of 0–25 mM and 0.1–100 mM and limits of detection of 3.61 mM and 0.16 mM, respectively, which cover the clinically-relevant ranges of lactate and sodium in human sweat. We demonstrated accurate lactate and sodium measurements in human sweat from a healthy volunteer, and the results are in good agreement with standard test results. We also conducted on-body measurements on the same human volunteer during exercise and confirmed the robustness of the signal readout during body movements and the excellent accuracy of the testing results. An integrated thread-based wearable nanobiosensor for on-body detection of sweat lactate and sodium during physical exercise. Zinc oxide nanowires (ZnO NWs)-decorated thread electrodes for improving device sensitivity. On-skin measurement was demonstrated on a human volunteer with robust signal readouts and accurate testing results. [ABSTRACT FROM AUTHOR]

In young adults with acute pancreatitis a wide etiologic spectrum has to be considered. Among the possible causes, cystic fibrosis is rare. Besides the typical clinical triad of pancreatic exocrine insufficiency, chronic obstrue-tive pulmonary disease, and elevated sweat chloride levels, there is a wide spectrum of variants of the cystic fibrosis syndrome. Especially mild manifestations of the disease may, therefore, escape proper identification. Here we describe a young man who presented initially with recurrent acute pancreatitis without pulmonary disease and without a family history of cystic fibrosis, in whom the diagnosis of cystic fibrosis was established by slightly elevated sweat chloride levels and obstructive azoospermia. Five years after the first attack of pancreatitis the patient developed pancreatic exocrine insufficiency. [ABSTRACT FROM AUTHOR]