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PubMed2002

Analysis of the proteome in the human pituitary.

The pituitary is the master endocrine gland responsible for the regulation of various physiologic and metabolic processes. Proteomics offers an efficient means for a comprehensive analysis of pituitary protein expression. This paper reports on the application of proteomics for the mapping of major proteins in a normal (control) pituitary. Pituitary proteins were separated by two-dimensional gel electrophoresis with immobilized pH 3-10 gradient strips. Major protein spots that were visualized in the two-dimensional gel by silver staining were excised, and the proteins in these spots were digested with trypsin. The tryptic digests were analyzed by mass spectrometry, and the mass spectrometric data were used to identify the proteins through searches of the SWISS-PROT or NCBInr protein sequence databases. The majority of the proteins were identified on the basis of peptide mass fingerprinting data obtained by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Several proteins were also characterized based on product-ion spectra measured by post-source decay analysis and/or liquid chromatography-electrospray-quadrupole ion trap mass spectrometry. To date, 62 prominent protein spots, corresponding to 38 different proteins, were identified. The identified proteins include important pituitary hormones, structural proteins, enzymes, and other proteins. The protein identification data were used to establish a two-dimensional reference database of the human pituitary, which can be accessed over the Internet (http://www.utmem.edu/proteomics). This database will serve as a tool for further proteomics studies of pituitary protein expression in health and disease.

Computational Biology↗

PubMedDate not supplied

Active Learning Centre: design and evaluation of an educational World Wide Web site.

OBJECTIVE: A new medium--World Wide Web (WWW)--has grown rapidly over the last few years. It provides opportunities for development of new educational tools and facilitates learning through interactivity, self-paced study and easy access. The aim of this project was to devise all educational WWW site (Active Learning Centre) that would take advantage of the capabilities of the new medium and assess its utilization by users. METHODS: Active Learning Centre provides customizable computer-generated feedback tests, searchable databases (currently Microbiology, Pharmacology, Vaccines, and Spanish-language Cardiovascular Medications), remote WWW-based database authoring, and multilingual support. Its modular architecture allows easy expansion into new areas of knowledge. To evaluate the Active Learning Centre we conducted a study evaluating utilization of the site and user feedback. RESULTS: The site is being used by thousands of patrons from around the world, the majority of whom are health professionals/health profession students from English-speaking countries. Customizable interactive tests are the most popular feature of the site. Most users give the site high ratings and would like it to expand further. CONCLUSION: The paradigm of combining interactive feedback tests with searchable % reference databases has been successful. Further expansion of the site to incorporate other areas of knowledge is planned.

Computer-Assisted Instruction↗

PubMed1999

Process control procedures to augment quality control of leukocyte-reduced red cell blood products.

Quality control of leukocyte-reduced packed red cell units (LRprc) produced in blood facilities must conform to regulatory criteria, which state that units may not contain more than 1 x 10(6) to 5 x 10(6) white blood cells (WBC) per unit. The post-filtration WBC content of a total of n = 386 LRprc units was counted with a Nageotte chamber to model the probability that a unit would not meet the regulatory criteria. The distribution of the residual leukocyte counts is close to a negative binomial distribution (NBD) and is independent of the packed red cell volume filtered. The observed probability that a unit of blood has a residual WBC greater than 5 x 10(6) is 2.6 +/- 2.6 x 10(-3). A power analysis of the two-sample Kolmogorov-Smirnov (KS) test in this application shows that a sample size of 20 is sufficient for determining that the process is in control when an out of control process has a k NBD parameter greater than or equal to that of the in control process. The three out of control processes observed to date appear to have this property. A sample of size 80 may be necessary for confirming that process validation data sets conform to the larger 'reference' database (n = 386) for processes that are out of control in such a way that their k NBD parameter is less than the k parameter of the in control process.

Blood Component Removal↗

PubMed1994

Single X-ray absorptiometry of the forearm: precision, correlation, and reference data.

The performance of a single X-ray absorptiometry (SXA) device incorporating an X-ray tube as a photon source was evaluated with respect to precision in vivo and in vitro, scan time, image quality, and correlation with an existing dual energy X-ray absorptiometry (DXA) device. SXA precision in vivo, expressed as a coefficient of variation (CV), was 0.66% for bone mineral content (BMC) and 1.05% for bone mineral density (BMD). Precision in vitro, based on 78 BMC measurements of a forearm phantom over 195 days, was 0.53%. Correlation with DXA at the 8 mm distal forearm site was high (r = 0.97 for BMC and r = 0.96 for BMD). A preliminary SXA reference database composed of 151 healthy Caucasian American women was developed to facilitate the interpretation of patient measurements. SXA scan time was 4 minutes and delivered a radiation exposure of 1.68 mrem. SXA image quality and spatial resolution were superior to SPA and comparable to DXA.

Absorptiometry, Photon↗

PubMed2001

Evolutionary relationships among G protein-coupled receptors using a clustered database approach.

Guanine nucleotide-binding protein-coupled receptors (GPCRs) comprise large and diverse gene families in fungi, plants, and the animal kingdom. GPCRs appear to share a common structure with 7 transmembrane segments, but sequence similarity is minimal among the most distant GPCRs. To reevaluate the question of evolutionary relationships among the disparate GPCR families, this study takes advantage of the dramatically increased number of cloned GPCRs. Sequences were selected from the National Center for Biotechnology Information (NCBI) nonredundant peptide database using iterative BLAST (Basic Local Alignment Search Tool) searches to yield a database of approximately 1700 GPCRs and unrelated membrane proteins as controls, divided into 34 distinct clusters. For each cluster, separate position-specific matrices were established to optimize sequence comparisons among GPCRs. This approach resulted in significant alignments between distant GPCR families, including receptors for the biogenic amine/peptide, VIP/secretin, cAMP, STE3/MAP3 fungal pheromones, latrophilin, developmental receptors frizzled and smoothened, as well as the more distant metabotrobic glutamate receptors, the STE2/MAM2 fungal pheromone receptors, and GPR1, a fungal glucose receptor. On the other hand, alignment scores between these recognized GPCR clades with p40 (putative GPCR) and pm1 (putative GPCR), as well as bacteriorhodopsins, failed to support a finding of homology. This study provides a refined view of GPCR ancestry and serves as a reference database with hyperlinks to other sources. Moreover, it may facilitate database annotation and the assignment of orphan receptors to GPCR families.

Amino Acid Sequence↗

PubMed2002

The tolerance-hyperbaric test: a chronobiologic approach for improved diagnosis of hypertension.

Blood pressure (BP) displays predictable large-amplitude circadian variability. Thus, the identification and the proper definition of hypertension are highly ambiguous when based on single time-unspecified measurements. One way to deal with such variability in the diagnosis of hypertension is to replace the commonly used constant limits of BP by a time-specified reference interval based on the normal circadian BP rhythm assessed by ambulatory BP monitoring (ABPM). A proper reference limit can be constructed, for instance, as a tolerance interval computed for every specific time interval throughout the 24 h. Once such a threshold (given by the upper limit of the tolerance interval) is constructed, a hyperbaric index (HBI) can be computed by numerical integration of the total area of any given patient's BP profile above threshold. The HBI plus the duration of excess within the 24h day serves as nonparametric endpoints for assessing hypertension. Both retrospective and prospective evaluation of this tolerance-hyperbaric test validate its high sensitivity and specificity in the diagnosis of hypertension. We describe the theory of the HBI as well as a newly created dedicated software program that automatically derives the tolerance intervals from a reference database of normotensive subjects and calculates the HBI and other potentially valuable parameters based on data obtained by ABPM. The establishment of time-qualified tolerance limits and the assessment of the extent and timing of BP elevation represents a valuable tool for the more accurate diagnosis of hypertension as well as means of gauging response to treatment.

Adult↗

PubMed1997

Reference data for ultrasonic bone measurement: variation with age in 2087 Caucasian women aged 16-93 years.

Data from the measurement of broadband ultrasonic attenuation (BUA) and speed of sound (SOS), using the Lunar Achilles ultrasonic densitometer, were collected for Caucasian women from five centres in the United Kingdom (Leeds, London, Nottingham, Lincoln and Sheffield). After correcting for machine variability at each site, the data were combined into a central reference database comprising 2087 women aged 16-93 years. The data are presented in 5-year bands and show a mean fall of 0.36% per year for BUA and 0.08% per year for SOS in the 60 years following the attainment of peak bone mass. This fall in BUA compares with that observed using dual energy X-ray absorptiometry studies of the lumbar spine and femoral neck of 0.32% per year and 0.44% per year, respectively, for the age range 25-65 years.

Adolescent↗

PubMed2001

(133)Xe SPECT cerebral blood flow study in a healthy population: determination of T-scores.

UNLABELLED: Dementia is becoming a major health problem as the population of the Northern Hemisphere ages. Early differential diagnosis between normal cognitive decline and dementia is particularly difficult. If psychometric evaluation can contribute to the diagnosis, quantitative cerebral functional imaging would play an important role. We therefore proposed, first, to constitute a normative dataset that could later be used to identify subjects at risk for neurodegenerative processes and, second, to describe the risk of abnormal global cerebral blood flow (gCBF) by defining categories based on the standardized cutoff scores of a young, healthy population (T-score). METHODS: Of a total of 203 healthy volunteers, 187 were included in the protocol, which included evaluation of medical history, neurologic and neuropsychologic status, and body composition; analysis of blood; and measurement of gCBF by means of (133)Xe SPECT. RESULTS: With ANOVA analysis using age and sex as between-subject factors and gCBF as a within-subject factor, a significantly higher gCBF was found in women than in men. In addition, a linear reduction as a function of age was observed for both sexes (-0.3%/y). T-score was determined for the 18- to 28-y-old age group, for whom gCBF was found to be 46.7 +/- 5.1 mL/min/100 g tissue in men and 49.0 +/- 5.0 mL/min/100 g tissue in women. The age-dependent decrease could thus be expressed in T-scores and, in the 29- to 38-y-old, 39- to 48-y-old, and >48-y-old age groups, averaged -0.63, -1.29, and -1.92, respectively, in men and -0.63, -0.83, and-2.40, respectively, in women. Cognitive performance, body composition, and blood analysis revealed the expected significant effects from sex and age. CONCLUSION: The large-scale reference database of gCBF measurements constituted from a healthy, well-controlled population enabled age and sex stratification, which showed significant differences between the sexes and a significant decline as a function of age. T-scores were determined and warrant further studies on the prospective identification of early dementia by (133)Xe SPECT in elderly individuals.

Adolescent↗

PubMed1995

Lessons in cooperation: four hospital consortia relate their quality improvement experiences.

BACKGROUND: In 1989, The Robert Wood Johnson Foundation launched a demonstration project to test a consortium approach to quality improvement. As part of this project, four hospital consortia in various parts of the United States are currently sharing quality resources (for example, training) and collaborating on various improvement efforts. The purpose of the project is to demonstrate that hospitals can take on more difficult problems and accomplish more in cooperation with each other than on their own. CASE STUDIES: The Institute for Quality Healthcare (Iowa City, Iowa) has built a comparative database so that 40 member hospitals can make meaningful comparisons on various aspects of performance; The Vermont Program for Quality in Health Care has lowered the postoperative infection rate in Vermont by monitoring compliance with consensus guidelines; Interwest Quality of Care, Inc, which has member organizations in Utah, Wyoming, and Idaho, has adapted and disseminated guidelines for diabetic care; and The Public Hospital Institute, in Berkeley, California, has worked with the Joint Commission on Accreditation of Healthcare Organizations to develop a written guide to help surveyors understand the unique operational traits of public hospitals. LESSONS LEARNED: Projects such as those with champions in several member organizations and comparative data analysis lend themselves more easily to cooperative work than others. They also provide some strategies for collaboration, such as continually reinforcing the principles of collaboration, obtaining a fully informed commitment, beginning with initiatives that are likely successes, and being serious and vocal about the commitment to confidentiality. CONCLUSIONS: Collaborators in quality improvement gain important resources, such as better information, more relevant reference databases, colleagues and support for quality improvement specialists, and economies of scale in education programs, training materials, and interaction with vendors. However, the difficulties in collaboration are great. Hospitals must continually consider not only "What's in this for me," but also "What can we accomplish as a group that is greater than what each of us can do alone?"

California↗

PubMed2001

Automated assessment of dipyridamole 201Tl myocardial SPECT perfusion scintigraphy by case-based reasoning.

UNLABELLED: This study evaluated the diagnostic accuracy of case-based reasoning (CBR) to automatically detect significant coronary artery disease from dipyridamole 201Tl myocardial SPECT perfusion scintigrams. METHODS: The study population included 240 patients (182 men, 58 women; mean age +/- SD, 61 +/- 12 y) on whom coronary angiography and perfusion scintigraphy were performed within 6 +/- 11 d of each other. The patients were divided into two groups according to the presence or absence of significant coronary disease in any major coronary vessel. Regional myocardial tracer uptake was observed in 84 segments by polar map analysis. For each scintigraphic image, a CBR algorithm based on a similarity metric was used to identify similar scintigraphic images within the case library. The angiographic results of these similar cases were used to obtain the CBR reading, which was compared with the true angiographic results. Myocardial scintigrams were also analyzed by a first-generation Cedars-Sinai (CS) method, including a comparison with a reference database, and by the visual analysis of an expert reader. RESULTS: By receiver-operating-characteristic analysis, the diagnostic accuracy of CBR was not different from the interpretation by the CS algorithm and from visual interpretation (P = not significant [NS]). For detection of significant coronary disease, the respective sensitivities at 50% and 80% specificity were 90% and 67% for CBR, 88% and 65% for CS polar map analysis, and 91% and 74% for visual interpretation. For the detection of coronary disease in the vascular territories assigned to the left anterior descending and the right coronary arteries, CBR and CS polar map analysis showed similar diagnostic accuracy (P = NS). However, for detection of disease in the circumflex artery, CS polar map analysis was slightly better than CBR (P = 0.03). CONCLUSION: Automated interpretation of dipyridamole 201Tl myocardial SPECT perfusion images by CBR has diagnostic accuracy similar to that of visual interpretation or CS analysis. Thus, use of a case library that includes a variety of normal and abnormal perfusion images does not appear to have greater diagnostic power than use of reference limits.

Adult↗

PubMed2003

Characterization of the gene expression profile of neuroblastoma cell line IMR-5 using serial analysis of gene expression.

The serial analysis of gene expression (SAGE) technique was used to generate a database of the most abundant transcripts of the MYCN-amplified neuroblastoma cell line IMR-5. A total of 8568 tags were sequenced and shown to represent 4034 unique tags, each of which corresponds to an individual transcript. Expression levels of genes are reflected by the frequency of occurrence of the respective tags. To validate fidelity of SAGE data, relative abundances of seven transcripts were evaluated by semiquantitative reverse transcriptase-polymerase chain reaction. Transcripts that were detected nine times or more (>0.1% of the total tag population) accounted for 36% of the total messenger RNA mass but only 3% of the total number of individual transcripts. A strong preponderance of genes involved in protein synthesis, in particular those encoding for ribosomal proteins, were observed among these high-abundance transcripts. Tags corresponding to the amplified gene DDX1 were conspicuously overrepresented in comparison to the other amplified genes MYCN, neuroblastoma amplified gene and MEIS1, which suggests an additional mechanism apart from genomic amplification contributing to the strong upregulation of this gene. This study provides a comprehensive gene expression profile of neuroblastoma cell line IMR-5 and may be used as a reference database for identification of candidate genes that are involved in etiology and pathogenesis of neuroblastoma.

Databases as Topic↗

PubMed2003

Psychiatric disorder in veterans of the Persian Gulf War of 1991. Systematic review.

BACKGROUND: Veterans of the Persian Gulf War of 1991 have reported symptoms attributed to their military service. AIMS: To review all studies comparing the prevalence of psychiatric disorders in Gulf War veterans and in a comparison group of service personnel not deployed to the Gulf War. METHOD: Studies of military personnel deployed to the Gulf published between 1990 and 2001 were identified from electronic databases. Reference lists and websites were searched and key researchers were contacted for information. A total of 2296 abstracts and 409 complete articles were reviewed and data were extracted independently by two members of the research team. RESULTS: The prevalence of psychiatric disorder in 20 studies of Gulf War veterans was compared with the prevalence in the comparison group. Prevalence of post-traumatic stress disorder (PTSD) and common mental disorder were higher in the Gulf War veterans. Heterogeneity between studies was significant, but all reported this increased prevalence. CONCLUSIONS: Veterans of the Persian Gulf War reported an increased prevalence of PTSD and common mental disorder compared with other active service personnel not deployed to the Gulf. These findings are attributable to the increase in psychologically traumatic events in wartime.

Case-Control Studies↗

PubMed2026

Genome-based predictions of metabolic preferences and substrate phenotypes in psychrotrophic bacteria from permafrost environments.

Genomes reveal vast functional potential, but harbor genomic noise that obscures prediction of metabolic and environmental preferences. Genomic databases are skewed towards clinically relevant and easily cultivated bacteria, limiting predictions for diverse and underrepresented environmental taxa. Psychrotrophic bacteria, which can survive and grow in cold, nutrient-limited, dry, and saline environments, are especially underrepresented despite their relevance for understanding microbial responses to changing cold environments and potential biotechnological value given growth at low temperatures. Assembling complete genomes of 48 isolates from Alaskan permafrost, seasonally frozen active layer soils, and terrestrial ice, we used Kyoto Encyclopedia of Genes and Genomes (KEGG) ortholog annotations to evaluate the predictability of metabolic resource-use traits observed using phenotypic tests. Genome-predicted values for glycolytic versus gluconeogenic catabolic preference index, or sugar-acid preference (SAP), explained over 50% of the variance in empirically observed SAP. SAP was inversely correlated to genomic GC content, which follows phylum-level trends, indicating that coarse metabolic preference covaries with phylogeny. Regularized elastic net models offered a more granular view, linking KEGG genes to specific substrate utilization and sensitivity phenotypes and yielding moderate but reproducible accuracy (AUC 0.70-0.79) for 11 substrates, demonstrating that specific substrate responses may be predictable from relatively small subsets of KO genes. These results extend recent advances, such as the SAP metric, and highlight associations among genomic GC content, phylum, and broad metabolic strategy. Linking genomic content to phenotype using isolates is a necessary step toward predictive models of microbial function in environmental communities, and this work can be used for hypothesis generation, with applications towards more expansive data sets.IMPORTANCECold region soils and ice host psychrotrophic bacteria with metabolic traits and adaptations that enable persistence in harsh, resource-limited environments. However, these taxa are underrepresented in genomic reference databases dominated by well-studied, mesophilic organisms. This gap limits inference of ecological strategies and our ability to predict how these microbes may influence the large, thaw-vulnerable carbon reservoirs in permafrost. Here, we show that genomic GC content is associated with the sugar-versus-acid catabolic preference (SAP) of isolates across major phyla, suggesting that broad genomic features may provide a coarse signal of metabolic strategy. We demonstrate that a modified SAP metric, using binary (positive/negative) substrate utilization rather than detailed growth rate measurements, is moderately predictive, thus extending its application to slow-growing or difficult-to-culture taxa. Together, these advances broaden the toolkit for linking genome content to resource-use traits (phenotype) in poorly characterized, cold-adapted bacteria and offer a tractable entry point to broad prediction and hypothesis generation.

Genome, Bacterial↗

PubMed1994

Assessment of age-related bone loss in normal South African women by means of the Hologic QDR 1000 system.

The aim of this study was to evaluate age-related changes in cortical and trabecular bone mineral density (BMD) in South African subjects, and to develop a local reference database for dual energy X-ray absorptiometry with the QDR 1000 densitometer. A questionnaire was used to recruit volunteers. Age, years since menopause, use of medications and medical diseases were recorded. Men were excluded. Only whites and coloureds were studied. Three hundred and eleven women had single measurements over a 2-year period. Seven sets of subjects were defined according to age (18-44; 45-49; 50-54; 55-59; 60-64; 65-69; > 70 years) (N = 163; 32; 35; 23; 25; 16; 17 respectively). Height and weight did not change significantly with age. There were significant differences in lumbar and femoral BMD (Ward's) compared with those of American subjects in the different age categories. Both the lumbar and total femoral BMD began to fall significantly between the ages of 60 and 65 years (P < 0.01). Ward's triangle showed a significant fall in BMD between 45 and 50 years of age (P < 0.01). Ward's BMD predicted 36% of the variation in lumbar BMD at 45 years but 10% at 70 years. Ward's triangle is a useful predictor of femoral bone loss in later years. The fracture threshold at the lumbar vertebrae was 0.822 g/cm2; at Ward's triangle it was 0.443 g/cm2. This gave a 16% prevalence of osteopenia in the lumbar region and a prevalence of 24% at Ward's area.

Adult↗

PubMed2000

Measurements used to characterize the foot and the medial longitudinal arch: reliability and validity.

BACKGROUND AND PURPOSE: Abnormality in the structure of the medial longitudinal arch of the foot is commonly thought to be a predisposing factor to injury. The purpose of this investigation was to compare the reliability and validity of several measurements used to characterize various aspects of the foot, including the medial longitudinal arch. SUBJECTS: One hundred two feet (both feet of 51 subjects) were measured to establish a reference database. From this group, a subset of 20 feet (both feet of 10 subjects) was used to determine intertester and intratester reliability. Radiographs of a further subset of 10 feet (right feet of 10 subjects) were used to determine validity. METHODS: Five foot measurements were taken in 2 stance conditions: 10% of weight bearing and 90% of weight bearing. RESULTS: Intraclass correlation coefficients (ICCs) for intertester and intratester measurements were between.480 and.995. The most reliable method of characterizing arch type in 10% of weight bearing between testers was dividing navicular height by foot length in 10% of weight bearing. However, this measure yielded highly unreliable measurements in 90% of weight bearing. The most valid measurements were navicular height divided by truncated foot length, navicular height divided by foot length in 10% of weight bearing, and navicular height divided by foot length in 90% of weight bearing. Dorsum height at 50% of foot length divided by truncated foot length showed relatively high intertester reliability (ICC=.811 in 10% of weight bearing, ICC=.848 in 90% of weight bearing) and validity (ICC=.844 in 10% of weight bearing, ICC=.851 in 90% of weight bearing). CONCLUSION AND DISCUSSION: These data suggest that, of the measures tested, the most reliable and valid method of clinically assessing arch height across 10% and 90% of weight bearing was dividing the dorsum height at 50% of foot length by truncated foot length.

Adult↗

PubMed1997

Diversity of Streptococcus agalactiae and Staphylococcus aureus ribotypes recovered from New York dairy herds.

OBJECTIVES: To develop a reference database for characterization of bovine Staphylococcus aureus and Streptococcus agalactiae strains by automated ribotyping and to use it to assess the discriminatory power of this typing procedure and the geographic distribution of Sta aureus and Str agalactiae strains in New York state dairy herds. SAMPLE POPULATION: 22 commercial dairy herds. PROCEDURE: Isolates of Sta aureus and Str agalactiae from bovine milk were identified by standard bacteriologic procedures, then typed by automated ribotyping. Antimicrobial susceptibility of isolates was tested in vitro. Two indicators made from the data were percentage of farms with multiple ribotypes and percentage of single ribotypes found in several geographic regions. Standard bacteriologic diagnosis, automated ribotyping, and determination of antibiograms (Kirby-Bauer method) also were done. RESULTS: Of 50 Sta aureus and 44 Str agalactiae isolates from composite milk samples of 12 and 10 herds, respectively, 18 and 14 ribotypes, respectively, were identified. The discriminatory power of automated ribotyping was approximately 0.96 (Hunter-Gaston's formula). A higher percentage of herds with Sta aureus had multiple ribotypes. The most common Sta aureus ribotypes tended to have broader geographic distribution. Some Sta aureus ribotypes were significantly associated with antibiotic resistance profiles. CONCLUSIONS: Automated ribotyping appears to characterize bovine strains of bacteria associated with intramammary infections with a high discriminatory index. Potential applications include identification of strains that appear to have broad geographic distribution suggesting interfarm transfer, discrimination between recurrent versus new intramammary infections (ie, for control of Str agalactiae and Sta aureus), and evaluation of antibiotic therapy.

Animals↗

PubMed2003

The incidence of recurrent venous thromboembolism after treatment with vitamin K antagonists in relation to time since first event: a meta-analysis.

BACKGROUND: After a first episode of venous thromboembolism, patients are treated with vitamin K (phytonadione) antagonists. There are indications that the risk of recurrence after treatment with vitamin K antagonists decreases relative to the time since the first event. The aim of the present meta-analysis is to describe the risk of recurrent venous thromboembolism after treatment with vitamin K antagonist in relation to the time since the index event. METHODS: Computerized searches in MEDLINE and EMBASE databases; reference checks of pertinent articles; personal communication with colleagues to find randomized clinical trials and cohort studies in which patients with venous thromboembolism were treated with vitamin K antagonists. Per treatment arm, 2 reviewers independently extracted data on the number of recurrent events and the duration of follow-up per time period of 3 months. RESULTS: A total of 135 potentially eligible studies were identified. Of these, 18 studies could be included, comprising 25 treatment arms that could be analyzed. Treatment arms were divided into 3 groups based on treatment duration (short, medium, and long). For all 3 groups, the monthly incidence immediately after discontinuation of treatment was high and declined rapidly thereafter. The monthly incidence after 9 months seemed independent of the treatment duration. CONCLUSIONS: There is a diminishing risk of recurrent venous thromboembolism over time and a stabilization after 9 months independent of the duration of the initial treatment with vitamin K antagonists. These findings have important implications for decision making about the optimal duration of treatment with vitamin K antagonists.

Anticoagulants↗

PubMed1998

Complementary therapies for depression: an overview.

Depression is one of the most common reasons for using complementary and alternative therapies. The aim of this article is to provide an overview of the evidence available on the treatment of depression with complementary therapies. Systematic literature searches were performed using several databases, reference list searching, and inquiry to colleagues. Data extraction followed a predefined protocol. The amount of rigorous scientific data to support the efficacy of complementary therapies in the treatment of depression is extremely limited. The areas with the most evidence for beneficial effects are exercise, herbal therapy (Hypericum perforatum), and, to a lesser extent, acupuncture and relaxation therapies. There is a need for further research involving randomized controlled trials into the efficacy of complementary and alternative therapies in the treatment of depression.

Acupuncture Therapy↗