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PubMed1986

Integrated image and X-ray microanalysis of hepatic lysosomes in a patient with idiopathic hemosiderosis before and after treatment by phlebotomy.

Morphometrical and X-ray elemental information was extracted from Scanning Transmission Electron Microscopy (STEM) images of hepatic lysosomes of a patient with idiopathic hemosiderosis before and after treatment by phlebotomy. The elements of interest were iron, stored in pathological quantities in hepatic lysosomal structures and cerium, used as a capture ion after a cytochemical reaction to detect acid phosphatase activity in the lysosomal structures. Morphologically the lysosomal structures are heteromorph and the elements iron and cerium are heterogeneously distributed. With "reduced raster" (= reduced scanning area) analysis at 16 X 16 pixelpoints (integrating image and X-ray microanalysis), a marked difference in the area of the cross sectioned lysosomal structures before and after treatment could be demonstrated. Simultaneously the difference in the relative orientation of the elements iron and cerium before and after phlebotomy could be visualized. Chelex ion exchange beads, loaded with 11.5% w/w iron, and coembedded with the tissue blocks, were used as an internal standard. A mean iron peak to background ratio was obtained and a factor, converting ratio to absolute iron concentration, was calculated. The same calculation procedure, now per pixelpoint, was followed for the hepatic lysosomal structures. A marked difference in iron concentration in the individual lysosomal structures was observed before and after treatment by phlebotomy.

Bloodletting↗
PubMed1992

On-line assessment of ventricular function by automatic boundary detection and ultrasonic backscatter imaging.

To provide an approach suitable for on-line analysis of ventricular function, a conventional two-dimensional ultrasound imaging system was modified to detect and track blood-tissue interfaces in real time based on their quantitative acoustic properties. This modification permitted on-line display of the left ventricular cavity area, fractional area change, volumes and ejection fraction on a beat by beat basis. Images were obtained from 54 patients and 12 normal subjects with broad ranges of ventricular dimensions and systolic function. On-line measurements of cavity areas were compared with off-line measurements of cavity areas (analysis of videotaped conventional images). Left ventricular cavity areas measured on-line from short-axis views correlated closely with off-line views as did areas from apical views. On-line fractional area change correlated well with ejection fraction calculated off-line. More than 70% of patients could be studied adequately with the approach developed. Thus, automatic boundary detection based on quantitative assessment of tissue acoustic properties permits on-line quantitation of ventricular cavity areas and indexes of function.

Algorithms↗
PubMed2003

Automated melanoma detection: multispectral imaging and neural network approach for classification.

Our aim in the present research is to investigate the diagnostic performance of artificial neural networks (ANNs) applied to multispectral images of cutaneous pigmented skin lesions as well as to compare this approach to a standard traditional linear classification method, such as discriminant function analysis. This study involves a series of 534 patients with 573 cutaneous pigmented lesions (132 melanomas and 441 nonmelanoma lesions). Each lesion was analyzed by a telespectrophotometric system (TS) in vivo, before surgery. The system is able to acquire a set of 17 images at selected wavelengths from 400 to 1040 nm. For each wavelength, five lesion descriptors were extracted, related to the criteria of the ABCD (for asymmetry, border, color, and dimension) clinical guide for melanoma diagnosis. These variables were first reduced in dimension by the use of factor analysis techniques and then used as input data in an ANN. Multivariate discriminant analysis (MDA) was also performed on the same dataset. The whole dataset was split into two independent groups: i.e., train (the first 400 cases, 95 melanomas) and verification set (last 173 cases, 37 melanomas). Factor analysis was able to summarize the data structure into ten variables, accounting for at least 90% of the original parameters variance. After proper training, the ANN was able to classify the population with 80% sensitivity, 72% specificity, and 78% sensitivity, 76% specificity for the train and validation set, respectively. Following ROC analysis, area under curve (AUC) was 0.852 (train) and 0.847 (verify). Sensitivity and specificity values obtained by the standard discriminant analysis classifier resulted in a figure of 80% sensitivity, 60% specificity and 76% sensitivity, 57% specificity for the train and validation set, respectively. AUC for MDA was 0.810 and 0.764 for the train and verify set, respectively. Classification results were significantly different between the two methods both for diagnostic scores and model stability, which was worse for MDA.

Adolescent↗
PubMed1985

The effects of alcohol exposure in utero on acetylcholinesterase, Na/K-ATPase and Ca-ATPase activities in six regions of rat brain.

The neural membrane-bound enzymes, acetylcholinesterase, Na/K-ATPase and Ca-ATPase were examined in six brain areas in perinatal rats at 5, 15 and 25 days of age following alcohol exposure in utero. Female Wistar rats were mated with adult male Wistar rats and maintained on either a liquid diet containing ethanol (5% w/v) or on a control liquid diet for various periods during gestation and the perinatal period. These periods were: before and during gestation only (until birth of the offspring); before and during gestation and following birth; during only a period of gestation and continuing postnatally. Enzyme activity was determined by spectrophotometric methods in the following areas of the brain in each offspring: telencephalon, cerebellum, hippocampus, septal area, preoptic area, and medial basal hypothalamic area. Analysis of the data indicates that alcohol exposure in utero will heterogeneously decrease enzyme activity among the six brain areas when compared to enzyme activity in the same brain areas in animals which were not exposed to alcohol in utero. The activity of the three enzymes were most significantly reduced on day 5 of age, compared to levels in the control animals. Enzyme activity in each brain area was generally most significantly affected in animals exposed to alcohol both pre- and postnatally. The results indicate that fetal alcohol exposure reduces neuronal enzyme activity relative to the period of ethanol exposure in utero; the longer the period of time that alcohol was consumed by the mothers pre- and postnatally, the greater the effect of alcohol on the enzyme activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylcholinesterase↗
PubMed2004

Acute renal failure needing dialysis in the intensive care unit and prognostic scores.

BACKGROUND: Generic prognostic scores used in acute renal failure (ARF) give imprecise results; disease-specific indices applied to distinct populations or intensive care practices becomes inaccurate. The current study evaluates the adequacy of prognostic scores, in patients with severe ARF needing dialysis. METHODS: Known generic (APACHE II) and disease-specific (ATN-ISS) indices were applied to a cohort (n = 280) with ARF needing dialysis, under intensive care. Possible risk factors as causal factors, organ dysfunctions and clinical variables were examined, and a local index assembled by multivariate logistic regression analysis. Area under the receiver operating characteristics (ROC) curves evaluated the indices discriminating capacity. Goodness-of-fit testing and linear regression analysis appraised calibration. Validation was accomplished by the bootstrapping technique. The end-point was hospital mortality. RESULTS: Overall mortality was 85%. Female gender < 44 years (OR: 0.29; 95% CI: 0.10-0.84), liver/obstructive biliary disease (OR: 6.03; 95% CI: 1.65-22.08), being conscious (OR: 0.49; 95% CI: 0.21-1.14), use of vasoactive drug (OR: 3.13; 95% CI: 1.25-7.83), respiratory dysfunction (OR: 5.20; 95% CI: 1.25-7.83) or sepsis (OR: 2.62; 95% CI: 1.14-6.02) were associated with outcome. Areas under the ROC curve of 0.815, 0.652 and 0.814; Goodness-of-fit test P = 0.593, P < 0.001 and P = 0.002; and linear regression R2 = 0.973, R2 = 0.526 and R2 = 0.919 for the local index, APACHE II and ATN-ISS, respectively, indicate better performance by the local index. The local index median area under the ROC curve, by bootstrapping, was 0.820 (95% CI: 0.741-0.907). CONCLUSIONS: APACHE II score was inaccurate, and ATN-ISS poorly calibrated. When mortality or intensive care practices significantly deviate, local scores may better evaluate prognosis in severe ARF.

Acute Kidney Injury↗
PubMed1990

Informed inquiry into practice variations: the Maine Medical Assessment Foundation.

This paper reports on the development of a successful physician organized and driven medical assessment program, the Maine Medical Assessment Foundation. Responding to the issues and challenges presented by practice pattern variation in the state of Maine, eight physician specialty study groups have been developed in the state over the past ten years. Working in a confidential, educational, non-regulatory format, study groups have had remarkable success in providing feedback of epidemiologic data on area variations to practitioners. This process has succeeded in modifying practice patterns, resulting in marked improvements in quality of care and decreases in apparently excessive utilization of health care resources. Simultaneously, physicians have become supporters of the process of small area analysis and they have joined in community based outcomes research projects. This successful program can be a model for other areas.

Education, Medical, Continuing↗
PubMed2005

Utility of breath-hold fast-recovery fast spin-echo t2 versus respiratory-triggered fast spin-echo T2 in clinical hepatic imaging.

OBJECTIVE: The objective of our study was to compare a breath-hold fat-suppressed fast-recovery fast spin-echo (FSE) T2-weighted sequence with a respiratory-triggered fat-suppressed FSE T2-weighted sequence to assess the effect on image quality and lesion detection and characterization in clinical hepatic imaging. MATERIALS AND METHODS: Both the breath-hold fat-suppressed fast-recovery FSE and respiratory-triggered fat-suppressed FSE T2-weighted sequences were acquired in 46 patients. Two radiologists, blinded to clinical data, independently evaluated randomized images from both sequences. Qualitatively, images were graded on a 5-point scale for five different characteristics. The number and location of lesions were recorded. The confidence of detection and the confidence of characterization (solid vs nonsolid) were graded on a 5-point scale. A consensus review using radiology, clinical, and pathology data served as the standard. Receiver operating characteristic (ROC) curve analysis (area under the ROC curve [A(z)]) was used to compare each reviewer's interpretation against the consensus interpretation. Quantitative analysis was performed by calculating the liver signal-to-noise ratio (SNR), liver-to-spleen contrast-to-noise ratio (CNR), and lesion-to-liver CNR. Both one- and two-tailed Student's t tests were used to check for significance. RESULTS: Qualitatively, both reviewers graded the breath-hold fat-suppressed fast-recovery FSE T2-weighted sequence better than the respiratory-triggered fat-suppressed FSE T2-weighted sequence on all five characteristics (p < 0.005). Of 78 lesions detected, 29 were characterized as solid; 47, nonsolid; and two, indeterminate. On ROC analysis, there were no significant differences between the breath-hold fat-suppressed fast-recovery FSE and respiratory-triggered fat-suppressed FSE T2-weighted sequences in lesion detection (A(z) reviewer 1, 0.77 and 0.83, respectively, [p = 0.12]; A(z) reviewer 2, 0.84 and 0.80, respectively [p = 0.12]) or in lesion characterization (A(z) reviewer 1, 0.86 and 0.92, respectively [p = 0.33]; A(z) reviewer 2, 0.90 and 0.91, respectively [p = 0.79]). Quantitatively, liver SNRs, spleen CNRs, and lesion CNRs (solid and nonsolid lesions) were significantly better on the breath-hold fat-suppressed fast-recovery FSE T2-weighted images than on the respiratory-triggered fat-suppressed FSE T2-weighted images (p < 0.005). CONCLUSION: Breath-hold fat-suppressed fast-recovery FSE T2-weighted images were of better quality than respiratory-triggered fat-suppressed FSE T2-weighted images, and lesion detection and characterization were comparable.

Adult↗
PubMed1990

A small area simulation approach to determining excess variation in dental procedure rates.

All small area analyses need to compare the observed variability in rates to that expected by chance alone, but the expected variability is usually not known. This paper uses patient-level data for five dental procedures to simulate the distributions of the summary statistics that are usually generated in such studies. These statistics are found to vary greatly even under the "null hypothesis" that all dentists are using procedures at the same rates. The simulated dentist rates are compared to observed rates obtained in a different study. These findings illustrate problems that can occur in small area analysis studies, and emphasize the importance of using statistical techniques that are appropriate for the data that are to be analyzed. Investigators should make every effort to obtain patient-level data, or at least to understand the underlying distribution of the number of procedures per patient, to avoid mistaking significant deviations from an incorrect model as evidence for significant variation among small areas.

Analysis of Variance↗
PubMed2006

A simple route utilizing surfactant-assisted templating sol-gel process for synthesis of mesoporous Dy2O3 nanocrystal.

A simple route of combined sol-gel process with surfactant-assisted templating technique was successfully employed for the first time to synthesize nanocrystalline mesoporous Dy(2)O(3) with narrow monomodal pore size distribution under mild conditions. The nanocrystalline Dy(2)O(3) with monomodal mesoporous characteristic was ultimately achieved by controlling the hydrolysis and condensation steps of dysprosium n-butoxide modified with acetylacetone in the presence of laurylamine hydrochloride surfactant aqueous solution. The synthesized material was methodically characterized by thermogravimetry and differential thermal analysis (TG-DTA), X-ray diffraction (XRD), scanning electron microscopy (SEM), high resolution transmission electron microscopy (HRTEM), selected-area electron diffraction (SAED), N(2) adsorption-desorption, Brunauer-Emmett-Teller (BET) surface area analysis, and Barrett-Joyner-Halenda (BJH) pore size distribution analysis. The particle size of the synthesized Dy(2)O(3) in nanosized range obtained from the SEM and HRTEM micrographs was in good accordance with the crystallite size estimated from the XRD result. The N(2) adsorption-desorption result exhibited hysteresis pattern with single loop, indicating the existence of monomodal mesopore. The extremely narrow pore size distribution with mean pore diameter in the mesopore region of the synthesized Dy(2)O(3) was also confirmed by the BJH result.

Journal Article↗
PubMed2005

The operating performance and products distribution of the catalytic oxidation of methyl-isobutyl-ketone over a Pt/gamma-Al2O3 catalyst.

Catalytic oxidation is one of the cost-effective technologies to solve the troublesome volatile organic compounds. This study treated methyl-isobutyl-ketone (MIBK) by a commercial catalyst, Pt/gamma-Al(2)O(3), in a fixed-bed reactor. The effects of operating factors, such as operating temperature, MIBK concentration, space velocity, and O(2) concentration, on the performance of the catalyst were investigated. The products and reactants distributions from the oxidation of MIBK over Pt/gamma-Al(2)O(3) were observed. The results show that the products containing carbon atoms are CO, CO(2), and C(3)H(6)O. Two catalyst life-tests were also carried out to characterize the deactivation effect of MIBK. The result shows that the deactivation effect may be due to the coke on the catalyst surface at 423 K. From the statistical analysis, the operating temperature is the most effective factor on the conversion of MIBK. The catalysts were also characterized by surface area analysis and elemental analysis before and after the test. The results show that the catalytic deactivation may be due to carbon coating. At low temperature (423 K), the phenomenon of carbon coating was more obvious than that at high temperature (573 K). The product distributions from the oxidation of MIBK over Pt/gamma-Al(2)O(3) were analyzed by GC. The results indicate that the C(3)H(6)O is formed from the beginning, presenting a peak at 423 K, 6.54 ppm. The CO concentration also peaked at the same temperature, 6.84 ppm.

Aluminum Oxide↗
PubMed1996

Regional variations in the utilization rate of vaginal and abdominal hysterectomies in the United Kingdom.

BACKGROUND: Large geographic variations in hysterectomy rates are well known; however, very little is known about geographic variations in the route of the procedure, i.e. whether it is performed abdominally or vaginally. We compared utilization rates for abdominal and vaginal hysterectomies for the 14 Regional Health Authorities of England, and Northern Ireland over a three-year period. METHODS: Data were collected in the form of hospital episode statistics and small area analysis techniques were used to document regional variations. RESULTS: Large regional differences in the utilization of vaginal hysterectomies were recorded. Three areas in particular (Northern Ireland, Yorkshire and NW Thames) displayed high vaginal to abdominal ratios. Northern Ireland recorded the highest ratio (0.366), Mersey Regional Health Authority the lowest (0.139). The use of the vaginal route was found to increase with age, and was the most common route for the > 65 years age group. CONCLUSION: Despite an increasing volume of evidence advocating the use of the vaginal route, there appears to be a resistance to its use, except in older women. The role of physician practice style, and in particular group clinical judgement, is highlighted as being significantly involved in explaining the observed geographic variations.

Adult↗
PubMed2005

Diagnostic and prognostic utility of an inexpensive rapid on site malaria diagnostic test (ParaHIT f) among ethnic tribal population in areas of high, low and no transmission in central India.

BACKGROUND: Malaria presents a diagnostic challenge in most tropical countries. Rapid detection of the malaria parasite and early treatment of infection still remain the most important goals of disease management. Therefore, performance characteristics of the new indigenous ParaHIT f test (Span diagnostic Ltd, Surat, India) was determined among ethnic tribal population in four districts of different transmission potential in central India to assess whether this rapid diagnostic test (RDT) could be widely applied as a diagnostic tool to control malaria. Beyond diagnosis, the logical utilization of RDTs is to monitor treatment outcome. METHODS: A finger prick blood sample was collected from each clinically suspected case of malaria to prepare blood smear and for testing with the RDT after taking informed consent. The blood smears were read by an experienced technician blinded to the RDT results and clinical status of the subjects. The figures for specificity, sensitivity, accuracy and predictive values were calculated using microscopy as gold standard. RESULTS: The prevalence of malaria infection estimated by RDT in parallel with microscopy provide evidence of the type of high, low or no transmission in the study area. Analysis revealed (pooled data of all four epidemiological settings) that overall sensitivity, specificity and accuracy of the RDT were >90% in areas of different endemicity. While, RDT is useful to confirm the diagnosis of new symptomatic cases of suspected P. falciparum infection, the persistence of parasite antigen leading to false positives even after clearance of asexual parasitaemia has limited its utility as a prognostic tool. CONCLUSION: The study showed that the ParaHIT f test was easy to use, reliable and cheap. Thus this RDT is an appropriate test for the use in the field by paramedical staff when laboratory facilities are not available and thus likely to contribute greatly to an effective control of malaria in resource poor countries.

Adult↗
PubMedDate not supplied

[Seasonality of birth in schizophrenia patients. Literature review].

Schizophrenia is a major public health problem. The paper presents a review of the literature about seasonality of birth in schizophrenia. Tramer (1929) reported the first study on seasonality of birth in mental disorders. Seasonality of the birth of people who develop schizophrenia refers to a 5-8% excess of births in winter months. However, the peak of research into this phenomenon started in the 1990's. Torrey et al. (1997) reviewed over 250 studies from 29 countries in the Northern Hemisphere and 5 publications by authors from the Southern Hemisphere, concerning the relationship between birth seasonality and the incidence of schizophrenia. The research findings from the Northern Hemisphere were consistent, indicating a 5-8% increase in the risk for mental disorders in individuals born between December and May. Meta-analysis of investigations from the Northern Hemisphere indicates that seasonality of birth increases with geographical width. Results of research from other geographical areas, analysis of stability of this phenomenon during decades and attempts of explanation of seasonality are presented.

Birth Rate↗
PubMed1993

Linking environmental and health care databases: assessing the health effects of environmental pollutants.

The assessment of pollutant effects on health status requires the mergence and analysis of two different databases: pollution measurements and health care information. This paper compares two subsets of these data: Ohio Environmental Protection Agency data on ambient air pollutants and Ohio Medicare data on respiratory diseases. Small area analysis was performed to assess statewide variations in hospital admission rates for respiratory diseases. The ambient air pollutant levels for each small area were compared to the variations in respiratory disease rates. Five groups of diseases correlated with pollutant levels. In addition, pollutant levels were significantly associated with medical complications. This study demonstrates the feasibility and benefit of linking environmental and health care databases and suggests the need for a more comprehensive, automated analysis of more pollutants and diseases.

Air Pollutants↗
PubMed1988

Effect of specimen size on work-of-fracture measurements.

It has been suggested that work-of-fracture, which quantifies the ability of a material to resist fracture, is dependent on specimen size. This experiment compared work-of-fracture, calculated as energy per unit area, for different specimen sizes of Plexiglas, bovine tibial bone and aluminum. Three different geometrically similar cross sections were tested for each material for a total of 54 specimens. Work-of-fracture was measured by loading a notched beam (triangular cross section) in three-point bending at a constant deformation rate. The energy necessary to cause fracture was measured from a load-deformation curve. Specimen fracture area was determined using macrophotography. Atomic absorption spectrophotometry was used to determine weight percent calcium of bone specimens and quantitative light microscopy was used to determine fractional void area. Analysis of variance showed no effect of specimen size on work-of-fracture for aluminum or Plexiglas specimens (p greater than 0.05). A significant difference was found, however, between the large (area = 11.7 +/- 1.9 mm2) and small (area = 3.48 +/- 0.68 mm2) bone specimens and between the medium (area = 5.89 +/- 0.69 mm2) and small (area = 3.48 +/- 0.68 mm2) bone specimens. No correlation was found between work-of-fracture and either calcium content (r2 = 0.128) or fractional void area (r2 = 0.0713). The mean work-of-fracture values found are as follows: aluminum, 59.8 +/- 13.7 kJ m-2; Plexiglas, 0.620 +/- 0.074 kJ m-2; bone (area 5.89 +/- 0.69 mm2-11.7 +/- 1.9 mm2), 9.72 +/- 1.93 kJ m-2 and bone (area 3.48 +/- 0.68 mm2), 5.48 +/- 1.79 kJ m-2.

Aluminum↗
PubMed2006

Immobilization of Keggin and Preyssler tungsten heteropolyacids on various functionalized silica.

The Keggin and Preyssler tungsten heteropolyacids, H3PW12O40 and H15P5W30O110, have been immobilized on the inner surface of mesoporous MCM-41, fume silica and silica-gel by means of chemical bonding to aminosilane groups. The materials were characterized by FT-IR spectroscopy, low-angle XRD and BET surface area analysis. The tendencies of heteropolyacids adsorption in solution on functionalized silicas have been investigated by UV-vis. Among the functionalized silica materials, MCM-41 showed the largest amine to silica and the least heteropolyacid to silica ratios. The BET surface area revealed that in all three cases the surface area decreased after grafting amine group and anchoring of the HPAs clusters. Low-angle XRD analysis showed that by introducing HPA into functionalized MCM-41 the intensity of the main reflection decreased significantly.

Journal Article↗
PubMed2006

Glaucoma detection with the Heidelberg retina tomograph 3.

PURPOSE: To compare the ability of the Heidelberg retina tomograph version 3 (HRT 3) and HRT version 2 (HRT 2) to discriminate between healthy and glaucomatous eyes. DESIGN: Retrospective cross-sectional study. PARTICIPANTS: Seventy-one eyes of 71 healthy volunteers and 50 eyes of 50 glaucoma patients were studied. The average visual field mean deviation of the glaucoma group was -6.03+/-5.78 dB. INTERVENTION: All participants had comprehensive ocular examinations, perimetry, and HRT scanning within 6 months. HRT 2 data were analyzed using HRT 3 software without modifying the disc margin. MAIN OUTCOME MEASURES: Discrimination capabilities between healthy and glaucomatous eyes were determined by areas under the receiver operating characteristics (AROCs) curves. Comparisons between corresponding AROCs obtained by HRT 2 and HRT 3 analyses were performed using the nonparametric DeLong method. Agreement between classifications as defined by the different analysis methods was quantified by kappa analysis. RESULTS: The individual stereometric parameters with the best discrimination were linear cup/disc ratio (AROC = 0.897; 95% confidence interval [CI], 0.836-0.958) for standard HRT 3 analysis and horizontal retinal nerve fiber layer curvature (0.905) for HRT 3 glaucoma probability score (GPS) analysis. Areas under the receiver operating characteristics for discrimination between glaucomatous and healthy eyes of the overall classification by HRT 2 Moorfields regression analysis (MRA), HRT 3 MRA, and GPS were 0.927 (95% CI, 0.877-0.977), 0.934 (0.888-0.980), and 0.880 (0.812-0.948), respectively. The difference between the 3 AROCs was not significant (P = 0.44). The agreement between HRT 2 and HRT 3 overall MRA classification was good (kappa = 0.70; CI, 0.59-0.80) with HRT 3 tending to report more abnormalities than HRT 2 analysis. The agreement between overall HRT 3 MRA and overall GPS was kappa = 0.58 (CI, 0.45-0.70). CONCLUSIONS: The glaucoma discriminating ability of the new HRT 3 software is similar to that of the previous generation HRT 2. The GPS analysis showed promising results in differentiating between healthy and glaucomatous eyes without the need for subjective operator input.

Adult↗