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Remote homology detection based on oligomer distances.

MOTIVATION: Remote homology detection is among the most intensively researched problems in bioinformatics. Currently discriminative approaches, especially kernel-based methods, provide the most accurate results. However, kernel methods also show several drawbacks: in many cases prediction of new sequences is computationally expensive, often kernels lack an interpretable model for analysis of characteristic sequence features, and finally most approaches make use of so-called hyperparameters which complicate the application of methods across different datasets. RESULTS: We introduce a feature vector representation for protein sequences based on distances between short oligomers. The corresponding feature space arises from distance histograms for any possible pair of K-mers. Our distance-based approach shows important advantages in terms of computational speed while on common test data the prediction performance is highly competitive with state-of-the-art methods for protein remote homology detection. Furthermore the learnt model can easily be analyzed in terms of discriminative features and in contrast to other methods our representation does not require any tuning of kernel hyperparameters. AVAILABILITY: Normalized kernel matrices for the experimental setup can be downloaded at www.gobics.de/thomas. Matlab code for computing the kernel matrices is available upon request. CONTACT: thomas@gobics.de, peter@gobics.de.

Algorithms↗

A comparative assessment of cephalometric errors.

Measuring a cephalometric radiograph is an imprecise task, and the errors associated with this should be quantified and understood. The potential sources of error are outlined and the literature relating to the assessment of measurement errors is reviewed. Three techniques are examined: the error attributable to a single recording; its associated confidence limits; and the coefficient of reliability were the most commonly applied. Data from two error studies were pooled and used to compare the accuracy of 12 skeletal, dental, and soft tissue measurements, using various assessments of each of the three techniques. Within each group, the use of different mathematical criteria led to variation in the results; one method was totally unsuitable. As with all statistical procedures, a knowledge of the technique facilitates interpretation of the results. Some suggestions as to the most satisfactory approach to the estimation of measurement error in cephalometry are given.

Cephalometry↗

Qualitative methods: beyond the cookbook.

BACKGROUND: Qualitative methods appear increasingly in vogue in health services research (HSR). Such research, however, has utilized, often uncritically, a 'cookbook' of methods for data collection, and common-sense principles for data analysis. RESULTS AND CONCLUSIONS: This paper argues that qualitative HSR benefits from recognizing and drawing upon theoretical principles underlying qualitative data collection and analysis. A distinction is drawn between problem-orientated and theory-orientated research, in order to illustrate how problem-orientated research would benefit from the introduction of theoretical perspectives in order to develop the knowledge base of health services research.

Data Collection↗

Predictive model for plasma concentration-versus-time profiles of investigational anticancer drugs in patients.

We report a model that provides a strong correlation between mouse toxicity data [mouse lethal dose 10% (LD10)] and human plasma concentration-versus-time (CXT) data for 22 commonly used anticancer agents. Mouse toxicity data (LD10) from two dosing schedules, daily times one and daily times seven, were evaluated for the two mouse strains BDF/1 and Swiss. Data from BDF/1 mice were selected for analysis because they were more abundant. Strong correlations were found between LD10 and human plasma CXT data for both daily times one and daily times seven dosing schedules--ln (CXT) = -1.6504 + [0.8408 X ln (LD10)], r = .84, P less than .0001, and ln (CXT) = -0.0754 + [0.8954 X ln (LD10)], r = .90, P less than .0001, respectively. These correlations may serve as useful models to predict the maximally tolerated dose of an investigational anticancer agent prior to entry into clinical trials and to assist in the selection of clinically relevant in vitro CXTs for new-agent screening against human tumors.

Animals↗

Ranking: a closer look on globalisation methods for normalisation of gene expression arrays.

Data from gene expression arrays are influenced by many experimental parameters that lead to variations not simply accessible by standard quantification methods. To compare measurements from gene expression array experiments, quantitative data are commonly normalised using reference genes or global normalisation methods based on mean or median values. These methods are based on the assumption that (i) selected reference genes are expressed at a standard level in all experiments or (ii) that mean or median signal of expression will give a quantitative reference for each individual experiment. We introduce here a new ranking diagram, with which we can show how the different normalisation methods compare, and how they are influenced by variations in measurements (noise) that occur in every experiment. Furthermore, we show that an upper trimmed mean provides a simple and robust method for normalisation of larger sets of experiments by comparative analysis.

Cell Line↗

The MetaFMF website: a high quality tool for meta-analysis of FMF.

We present here the MetaFMF database (freely accessible at http://fmf.igh.cnrs.fr/metaFMF/index_us.html) that attempts to gather and unify, in a common resource, data on phenotype-genotype correlation in familial Mediterranean fever (FMF). A single accession form, including a large number of quality controls, has been implemented such that data, collected worldwide, are included in an homogeneous manner. The inclusion criterion has the objective to avoid interpretational bias: patients will be included only if they bear at least two mutations. The clinical form has been set up by an International editorial board (12 FMF expert centres), which guarantees the validity of the data. Data are anonymous and submitted by a secure interface, in which the researcher is logged in with a specific ID and password. A pilot study on 211 patients has shown the feasibility and relevance of this project. We anticipate that the use of MetaFMF will enable reliable assessment of phenotype-genotype correlations in FMF, and define a set of severe versus mild mutations/genotypes. It should also highlight reasons for previous inconsistencies in such correlations.

Data Collection↗

Assessment of total body water from anthropometry-based equations using bioelectrical impedance as reference in Korean adult control and haemodialysis subjects.

BACKGROUND: Several indirect prediction equations to estimate total body water (TBW) with simple demographic and anthropometric data are commonly used by researchers and dialysis units. These equations are largely based on observations in subjects of the Western hemisphere. The purpose of this study was to investigate the possible application of anthropometry-based TBW equations to a Korean adult control population and maintenance haemodialysis (HD) patients using multifrequency bioelectrical impedance analysis (BIA) as reference. METHODS: We performed BIA and anthropometric measurements in 67 healthy adults and 101 HD patients. Four anthropometry-based equations were used: 58% of actual body weight (TBW-58), the Watson formula (TBW-W), the Hume formula (TBW-H), and the Chertow formula (TBW-C). Multifrequency BIA was performed at fasting state in controls and after HD. RESULTS: TBW-BIA was 34.6+/-6.9 l in control and 29.9+/-5.1 l in HD patients. TBW-58 and TBW-C gave significantly greater TBWs than TBW-BIA in both control and HD subjects. The correlation coefficients of TBW-BIA with calculated TBWs were lowest in TBW-58 (0.754 in control and 0.856 in HD subjects), and highest in TBW-C (0.944 in control and 0.916 in HD subjects). Mean prediction error was greatest in the Chertow formula for control and HD patients. Mean prediction error, limits of agreement, and root mean square error were lowest between TBW-BIA and TBW-H in control and between TBW-BIA and TBW-W in HD subjects. The correlation coefficient in the Bland-Altman plot was closer to zero and parallel with TBW-W than TBW-H in control and HD subjects. CONCLUSION: Currently available TBW equations overestimate TBW in both Korean normal control subjects and HD patients. Among them, the Watson formula appears to be the closest to TBW and to have the least bias. Based on this analysis, it is reasonable to use the Watson formula for the calculation of TBW in Korean adult control and HD subjects until an Asian-based TBW equation is available.

Adult↗

Commercial approaches to genetic selection for growth and feed conversion in domestic poultry.

Tremendous genetic progress has been observed historically for growth and feed conversion through the efforts of the primary breeding companies. However, significant between-strain variation still exists due to differences in selection emphasis and selection techniques practiced by these organizations. This paper provides an overview of methods currently employed in commercial poultry breeding with reference to factors complicating program design and future challenges facing the industry. Mass selection for body weight has resulted in a significant reduction in the number of days required to grow bird to market weight with indirect improvements in feed conversion. Direct selection for feed conversion is accomplished through part record testing of males that have been preselected for body weight, conformation, and defect traits. Data are commonly subjected to complex statistical analysis both to correct feed conversion for variation in body weight and to improve the accuracy of breeding value estimates. Feed conversion breeding values of male sibs are sometimes used for the selection of female candidates as well. Selection for growth rate and efficiency has resulted in negative complications, such as ascites, reduced reproductive performance, skeletal abnormalities, and increased carcass fatness. Some of these factors may be partially ameliorated through modified selection practices. If not addressed by the breeding industry, the disruption of physiological homeostasis might ultimately represent economic and genetic barriers to further progress in improving growth and efficiency. Modern techniques in molecular genetics, utilized in conjunction with traditional quantitative genetic approaches, will provide additional opportunities to circumvent these physiological complications associated with genetic selection for growth and feed efficiency.

Animals↗

Incidence, diagnosis, and treatment of enteric and colorectal fistulae in patients with Crohn's disease.

OBJECTIVE: The authors review their experience, evaluating the incidence and examining the various modalities employed in the diagnosis and treatment of patients with Crohn's disease complicated by fistulae. SUMMARY BACKGROUND DATA: Although common, internal and external fistulae in Crohn's disease may pose challenging problems to the surgeon. METHODS: Of 639 patients who underwent surgical treatment at the University of Chicago between 1970 and 1988 for complications of Crohn's disease, 222 patients (34.7%) were found to have 290 intra-abdominal fistulae. RESULTS: A fistula was diagnosed preoperatively in 154 patients (69.4%), intraoperatively in 60 (27%), and only after examination of the specimen in 8 (3.6%). The fistula represented the primary or single indication for surgical treatment in 14 patients (6.3%) and one of several indications in the remaining patients. Of 165 patients with an abdominal mass or abscess, 69 (41.8%) had a fistula. All patients underwent resection of the diseased intestinal segment; 160 (73.1%) with primary anastomosis and the remaining 62 with a temporary or permanent stoma. The fistula was directly responsible for a stoma in only 16 patients (7.2%) and was never responsible for a permanent stoma. Resection of the diseased bowel achieved en bloc removal of the fistula in 145 cases. Removal of 93 additional fistulae required resection of the diseased bowel segment along with closure of a fistulous opening on the stomach or duodenum (n = 14), bladder (n = 35), or rectosigmoid (n = 44). When the fistula drained through a vaginal cuff (n = 4), the opening was left to close by secondary intention; when the fistula opened through the abdominal wall (n = 46), the fistulous tract was debrided. In the remaining two entero-salpingeal fistulae, en bloc resection of the involved salpinx accomplished complete removal of the fistula. There was a dehiscence of one duodenal and one bladder repair; 14 patients (6%) experienced postoperative septic complications and one patient died. CONCLUSIONS: Fistulae are diagnosed preoperatively in 69% of cases and can be suspected in as many as 42% of patients with an abdominal mass. Fistulae are the primary or single indication for surgical treatment and are directly responsible for a stoma only in a few patients. Treatment, based on resection of the diseased bowel and extirpation of the fistula, can be accomplished with minimal morbidity and mortality.

Adult↗

Lactic acidosis during sepsis is related to increased pyruvate production, not deficits in tissue oxygen availability.

OBJECTIVE: The purpose of this study was to quantitate the derangements in intermediary carbohydrate metabolism and oxygen use in severely septic patients in comparison with healthy volunteers. SUMMARY BACKGROUND DATA: It commonly has been assumed that the development of lactic acidosis during sepsis results from a deficit in tissue oxygen availability. Dichloroacetate (DCA), which is known to increase pyruvate oxidation but only when tissue oxygen is available, provides a means to assess the role of hypoxia in lactate production. METHODS: Stable isotope tracer methodology and indirect calorimetry was used to determine the rates of intermediary carbohydrate metabolism and oxygen use in five severely septic patients with lactic acidosis and six healthy volunteers before and after administration of DCA. RESULTS: Oxygen consumption and the rates of glucose and pyruvate production and oxidation were substantially greater (p < 0.05) in the septic patient compared with healthy volunteers. Administration of DCA resulted in a further increase in oxygen consumption and the percentage of glucose and pyruvate directed toward oxidation. Dichloroacetate also decreased glucose and pyruvate production, with a corresponding decrease in plasma lactate concentration. CONCLUSIONS: These findings clearly indicate that the accumulation of lactate during sepsis is not the result of limitations in tissue oxygenation, but is a sequelae to the markedly increased rate of pyruvate production. Furthermore, the substantially higher rate of pyruvate oxidation in the septic patients refutes the notion of a sepsis-induced impairment in pyruvate dehydrogenase activity.

Acidosis, Lactic↗

One- or two-stage procedure for restorative proctocolectomy: rationale for a surgical strategy in ulcerative colitis.

OBJECTIVE: To analyze the results of different strategies for restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) in ulcerative colitis. SUMMARY BACKGROUND DATA: No commonly accepted criteria exist for choosing between the one-stage or the two-stage procedure (with or without temporary diverting ileostomy) for IPAA. The authors analyzed the outcome of patients principally suitable for either of the two alternative surgical strategies. METHODS: A matched-pair control study was performed, comparing surgical details and the early and late outcome of the one-stage (study group, n = 57) versus the two-stage procedure (control group, n = 114), for IPAA. RESULTS: No differences were found between the study group and the control group regarding the matching criteria gender, median age at IPAA, systemic corticoid medication, or activity of colitis. Comparing the patients who underwent a one-stage procedure with those who underwent a two-stage procedure, the proportion of patients without complications was significantly higher (P =.0042) and the frequency of late complications was significantly lower (P =.0022) in patients who underwent the one-stage procedure. The percentage of patients with anastomotic strictures was significantly higher in the control group than in the study group (P =.0022). No significant difference was found between the two groups regarding early complications, pouch-related septic complications, pouchitis, median duration of surgery for IPAA, median blood loss, need for transfusion, or median hospital stay. CONCLUSIONS: In patients with ulcerative colitis in whom there is a choice between a one-stage procedure or a two-stage procedure with a defunctioning ileostomy, the one-stage procedure is clearly superior. This finding is of great clinical relevance both for the subjective interests of the patient and from an economic point of view.

Adult↗

Long-term codeine use is associated with depressive symptoms.

A community survey was conducted among long-term (>6 months) users of codeine-containing products to characterize chronic use of these extensively consumed medications. Respondents recruited through newspaper advertisements completed a mailed questionnaire. Three hundred thirty-nine completed questionnaires were obtained, yielding a response rate of 70%. Codeine dependence/abuse as defined by DSM-IV criteria was present in 41% of the respondents. Two thirds of the subjects had sought help for mental health problems, most often depression (70%). Scores on the Symptom Checklist-90 subscales were modestly elevated, particularly on the Depression subscale (1.2 +/- 0.9). Long-term codeine use is strongly associated with dependence. Depression and depressive symptoms are common. These data suggest that dysphoric mood states may be significant in maintaining long-term codeine use.

Adolescent↗

The quality of 3D reconstructions from 1.0 and 1.5 pitch helical and conventional CT.

PURPOSE: CT data are commonly used to create 3D images. For this purpose, thin and overlapped slices are desirable. Helical (spiral) CT offers the ability to adjust the slice reconstruction interval from 0 to 100%. However, its use in 1.0 and 1.5 pitch helical CT and 3D imaging, especially with respect to surface detail, is relatively untested. METHODS: Ten objects selected for their varying size, shape, and density were scanned (fourth generation Picker PQ2000) by contiguous 2,4 and 8 mm conventional and helical sequences. The latter were obtained with a pitch of both 1.0 and 1.5 and were reconstructed into a 3D image with 0-75% overlapping of the reconstructed slices. Each of the 24 different sequences per scanned object was reconstructed into identical sets (projections) of 3D images displayed on color film. The 24 3D image sets for each object were submitted to six blinded radiologists who separately ranked them from best to worst. RESULTS: 3D reconstructions obtained from CT scans with a thinner slice thickness, half-field (15 cm FOV), and helical technique were rated as statistically superior. The 1.0 and 1.5 helical sequences obtained with a 4 or 8 mm slice thickness scored statistically better than 3D reconstructions from equivalent conventional scans. Overlapping of the reconstructed helical slices by 25-75% generally improved the quality of the 3D reconstruction. CONCLUSION: Helical CT with either a 1.0 or a 1.5 pitch offers the ability to obtain higher quality 3D reconstructions than from comparable conventional CT scans.

Humans↗

The influence of different sitting positions on cervical and lumbar posture.

STUDY DESIGN: This study used a repeated measures design to assess the effects of multiple sitting postures on various spinal angles. All subjects were tested in slouched, erect, forward inclined, and comfortable postures. OBJECTIVES: The purposes of this study were to evaluate the changes in head, cervical, lumbar, and pelvic postures in different sitting positions and also to determine if there is a relation between lumbar posture and cervical posture during sitting. SUMMARY OF BACKGROUND DATA: Clinicians commonly assert that head and neck position is strongly influenced by lumbar and pelvic position. A biomechanical model was developed that allowed detailed, quantitative description of head, neck, lumbar, and pelvic postures. This model enabled a distinction to be made between upper and lower cervical motions. METHODS: Various spinal angles were measured in 30 healthy subjects in four sitting positions using a three-dimensional digitizing system. Reliability of the measurement procedure was determined using an intraclass correlation coefficient and the values for most angles was above 0.8. RESULTS: With the exception of head orientation, analysis of variance revealed significant differences in spinal angles between different sitting positions. Head orientation appeared to be maintained by compensatory adjustments in both the upper and lower cervical spine and changes in lumbar posture were associated with compensatory changes in overall cervical position. As the lumbar spine moved toward extension, the cervical spine flexed and as the lumbar spine flexed the cervical spine extended. However, there was variation among subjects as to whether cervical spine adjustments occurred primarily in the upper or lower cervical region. CONCLUSIONS: Different sitting postures clearly resulted in changes in cervical spine position. Lumbar and pelvic position should be considered when control of cervical posture is desired.

Adult↗

Anterior vertebral body screw pullout testing. A comparison of Zeilke, Kaneda, Universal Spine System, and Universal Spine System with pullout-resistant nut.

STUDY DESIGN: A biomechanical study of pullout of anteriorly implanted screws in cadaveric vertebral bodies. OBJECTIVES: To investigate and compare the pullout strength of the Zielke, Kaneda, Universal Spine System (USS) pedicle screw, and USS pedicle screw with a new pullout-resistant nut. SUMMARY OF BACKGROUND DATA: A common problem with anterior purchase regardless of the implant system is screw pullout at the proximal and distal ends of multilevel constructs. There is limited information on a solution to this problem. METHODS: The L1 to L4 vertebral bodies from four cadavers had one each of Zielke and Kaneda pedicle screws (Acromed Corp., Cleveland, OH), USS pedicle screw (Synthes Spine, Paoli, PA), and USS pedicle screw with pullout-resistant nut implanted transversely across the center of the vertebral body with bicortical purchase in a similar fashion as would be used clinically. The screws were extracted using a servohydraulic material testing system. The maximum axial forces were recorded. RESULTS: The Zielke and Kaneda screws had no significant difference in mean pullout strength (P = 0.542). The USS screw alone was less strong (P = 0.009). The USS screw and pullout-resistant nut increased the pullout strength by twofold (P = 0.00006). In the screw pullout tests, the mode of failure was at the screw thread's interface. The USS screw and pullout-resistant nut failed by imploding the body around the nut. With the USS screw and pullout-resistant nut, the pullout strength was determined by the compressive strength of the bone. CONCLUSIONS: The addition of a pullout-resistant nut to an anterior vertebral body screw improves the pullout strength by twofold and changes the mode of failure to rely ultimately on the inherent vertebral body strength rather than the screw's characteristics. The addition of a pullout-resistant nut may be applicable to multilevel implant constructs to prevent screw pullout at the top and bottom.

Biomechanical Phenomena↗

Femoral ring versus fibular strut allografts in anterior lumbar interbody arthrodesis. A biomechanical analysis.

STUDY DESIGN: A comparison between femoral ring and fibular strut allografts in anterior lumbar interbody arthrodesis, as assessed by biomechanical analysis. OBJECTIVES: To assess the difference in stability and rigidity provided by the femoral ring allograft versus that provided by fibular strut allograft. SUMMARY OF BACKGROUND DATA: Two commonly used techniques for spinal arthrodesis at L4-L5 include the femoral ring allograft and the fibular strut allograft. The postoperative stability has not been evaluated biomechanically. METHODS: An anterior lumbar interbody fusion on seven cadaveric specimens was performed using femoral ring and fibular strut allografts. Biplanar radiography was used to measure the 6 degrees of motion of L4 with respect to L5 during a range of loading maneuvers. RESULTS: When an extension moment was applied, the femoral ring allograft extended 4.2 degrees more than the intact specimen, compared with 1.6 degrees with the fibular strut allograft (P = 0.18). When the flexion moment was imposed, lateral bending increased by 2.2 degrees with the femoral ring, compared with 0.7 degree with the fibular strut allograft (P = 0.06). During lateral bending, increased lateral translation was observed to be 0.9 mm with the fibular strut allograft compared with 1.4 mm with the femoral ring allograft (P = 0.06). CONCLUSIONS: Although not statistically significant, the fibular strut allograft creates a more rigid construct immediately after surgery during flexion-extension, lateral bending angulations, and lateral translation. One should consider using the fibular strut allograft over the femoral ring allograft, as it is more stable and rigid construct in the immediate postoperative period.

Aged↗

Quality of life in patients with pituitary tumors: a preliminary study.

Patients with pituitary tumors frequently complain of quality of life problems despite normal hormonal blood levels. The goals of the study were to determine whether the sickness-related quality of life reported by these patients was poorer than that expected by the general population and whether some of these complaints and areas of dysfunction were more troublesome than others. Forty-three patients from a southeast Michigan pituitary disorders support group volunteered to complete a survey focusing on demographic, disease data and common complaints plus the Sickness Impact Profile (SIP). The results indicated that mental and physical fatigue were the most troublesome symptoms with sleep and libidinal complaints also of significant concern. The SIP indicated significant discontent among patients with regard to overall quality of life. Although this observational investigation seemed to underscore the fact that patients with pituitary tumors have a decreased quality of life despite apparently normal hormonal status, further subgroup analysis and subsequent surveys will be required to determine the actual significance of these findings.

Adult↗

Development of a standardized language for case management among high-risk elderly.

Consistency and communication remain key barriers to tracking case management outcomes and developing the best practices. A dictionary of case management problems, goals, interventions, and outcomes was developed to support a prevention-oriented case management program targeted on elderly high-risk patients. Case management featured an annual screening questionnaire, appointment monitoring, disease education, self-management support, and ongoing care coordination. The dictionary resulted in a Standardized Language for Case Management (SLED). This has since been reviewed and modified on the basis of comments and recommendations from 5 leading case management organizations and is aligned with Standards of Practice for Case Management. The article provides a description of the standardized language terms, the rationale underlying the documentation, examples of how this dictionary of definitions can be incorporated into the daily practice of case management, and examples of some of the benefits to the field that can be achieved with the use of a common data-recording system.

Aged↗