A multidimensional nomogram for the identification and treatment of acid-base derangements.
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Acid-Base Equilibrium↗
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[False irradiation method in magnetobiological experiments with Helmholtz's rings].
To carry on correct investigation of variable magnetic field influence on biological objects the method of complex usage of Helmholtz's rings is suggested. For this purpose the same Helmholtz's rings are suggested to be used to produce false radiation in the control experiments with opposite in phase current in the coils of the Rings. Calculations of the homogenuity of the magnetic field are made with nomograms drawn. With the aid of the nomograms one can choose parameters of the rings, which ensure any presettled degree of screening of initial operational magnetic field.
Electromagnetic Fields↗
Transcriptome Analysis and Experimental Validation of Palmitoylation- Related Biomarkers in Atherosclerosis.
INTRODUCTION: Protein palmitoylation contributes to membrane localisation, signal transduction, and cell-fate regulation. It is closely associated with lipid metabolic dysfunction, immune inflammation, and vascular remodelling in atherosclerosis (AS). However, key palmitoylation-related transcriptomic markers and their potential causal associations with AS remain incompletely defined. METHODS: The Gene Expression Omnibus (GEO) dataset GSE100927 was used as the training cohort, and GSE43292 was used as an external validation cohort. Differentially expressed genes were identified using limma and intersected with palmitoylation-related genes to obtain palmitoylation-related differentially expressed genes (PRDEGs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were then performed using clusterProfiler. Two-sample Mendelian randomisation was used to evaluate potential causal relationships between characteristic genes and AS. Feature selection was conducted using random forest and support vector machine recursive feature elimination (SVM-RFE), and the overlapping genes selected by both methods were retained. Receiver operating characteristic (ROC) curves were used to assess diagnostic performance. A five-gene nomogram was constructed, and its clinical utility was evaluated using calibration curves and decision curve analysis (DCA). Gene set variation analysis (GSVA) was applied to compare pathway activity between high- and low-expression groups for each core gene. Single-cell analysis using Seurat and expression-based cell-cell communication analysis using CellChat were conducted with GSE159677, and upstream transcription factors were predicted using NetworkAnalyst. For in vivo validation, an AS model was established in ApoE⁸/⁸ mice fed a high-fat diet, and aortic gene and protein expression were assessed by RT-qPCR and western blotting. RESULTS: In GSE100927, 51 PRDEGs were identified. GO and KEGG enrichment analyses highlighted pathways associated with regulation of monoatomic ion transport, sarcomere and myofibril organisation, and immune inflammation. Mendelian randomisation suggested a potential protective causal association between SLC7A7 and AS. By integrating MR with random forest and SVM-RFE feature selection, we prioritised five core genes: PLCB2, GMIP, NEXN, PLN, and SLC7A7. These genes showed good diagnostic performance in GSE43292. The resulting nomogram was well calibrated and demonstrated stable net benefit in decision curve and clinical impact curve analyses. Single-gene GSVA identified consistently activated pathways across multiple genes, including innate and adaptive immune recognition, calcium signalling and myocardial contraction/cardiomyopathy, extracellular matrix-receptor interaction, cell junction pathways, autophagy-lysosome pathways, and several metabolic programmes. At the single-cell level, PLCB2 and GMIP were predominantly expressed in T cells and macrophages, NEXN and PLN were enriched in vascular smooth muscle cells, and SLC7A7 was mainly expressed in macrophages. CellChat analysis indicated increased signals for immune-related ligand-receptor interactions. In ApoE⁸/⁸ mice fed a high-fat diet, PLCB2, GMIP, and SLC7A7 were upregulated, whereas NEXN and PLN were downregulated; protein-level changes were concordant with the transcriptomic trends. DISCUSSION: These findings indicate that palmitoylation-related dysregulation in AS converges on immune inflammation, calcium signalling/contractile programmes, ECM remodelling, and autophagy-linked metabolism. The five-gene panel is supported by external validation, single-cell localisation to immune and vascular compartments, and concordant results in ApoE⁸/⁸ mice. CONCLUSION: This study identified and validated five palmitoylation-related genes associated with AS. SLC7A7 showed a potential protective causal signal in MR analysis. The enriched pathway patterns linked these genes to immune inflammation, calcium signalling-contraction coupling, ECM remodelling, cell adhesion, and autophagy- associated metabolic reprogramming. The five-gene nomogram showed potential utility for diagnostic classification and decision support, nominating candidate biomarkers and pathway targets for AS molecular subtyping, diagnosis, and mechanistic investigation.
Atherosclerosis (AS)↗
Prediction of optimum oral theophylline dose in patients with obstructive airways disease.
The hypothesis that a logarithmic correlation exists between the plasma theophylline concentrations 6 h after a test dose C(6) and the maintenance dose calculated to achieve a desired drug concentration during chronic oral administration (DM,CALC) was tested. A nomogram based on this relationship was evaluated as a means of predicting the optimum dose of theophylline in 14 patients with obstructive airways disease (DM,PRED). Each patient was given 5 mg/kg theophylline intravenously (i.v.) and plasma theophylline concentrations were measured for 12 h thereafter including one exactly 6 h after commencing the i.v. infusion C(6). Pharmacokinetic parameters derived from the plasma concentration-time curve were used to establish DM,CALC for a concentration of 10 micrograms/ml. DM,PRED was obtained from the nomogram using both the optimum and the actual values for C(6). Subsequently oral sustained-release theophylline was administered and the dose adjusted to establish a trough concentration of approximately 10 micrograms/ml. This dose was then corrected arithmetically, assuming a linear relationship between dose and plasma level, to represent that required to achieve a plasma concentration of exactly 10 micrograms/ml (DM,ACT). The correlation between C(6) and log DM,CALC was confirmed (r = 0.97 P less than 0.001), validating the hypothesis. DM,ACT was found to correlate significantly with DM,PRED (r = 0.90, P less than 0.01) substantiating the value of the nomogram. In nine of the 14 patients, DM,ACT corresponded satisfactorily to DM,PRED. In the remaining five, for whom DM,ACT lay outside the 95% confidence limits for the predicted dose, DM,PRED in general underestimated DM,ACT, an advantage in a drug with a low therapeutic index. The predictive error for DM,PRED was lower than that for DM,CALC, and the bias using either method was not significant. The results suggest that a single plasma theophylline assay following a test dose, and the nomogram may be useful in simplifying optimal theophylline administration.
Adult↗
A graphic approach for prediction of arterial oxygen tension at different concentrations of inspired oxygen.
A rapid, simple method for predicting the arterial oxygen tension (PaO2) at any fractional concentration of inspired oxygen (FIO2) is presented. The method is based on a nomogram interrelating PaO2, arterial carbon dioxide tension (PaCO2) and FIO2, allowing rapid determination of the arterial to alveolar oxygen tension ratio a/A PO2. The applicability of the nomogram and its reliability for predicting the PaO2 at any FIO2 were studied prospectively in nine consecutive patients requiring mechanical ventilation (16 trials). On each occasion, a desired PaO2 was chosen and from the nomogram an FIO2 expected to yield this PaO2 was administered. The PaO2 was then measured. Actual PaO2 differed from desired PaO2 by a mean of 2.6 mm Hg (range 0 to 10 mm Hg, standard deviation (SD) 4.8). Retrospectively, we analyzed the nomogram's ability to predict the PaO2 +/- 9.6 mm Hg (2 SD) at varying FIO2. The overall sensitivity of this method was 85 percent (126 predictions out of 149 trials). We conclude that appropriate levels of supplemental oxygen can be rapidly and reliably chosen using the nomogram in selected patients.
Adult↗
[Volume kinetics--a new method to control intravenous fluid infusion].
The body's handling of fluid given by intravenous infusion can be analysed and simulated by means of volume kinetics, in which pharmacokinetic principles are applied to dilution-time profiles obtained during fluid therapy. In volume kinetics, the emphasis is on the distribution of fluid to body fluid spaces which accordingly become expanded. These spaces do not always correspond to known anatomical or physiological fluid compartments. The time course of the effect of volume fluid distribution to these spaces may be investigated by means of computer-assisted simulation, or a nomogram based on values for volume kinetic variables obtained from infusion experiments.
Computer Simulation↗
Clomipramine metabolism. Model-based analysis of variability factors from drug monitoring data.
A steady-state model is here developed as a framework for the analysis of blood concentrations of clomipramine, obtained during routine drug monitoring. A model is proposed to account for its major metabolic pathways, hydroxylation and demethylation, including first-pass effect. Impaired hydroxylation capacity is shown to lead to a dramatic increase in the concentration of demethyl-clomipramine, with a concomitant moderate increase in that of the parent drug. Deficient demethylation capacity is associated with a reduced ratio of demethyl metabolite to parent drug. A nomogram is provided to allow easy determination of hydroxylation and demethylation capacities from routinely measured blood concentrations. Data from 150 patients are analysed in order to identify interindividual variability factors. Average pseudo-clearances, calculated from trough blood concentrations at steady-state, are 17 L/h for hydroxylation, 23 L/h for demethylation and 40 L/h for elimination of hydroxylated metabolites. Maximum to minimum ratios are 8, 27 and 11, respectively. The metabolising capacity through either process significantly decreases with increasing age, clearance estimates being 40 to 50% lower for patients 75 years or older than for those 40 years or younger. Tobacco smoking and chronic alcohol consumption induce and reduce the demethylation clearance, respectively. Inhibition of hydroxylation in the presence of phenothiazine comedication is also shown. Finally, small but significant differences according to sex are observed. Potential implications of the proposed model-based approach include adaptation of the dosage regimen to individual characteristics at the very beginning of antidepressant therapy, and early detection of patients with impaired metabolising capacities.
Adult↗
Plasma dilution and the rate of infusion of Ringer's solution.
Changes in the volume of the fluid space expanded by i.v. infusion of Ringer's acetate solution have been analysed recently using mathematical models. Data obtained by such analyses allow simulation of the dilution of the plasma volume during infusion of the solution at different rates. To obtain basic kinetic data for such simulations, the plasma dilution-time curves were measured during and after i.v. infusion of Ringer's solution 25 ml kg-1 over 30 min in 15 healthy male volunteers (mean age 31 yr) and over 30, 45 and 80 min in six females (mean age 32 yr). Based on these experiments, nomograms were constructed from which the rate of infusion of Ringer's solution and the infusion time required to obtain a defined plasma dilution in both males and females can be estimated together with the infusion rate needed to maintain the dilution at the level reached.
Adult↗
Pulmonary hypertension in sickle cell disease.
BACKGROUND: Recurrent vaso-occlusive episodes lead to progressive end-organ damage in patients with sickle cell disease. We sought to determine the prevalence of pulmonary hypertension in adult patients with sickle cell disease and to identify factors associated with this life-threatening complication. METHODS: Sixty patients (> or =18 years of age; mean [+/- SD] age, 37 +/- 13 years) followed at a University Medical Center were evaluated. They were selected by a systematic sampling of patients presenting to the clinic for routine follow-up visits. All enrolled subjects underwent a clinical examination, Doppler echocardiography, pulmonary function tests, and hematologic tests during a single visit. Pulmonary hypertension was defined using an age- and body mass index-adjusted nomogram. RESULTS: The prevalence of pulmonary hypertension was 30% (18/60). Ten patients had mild pulmonary hypertension (up to 44 mm Hg), 5 had moderate pulmonary hypertension (45 to 74 mm Hg), and 2 had severe pulmonary hypertension (> or =75 mm Hg). In a logistic regression model, both lower fetal hemoglobin level and lower systolic blood pressure were associated with the presence of pulmonary hypertension. CONCLUSION: We found that the prevalence of pulmonary hypertension in adult patients with sickle cell disease was substantial, particularly in those with lower levels of fetal hemoglobin and lower systolic blood pressure.
Adult↗
[Test object for controlling the quality of orthopantomography].
Great emphasis is placed on a FO-01 orthopantomographic phantom test for checking the position of the projection boundary of an isolated layer, its shape and thickness. The basic specific feature of the phantom test is that one can rather simply check the adjustment of orthopantomographs of different kinds (including digital ones) and make their comparative assessment by the projection of an isolated layer with certain resolution. Examples of projection nomograms of an isolated layer for different orthopantomographs, which are obtained by this test object are given.
Humans↗
Refractive outcome following radial keratotomy and combined radial and astigmatic keratotomy.
PURPOSE: To determine whether the visual and refractive outcomes of combined astigmatic and radial keratotomy (AK/RK) procedures was different from that following RK for the correction of naturally occurring compound myopic astigmatism and spherical myopia. SETTING: Private professional practice, San Diego, California, USA. METHODS: The computer database of all incisional procedures performed by one surgeon over 10 years was reviewed to compare the visual acuity outcome of AK/RK and RK procedures. Enhancement procedures were excluded. Only data from the last office visits were analyzed to establish the relationship between visual acuity and type of keratotomy procedure performed. A multiple regression model was constructed, which included covariates of age, postoperative keratometric cylinder, and postoperative refraction. RESULTS: After controlling for covariates, the AK/RK population had significantly lower postoperative uncorrected visual acuity levels than the RK population (P < .03) after one operation (prior to enhancement surgery). CONCLUSIONS: Using the nomograms for myopia correction for unenhanced RK cases, combined AK and RK procedures appeared to reduce the expected visual results. Surgeons may consider modifying surgical nomograms to account for the expected spherical undercorrection that can occur when myopia and astigmatism are corrected simultaneously.
Adult↗
Use of a simple symptom questionnaire to predict Barrett's esophagus in patients with symptoms of gastroesophageal reflux.
OBJECTIVE: Accurately predicting Barrett's esophagus (BE) in patients with gastroesophageal reflux disease (GERD) is difficult. Using logistic regression analysis of symptom questionnaire scores we created a model to predict the presence of BE. METHODS: We conducted a logistic regression analysis of symptom data collected prospectively on 517 GERD patients and created a prediction model based on patient gender, age, ethnicity, and symptom severity. RESULTS: There were 337 (65%) males and 180 (35%) females, of whom 99 (19%) had Barrett's esophagus (BE). Multiple logistic regression analysis was performed to determine the predictive ability of gender, age, and ethnicity along with symptoms of heartburn, nocturnal pain, odynophagia, presence of belching, dysphagia, relief of symptoms with food, and nausea. The only significant predictors (at the 0.05 level) were male gender, heartburn, nocturnal pain, and odynophagia (all with positive effects on the presence of BE) and dysphagia (which had a negative effect). A nomogram was produced to show the effect of a given predictor on the probability of having BE in the context of the effects of the other predictors, and to estimate the probability of having BE for a given individual. The mean score (+/-SD) for the BE patients in our sample was 397.4+/-46.2 with a range of 292-530. For the patients without BE, the mean score (+/-SD) was 351.3+/-60.3 with a range of 190 - 528 (p < 0.001). If screening for BE is performed at a score of 375 or more, our model would have a specificity of 63% with a sensitivity of 77% (95% CI 61-86% given the 63% specificity). CONCLUSIONS: By asking seven questions about symptom severity, clinicians may be able to assign a probability to the presence of BE, and thus, determine the need for endoscopy in GERD patients.
Adolescent↗
Nomograms for drug use in renal disease.
The medical literature is replete with dosing guidelines for patients with renal dysfunction. Altering dosing regimens in such patients is particularly important with drugs with a narrow therapeutic index, such as digoxin and the aminoglycoside antibiotics. A variety of methods have been used to devise dosing nomograms. This article reviews the salient features of different methods, and addresses the issues of predictability or unpredictability in attaining desired plasma concentrations of drug. It is suggested that therapy must be individualised, and that the clinician can best plan his therapy by understanding the principles on which dose adjustment is based, rather than using the same nomogram or guideline for each and every patient.
Adult↗
The detection of linkage disequilibrium between closely linked markers: RFLPs at the AI-CIII apolipoprotein genes.
Study of very closely linked DNA variants at various loci has frequently shown linkage disequilibrium. We studied three closely linked RFLPs at the apolipoprotein AI-CIII locus. Two variants detected by MspI and SstI were in strong linkage disequilibrium; but when conventional statistical tests were used, a third variant (PstI), located between the MspI and SstI markers, appeared to be in linkage equilibrium with these two "outside" markers. Similar discrepancies from the expected monotone relationship between physical distance and linkage disequilibrium have been reported by others. To investigate these discrepancies, the power to detect linkage disequilibrium was calculated. It could be shown that, for the gene frequencies encountered, very large sample sizes would be required to demonstrate negative (i.e., repulsion-phase) linkage disequilibrium. Such numbers are usually very difficult to attain in human studies. Failure to demonstrate linkage disequilibrium by conventional methods therefore does not imply its absence. Appropriate nomograms and tables are provided.
Apolipoprotein A-I↗
Nomograms for simplified demographic calculations.
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Adolescent↗
[Evaluation of the effects of a complex of physical factors on the functional state of men doing mental work].
The article evaluates influence of environmental, physical factors (noise, vibration, ambient temperature, illumination) on human functional state. The study involved 3 males performing mental tasks (following the object movements on monitor and correcting the track after variable interferences appearing in uneven time intervals) in specific microclimate chamber. The study revealed physiologic parameters more substantial for human functional state if influenced by environmental physical factors. For each parameter of human functional state and environmental physical factor a significance share was determined. If significant (r = 0.82, p < 0.001), correlations between parameters of human functional state and environmental physical factors became a material for integral equations. Method of cluster analyses defined 3 classes of human functional state and environmental status. Evaluation and regulation of those integral parameters became possible through a probability nomogram obtained.
Adult↗
Stratification of outcome for surgically treated unruptured intracranial aneurysms.
OBJECT: The combination of low anticipated rupture rates for many unruptured aneurysms, better delineation of treatment risks, and the availability of alternative modalities of treatment have led to heightened scrutiny of the surgical management of unruptured intracranial aneurysms. Most reports to date have provided aggregate data concerning surgical treatment risks. This study was performed to better delineate risk estimates for the surgical treatment of patients with unruptured intracranial aneurysms according to a patient's risk profile with regard to age, aneurysm location, and aneurysm size. METHODS: We studied 493 patients who were treated with surgical clipping of 604 unruptured saccular aneurysms. Information regarding aneurysm size, location, patient age, and 6-month or greater outcome were gathered prospectively from 1992 to 1999. Multivariate analysis was performed to identify independent risk factors for outcome. On the basis of the model, risk stratification curves were generated. RESULTS: In our series, the mean patient age was 53 years, and the mean lesion size was 8.8 mm. Lesion locations included the internal carotid artery (n = 259, 43%), the middle cerebral artery (n = 174, 28%), the anterior cerebral artery (n = 99, 17%), and the vertebrobasilar artery (n = 67, 11%). Multivariate analysis revealed that aneurysm size (beta = 0.122, P < 0.001), patient age (beta = 0.0308, P < 0.05), and vertebrobasilar location (beta = 1.37, P = 0.0080) were independently associated with high risk of poor outcome or death. CONCLUSION: Small aneurysms in the anterior circulation in young patients carry a very low treatment risk (approximately 1%), and treatment in elderly individuals (ages 70 years and older) with large lesions (greater than 10 mm), carries a significant risk of poor outcome (5% in the anterior circulation, 15% in the posterior circulation). The nomograms generated by this study should be particularly useful in discussing with patients the risks and benefits of surgical treatment of unruptured aneurysms.
Adult↗
[Determination of the time of death by measurement of central brain temperature].
The central brain temperature was recorded in 53 human corpses, stored at constant ambient temperatures between 10 degrees and 30 degrees C. The measurements were started on average 1.6 h post mortem and continued for 8-50 h. The sigmoidal shape of the temperature curves fitted the mathematical model of Marshall and Hoare (1962). This model provides a precise description of the temperature curves. For 44 corpses, studied at temperatures between 10 degrees and 25 degrees C, the time of death was calculated using fixed values for the adaptation parameters of the model. The margins of error for the 95% tolerance limit were +/- 1.5 h up to 6.5 h post mortem, +/- 2.5 h between 6.5 and 10.5 h post mortem and +/- 3.5 h between 10.5 and 13.5 h post mortem. For the recommended practical application a "brain temperature--time of death" nomogram is presented. We found that the rate of cooling was influenced by the amount of hair. Furthermore, it has been argued that the study method could be improved further. In consequence, we expect the central brain temperature to be even more accurate in the calculation of the time of death than has been discussed and shown on the basis of the present material.
Adult↗