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Digital Fourier techniques in the diagnosis and quantification of aortic stenosis with pulsed-Doppler echocardiography.

Pulsed Doppler echocardiography and digital Fourier analysis were utilized to examine flow distal to the aortic valve and to quantify aortic stenosis. A graphic index of parameters derived from velocity spectrum patterns generated by Fourier analysis was regressed against mean systolic pressure gradients in 21 adults with clinical evidence of aortic stenosis who underwent catheterization studies and five normal adults (r = .82). Correlation improved in the absence of regurgitation (r = .92). Sensitivity for detecting gradients greater than 30 mmHg was 86%; specificity was 90%. Doppler spectral analysis shows promise in alleviating the need for many invasive studies.

Aortic Valve Stenosis↗

Dietary saturated fat intake is inversely associated with bone density in humans: analysis of NHANES III.

Mounting evidence indicates that the amount and type of fat in the diet can have important effects on bone health. Most of this evidence is derived from animal studies. Of the few human studies that have been conducted, relatively small numbers of subjects and/or primarily female subjects were included. The present study assessed the relation of dietary fat to hip bone mineral density (BMD) in men and women using NHANES III data (n = 14,850). Multivariate models using SAS-callable SUDAAN were used to adjust for the sampling scheme. Models were adjusted for age, sex, weight, height, race, total energy and calcium intakes, smoking, and weight-bearing exercise. Data from women were further adjusted for use of hormone replacement therapy. Including dietary protein, vitamin C, and beta-carotene in the model did not influence the outcome. Analysis of covariance was used to generate mean BMD by quintile of total and saturated fat intake for 4 sex/age groups. Saturated fat intake was negatively associated with BMD at several hip sites. The greatest effects were seen among men < 50 y old (linear trend P = 0.004 for the femoral neck). For the femoral neck, adjusted mean BMD was 4.3% less among men with the highest compared with the lowest quintile of saturated fat intake (BMD, 95% CI: highest quintile: 0.922 g/cm2, 0.909-0.935; lowest quintile: 0.963 g/cm2, 95% CI: 0.950-0.976). These data indicate that BMD is negatively associated with saturated fat intake, and that men may be particularly vulnerable to these effects.

Adult↗

Development and characterization of a simple perfused oral microcosm.

AIMS: To validate perfused, inline, filter-based fermentation systems (multiple Sorbarod devices, MSD) for their ability to maintain stable oral bacterial communities. MSD enable replicate (n=5) microcosm biofilms (BF) to be established and sampled, together with their perfusates (PA, cells in eluted medium). METHODS AND RESULTS: Fresh saliva from human volunteers was used to inoculate MSD, incubated in an anaerobic cabinet and perfused with artificial saliva at 7 ml h(-1). BF within Sorbarod filters and cells eluted in the PA were analysed at 24-h intervals by differential bacteriological culture and checkerboard DNA-DNA hybridization (CKB, 40 oral species). Dynamic stability was apparent after 2-3 days within both BF and PA as evidenced by culture, CKB data and pH measurements. BF harboured large numbers of anaerobic species and facultative anaerobes [ca 10-11 log10 colony-forming units (CFU)/filter] comprising considerable numbers of streptococci and Gram-negative species. PA contained ca 9-10 log(10) CFU ml(-1) suggesting an apparent mean growth rate of 0.1 h(-1) for the BF, as a whole corresponding to a mean generation time of 10 h. CKB analysis revealed considerable bacterial diversity within the respective MSD. Inter-individual variations in the relative species abundance of inocula was broadly reproduced in the MSD (BF and PA), although considerable variation was apparent between triplicate models established using saliva from one saliva donor or from three individual donors. The dominance of Gram-negative species, indicated by culture was supported by CKB analysis (major species, Prevotella melaninogenica and Fusobacterium nucleatum). CONCLUSIONS: Data obtained from the various analytical approaches showed a high degree of congruence. The MSD enables the maintenance of complex, stable salivary microcosms and represents a simple, reproducible tool for modelling individual oral bacterial ecosystems. SIGNIFICANCE AND IMPACT OF THE STUDY: This study demonstrates the utility of the MSD for studying the micro-ecology of the oral cavity.

Bacteria↗

Managing safety and risk: the experiences of people with Parkinson's disease who use alternative and complementary therapies.

In this article I focus on how individuals living with Parkinson's disease manage safety and risk in their participation in alternative and complementary health care. I take a qualitative approach in this research, using semi-structured interviews and grounded theory techniques as means of generating and analysing data. My analysis centres on how these informants construct certain therapies as risk free and therefore safe, and others as risky and thus, inherently unsafe. I discuss the knowledge bases these informants draw on in their evaluations and describe the social contexts in which these assessments take place. While there is a substantial literature on risk in general, as well as the risk society, there has been less interest in micro-level analysis of risk. This article therefore contributes to knowledge through its focus on management of safety and risk in individuals' health-seeking behaviour.

Adult↗

Comparative aspects of the distribution, metabolism, and excretion of six iodothyronines in the rat.

We have studied the kinetics of 3 iodothyronines, 3,3'-diiodothyronine (T2), 3',5'-T2, and 3'-monoiodothyronine (T1), in groups of young adult male rats maintained under normal steady state physiological conditions. We have also performed a comparative analysis of these results, combined with corresponding kinetic indices of T4, T3, and rT3, to obtain a more comprehensive understanding of normal thyroid hormone production, distribution, and metabolism. Tracer doses of 125I-labeled 3,3'-T2, 3',5'-T2, and 3'-T1 were separately injected iv, and blood samples were collected 6-12 times for each iodothyronine in optimized sequential kinetic studies designed to maximize the precision of kinetic parameters. Labeled iodothyronines were separated quantitatively from their metabolites in each plasma sample by Sephadex G-25 column chromatography. Conventional kinetic analysis of the resulting data generated distribution volume, clearance, turnover, and mean residence time indices for each iodothyronine, and concomitant compartmental analysis of the same data provided additional results useful for integration and comparative analysis of the 6 iodothyronines. Kinetic parameters for all but T4 and T3 were similar, suggesting that similar mechanisms are responsible for the transport, metabolism, and distribution of nonhormonal iodothyronines. All but T4 and T3 (and, to a much lesser extent, 3'-T1) were almost completely and irreversibly metabolized, whereas 24-30% of the hormones (and 6% of 3'-T1) were excreted as such in feces only. Three-pool models fitted individual plasma kinetic data sets best in all cases (for all 6 iodothyronines), each with a plasma, a slowly exchanging (slow), and a rapidly exchanging (fast) pool, and kinetic parameters of interest were quantified for each iodothyronine (Ti). Quantitative analysis of an integrated 18-pool model for all 6 Tis revealed several other features of physiological interest. The fractional transport rate of T3 into the fast pool (liver, at least) is about an order of magnitude larger than that for all other Tis, supporting the hypothesis that transport of T3 into fast tissues (e.g. liver cells) is selectively amplified relative to that of the 5 other iodothyronines studied. Simultaneous and direct comparison of the 6 plasma kinetic data sets also supports this result. In addition, composite slow tissue pools, which probably exclude liver and kidney, contained the largest whole body fractions of all Tis (greater than 50%), and these also appear to be major sites of whole body T4 monodeiodinations.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

CT derived Patlak images of the human kidney.

This study aimed to produce Patlak images of the kidney from dynamic CT data and to determine whether such images are substantially affected by fluid movement between renal tubular segments. Renal permeability was measured in 31 kidneys by applying Patlak analysis to time-density data from kidney and aorta during dynamic CT. Permeability parameters were correlated against plasma urea. The renal region (cortex or medulla) with the greatest permeability was determined from parametric images generated using pixel by pixel analysis. The mean value for whole kidney permeability was 517.5 microliters min-1 ml-1. A correlation was found between whole kidney permeability and plasma urea (p < 0.01). Permeability values were highest in the renal medulla in 24 (77%) kidneys. The higher medullary values of permeability are artefactual, resulting from movement of fluid and contrast medium between cortex and medulla. Although Patlak images do not reflect true intrarenal permeability values, the apparent medullary permeability may provide diagnostically useful information about the concentrating ability of the kidney. CT measurements of whole kidney permeability reflect filtration function but the apparent intrarenal variations in permeability will result in measurement errors dependent upon the relative amounts of renal cortex and medulla included in the CT slice studied.

Adolescent↗

Prosthetic dental treatment needs in Eastern [corrected] Saudi Arabia.

OBJECTIVE: The objective of this study was to determine the prosthetic treatment needs of an adult population in Al-Ahsa Area, Kingdom of Saudi Arabia. METHODS: A sample of adults attending the King Fahad Hospital Dental Center, Al-Ahsa, Kingdom of Saudi Arabia were examined for prosthetic treatment needs utilizing the World Health Organization criteria during 1999. Statistical analysis system was utilized to generate frequencies, means and standard deviations, and various statistical tests were carried out. RESULTS: A total of 435 adults, 192 (44.1%) males and 243 (55.9%) females with a mean age of 47.7 (standard deviation 15.4) years were examined for prosthetic treatment needs. About two-thirds (64.8%) of the sample were in need of an upper denture. A significantly higher number of males (68.8%) needed an upper denture as compared to the females (61.7%). About three-quarters (73.8%) of the sample were in need of a lower denture. The need for lower denture was similar among the males (75.0%) and females (72.8%). About one-sixth (17.2%) of the sample was in need of an upper bridge. A higher number of females (18.9%) needed an upper bridge as compared to the males (15.1%). About one-quarter (22.5%) of the sample was in need of a lower bridge. A higher number of females (25.5%) needed lower bridge as compared to the males (18.8%). The need for upper denture was similar in both urban (64.7%) and rural (65.1%) dwellers. The need for lower denture was also similar in both urban (73.2%) and rural (75.2%) dwellers. A higher number of rural dwellers needed an upper (20.2%) and lower (26.4%) bridge as compared to the upper (16%) and lower (20.9%) bridge in urban dwellers. CONCLUSION: The results indicate that more than one- quarter of the sample needs a denture. A significantly higher number of males needed dentures than females. More females were in need of a bridge as compared with males. A significantly higher percentage of urban population needed full dentures as compared with rural population.

Aged↗

Utility of computerized morphometry combined with AgNOR staining in distinguishing benign from malignant pleural effusions.

A study was designed to evaluate the usefulness of computer-aided image analysis in distinguishing benign from malignant pleural effusions. Morphometric measurements of preparations stained by the routine Leishman technique and quantitation of nucleolar organizer regions (AgNORs) were done on 65 cytologic samples randomly selected for the study and divided as follows: 30 samples from patients having benign pleural cytology and 35 samples from patients with pleural malignancies. The following parameters were obtained: nuclear/cytoplasmic ratio (N/C); nuclear and cytoplasmic area (NA and CA, respectively) and perimeter (NP and CP, respectively); major and minor nuclear diameter (DN and dN, respectively); major and minor cytoplasmic diameter (DC and dC, respectively); and absolute and fractional AgNOR (AgNOR/NA) area. Conformational characteristics of both nucleus (FFN) and cytoplasm (FFCy) were also computed. Statistical studies were done by means of discriminant analysis. The discriminant function generated from the morphometric data correctly diagnosed 100% of the cases. The validity of the classification provided by the function was tested by a jack knife ("one out" procedure), which again classified all the cases correctly. Our data support the concept that quantitative morphologic studies could be used in the management of patients with pleural effusions.

Adult↗

Carcinoembryonic antigen, tissue polypeptide antigen and neuron-specific enolase pleural levels used to classify small-cell and non-small-cell lung cancer patients by discriminant analysis.

The classification of lung cancer into small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC) is essential for disease prognosis and treatment. For this purpose, we have tried to optimize the use of three tumour markers determined on pleural effusions, to differentiate SCLC from NSCLC by means of a canonic variable, generated by discriminant analysis, including subjects with histologically proven lung cancer. Discriminant analysis was performed by using carcinoembryonic antigen, neuron-specific enolase and tissue polypeptide antigen pleural levels, determined in 65 consecutive and unselected patients, histologically classified as 49 NSCLC and 16 SCLC. To validate the formula generated, a control group of 37 lung cancer patients (10 SCLC and 27 NSCLC), enrolled subsequently, was employed. Applying the discriminant analysis to SCLC and NSCLC patients a good classification was obtained (92% rate of correct classification). The aforementioned formula, applied to the validation group, showed a 92% rate of correct classification. This method, which is rapid, inexpensive and routinely applicable to malignant pleural effusions, may be reliably used to classify lung cancer patients.

Adult↗

Discriminant snakes for 3D reconstruction of anatomical organs.

In this work a new statistic deformable model for 3D segmentation of anatomical organs in medical images is proposed. A statistic discriminant snake performs a supervised learning of the object boundary in an image slice to segment the next slice of the image sequence. Each part of the object boundary is projected in a feature space generated by a bank of Gaussian filters. Then, clusters corresponding to different boundary pieces are constructed by means of linear discriminant analysis. Finally, a parametric classifier is generated from each contour in the image slice and embodied into the snake energy-minimization process to guide the snake deformation in the next image slice. The discriminant snake selects and classifies image features by the parametric classifier and deforms to minimize the dissimilarity between the learned and found image features. The new approach is of particular interest for segmenting 3D images with anisotropic spatial resolution, and for tracking temporal image sequences. In particular, several anatomical organs from different imaging modalities are segmented and the results compared to expert tracings.

Algorithms↗

VARAN: a web server for variability analysis of DNA microarray experiments.

UNLABELLED: Here, we describe a tool for VARiability Analysis of DNA microarrays experiments (VARAN), a freely available Web server that performs a signal intensity based analysis of the log2 expression ratio variability deduced from DNA microarray data (one or two channels). Two modules are proposed: VARAN generator to compute a sliding windows analysis of the experimental variability (mean and SD) and VARAN analyzer to compare experimental data with an asymptotic variability model previously built with the generator module from control experiments. Both modules provide normalized intensity signals with five possible methods, log ratio values and a list of genes showing significant variations between conditions. AVAILABILITY: http://www.bionet.espci.fr/varan/ SUPPLEMENTARY INFORMATION: http://www.bionet.espci.fr/varan/help.html

Algorithms↗

Fibroblast senescence in pressure ulcers.

Pressure ulcers appear as localized chronic wounds in the middle of normal functioning skin. This study focuses on pressure ulcer fibroblasts cultured from the ulcer bed, ulcer margin, and normal, nonulcerated skin adjacent to the wound. From these areas we show that pressure ulcer fibroblasts become prematurely senescent. Verification of senescence was based on failure of cell populations to undergo a 0.5 population doubling after 1 week in culture, light microscopic appearance of late-passage senescent cells in culture, light microscopic verification of senescence in vivo and in vitro by anti-terminin staining, and ultrastructural identification of senescent fibroblasts by anti-terminin colloidal gold labeling. Although not all ulcer fibroblasts are senescent, there is a range of proliferative ability. The senescent phenotype of ulcer fibroblasts remains intact in vitro as these cells remain viable but are unable to complete DNA synthesis. Fibroblast senescence is not uniform in chronic wounds but varies within areas of the ulcer bed and from patient to patient. Although ulcer fibroblasts exhibit limited proliferative ability, fibroblasts from the ulcer margin and adjacent normal skin show a continued ability to divide. However, in all areas of the wound, the mean generation time of the fibroblast population is longer than commonly observed for cultured human diploid fibroblasts. At first passage, the mean generation time for fibroblasts from all patients is significantly different (p = .001, analysis of variance) among fibroblasts from the ulcer bed (4.2 2.2 days), ulcer margin (2.9 +/- 1.3 days), and adjacent normal skin (1.9 +/- 0.6 days). Analysis of the three cell groups by the post hoc Tukey test, using corrected p values shows that the difference between mean generation times among fibroblast populations from adjacent normal skin and ulcer bed are significantly different (p < 0.05), whereas the difference between fibroblasts from adjacent normal skin and ulcer margin and ulcer margin and ulcer bed are not significantly different (p > 0.05). These data may help to explain the poor response of certain pressure sores to aggressive medical treatment.

Analysis of Variance↗

The nocturnal jejunal migrating motor complex: defining normal ranges by study of 51 healthy adult volunteers and meta-analysis.

Interdigestive human small bowel motility is characterized by the migrating motor complex (MMC). The aims of this study were to: (i) establish the normal range of variables of the nocturnal jejunal MMC and (ii) incorporate these data in a subsequent meta-analysis. Eighty-one recordings were performed by prolonged (24 h) ambulatory manometry in 51 subjects in two centres. Quantitative analysis was undertaken of 419 Phase III and 332 Phase II episodes. Adjusted mean values of seven variables were calculated using a mixed-effects model. Meta-analysis of pooled published data to generate a reliable 95% reference range was also performed. Adjusted mean values and confidence intervals are presented for all seven variables. Intrasubject variances were large in comparison with intersubject. Meta-analysis of 19 studies (356 pooled patients) meeting inclusion criteria produced wide reference ranges. At least five such ranges are useful for the detection of abnormality in the individual. This is the largest study of normal volunteers presented to date, with ranges for many variables produced using appropriate statistical methodology. A model for definition of abnormality has been proposed. We recommend that these data may be used by investigators in this field as a complement to other existing indicators of small bowel dysmotility.

Adolescent↗

Stage grouping of oropharyngeal cancer: evaluation of three systems by means of survival analysis.

Stage grouping is a method of summarizing multiple categories generated from the tumor, node, metastasis (TNM) classification system. Recently three different systems, the T and N integer score (TANIS), Hart, and 1997 Union Internationale Contre le Cancer systems, have been proposed. To verify their correlation to survival, a series of 64 patients affected by primary squamous cell carcinoma of the oropharynx was considered in this retrospective study. The data set was classified according to Union Internationale Contre le Cancer T stage and then grouped as recommended by the three systems. Results showed a crude survival rate of 28.13%. Univariate analysis by means of the logrank test yielded significant P values for the T and N integer score and Hart systems (0.0452 and 0.0179, respectively) and a borderline P value (0.0728) for the stratification based on the 1997 Union Internationale Contre le Cancer system. Multivariate analysis (Cox regression adjusted for age and sex) showed a significant correlation between the three staging systems and the mortality rate. Odds ratios were 1.36 (95% confidence interval, 1.12-1.66), 1.58 (95% confidence interval, 1.18-2.12), and 1.63 (95% confidence interval, 1.08-2.48) for the T and N integer score, Hart, and 1997 Union Internationale Contre le Cancer systems, respectively. The T and N integer score system showed the best statistical correlation, but a conclusive result could not be achieved because of the low number of patients in this study.

Adult↗

Early detection of rejection in pancreas transplantation.

A major dilemma in pancreas transplantation is the lack of reliable methods for the early detection of allograft rejection. Over a 26-mo period, 70 rejection episodes occurred in 36 patients (13 isolated-pancreas, 23 simultaneous pancreas-kidney recipients) with pancreaticoduodenocystostomy. A total of 300 radionuclide pancreas examinations were performed (mean 8.3/patient) utilizing 99mTc-labeled DTPA. Computer analysis generated a quantitative measure of blood flow to the allograft (technetium index, TI). Rejection episodes were defined as isolated pancreas, isolated kidney, or combined pancreas-kidney. Mean urinary amylase (UA) levels and TI during normal allograft function were 30,256 U/L and 0.57%, respectively, whereas levels heralding rejection were 6873 U/L and 0.39% (P less than .05). The treatment of rejection based on kidney dysfunction or combined pancreas-kidney dysfunction resulted in significantly higher graft salvage and a lower incidence of hyperglycemia compared with isolated-pancreas-allograft rejection. After therapy, a TI greater than 0.3% was associated with 95.9% graft survival, whereas levels less than 0.3% resulted in a 72.7% rate of graft loss (P less than .001). Similarly, pancreas allografts with a UA greater than 10,000 U/L had 92.2% functional survival, whereas levels less than 10,000 U/L resulted in a 53.3% rate of graft loss (P less than 0.001). Overall, reversal of rejection occurred in 80% of cases, with 10 pancreas and 2 kidney allografts lost due to rejection. Monitoring pancreas-allograft function by UA, TI, and renal function in simultaneous transplants allows for the timely diagnosis and successful treatment of pancreas-allograft rejection.

Adult↗

Detection of thiol modification following generation of reactive nitrogen species: analysis of synaptic vesicle proteins.

S-nitrosylation is an important means of regulating the activity of proteins. We have developed a method which allows unbiased identification of thiol modified proteins within a complex mixture following NO generation, by taking advantage of the fact that prior nitrosylation will block subsequent modification of cysteine residues with 1-biotinamido-4-[4'-(maleimidomethyl)-cyclohexane-carboxamid o] butane (biotin-BMCC). Thiol modified proteins are reduced in intensity when revealed by blotting and overlay with avidin-horseradish peroxidase. In the case of a purified synaptic vesicle fraction we observe a high degree of enrichment of specific biotinylated proteins relative to homogenate. We find that thiol modification of proteins in the presence of NO donors is widespread, occurring in the majority of proteins that will react with biotin-BMCC. In a further development of this technique we have depleted the biotinylated proteins from solubilised synaptic vesicles using avidin-agarose and analysed the supernatants with a panel of antibodies. This has allowed us to identify SNARE proteins (soluble NSF attachment protein receptors) as potential targets for S-nitrosylation.

Animals↗

Accurate assessment of body composition in obese females.

Although several generalized regression equations exist for body composition assessment the accuracy of these equations for special populations is uncertain. This study examined the ability to predict body composition variables from girth measurements in obese women. Girth measurements were taken on 156 obese women at abdomen 1 and abdomen 2 (mean value of the two was used), buttocks, and right thigh. Stepwise multiple-regression analysis generated on 110 randomly assigned subjects yielded the following equations: density (g/cc) = -0.00020(mean abdomen) - 0.00032(wt) + 0.00039(ht) + 0.97783 (R = 0.76, SEE = +/- 0.00061); % fat = 0.11077(mean abdomen) - 0.17666(ht) + 0.14354(wt) + 51.03301 (R = 0.76, SEE = +/- 2.9); fat wt (kg) = 0.62039(wt) - 0.17844(ht) + 0.09495(mean abdomen) + 5.88874 (R = 0.96, SEE = +/- 2.9); and lean body wt (kg) = 0.37939(wt) + 0.17898(ht) - 0.09494(mean abdomen) - 6.00423 (R = 0.89, SEE = +/- 3.0). Data from the remaining 46 women were used for cross-validation. These equations were valid, with validity coefficients for fat weight and lean body weight of r = 0.92 (SE = +/- 3.3 kg) and r = 0.86 (SE = +/- 3.3 kg), respectively, with no significant mean differences between actual and predicted values. The use of girth measurements is a simple and practical method of estimating fat weight and lean body weight in obese women.

Adult↗

[Influence of DNA ploidy and grading on survival in primary metastatic prostate carcinoma].

An aneuploid pattern of prostatic cancer defined by flow cytometry was shown to be of value in predicting progression rates and patient survival times. We evaluated the long-term value of DNA analysis in prostatic cancer in 61 patients with advanced disease. We performed flow cytometry on 61 fresh prostate specimens obtained-from a transrectal needle biopsy or a transurethral resection. All patients received antihormonal therapy. Time until death was evaluated in all patients. Of the DNA histograms analyzed, 37% showed a diploid pattern, 63% an non-diploid pattern, and 37% a tetraploid or hypertetraploid pattern. Kaplan-Meier plots were generated for analysis of the probability of survival. Mean survival time was 44 months for patients with diploid (range 1-126 months) and 40 months for patients with non-diploid tumors (range 1-96 months). This difference is not statistically significant. However, the combination of non-diploid and low-differentiated (G3) tumors reduced survival time significantly (mean 20 months, range 1-62 months). There was no patient with combination of a diploid and highly differentiated tumor.

Aged↗