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Time changes of creatine kinase and creatine kinase-MB isoenzyme versus discrimination values in the diagnosis of acute myocardial infarction: what is the optimal method for displaying the data?

We wanted to determine the optimal method for displaying data for the clinical evaluation of patients with possible acute myocardial infarction. Our primary question was, are the time changes (slopes) of the enzyme tests better predictors of disease than the discrimination values, i.e., the cut-off points? We studied 152 patients with and 114 without a diagnosis of acute myocardial infarction in their medical records. For patients with acute myocardial infarction, we found the most discriminating tests, in decreasing order of the area of the ROC curves, to be the creatine kinase-MB slope at 0 to 12 hours, the creatine kinase-MB slope at 12 to 24 hours, the creatine kinase-MB values between 12 and 24 hours, and the creatine kinase-MB values between 0 and 12 hours. Decreasing values of creatine kinase-MB in the first tests after admission were only slightly less discriminating than increasing ones. At 12 to 24 hours after admission, the total creatine kinase as a value or slope, or the "relative index" (a ratio of the creatine kinase-MB in microgram/l [times 100] to the total creatine kinase) as a value or slope were inferior to creatine kinase-MB presentations. From the data for 44 patients with acute myocardial infarction and a known time of onset of symptoms, we were able to estimate an approximate onset time in patients where this was not available.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Enzyme Tests↗

Clinical assay of the human erythrocyte lactate transporter. II. Analysis and display of normal human data.

We have applied a lactate efflux assay to human red cells at two temperatures and with initial lactic acid loads up to 8 mM, metabolically generated. Efflux was about 1.5 times faster at external pH of 8.5 than at 7.5; the latter was the standard pH used thereafter. Multiple lactate loads in a single blood specimen demonstrated clear evidence of saturation kinetics at both pH levels, since the efflux rate did not increase proportionally with the lactate load. Best-fitting rectangular hyperboles were determined for 129-131 assays from 43 volunteers at 20 degrees and 30 degrees. In most cases high and low lactate loads permitted a two-point evaluation of saturation kinetics, and a positive indication was obtained in 88 of 89 tests. The apparent efflux Km and Vm values may be influenced by pH as well as by lactate levels and cannot be taken as rigorous, although they agree reasonably well with literature data on influx and exchange velocities. The data displayed a Hill constant of 1, a 30 degrees/20 degrees velocity ratio of 2.7, and no significant clustering by sex or age. A single assay with initial lactate level above 5 mM at 30 degrees should be sufficient to identify cases with a defective transporter, using the 95% tolerance limits developed in this report.

Carrier Proteins↗

A graphical object display improves anesthesiologists' performance on a simulated diagnostic task.

OBJECTIVE: This study tests the hypothesis that a graphical object display (a data display consisting of meaningful shapes) will affect the ability of anesthesiologists to perform a diagnostic task rapidly and correctly. The diagnostic tasks studied were recognition and differentiation of five etiologies of shock--anaphylaxis, bradycardia, myocardial ischemia, hypovolemia, pulmonary embolus. METHODS: Data sets consisting of HR, Systemic Arterial BP, Pulmonary Arterial BP, CVP, and Cardiac Output were generated for five shock states and five non-shock states. The resulting 10 data sets were presented on a computer monitor to study subjects twice (first in an alpha-numeric format and then in the object format) for a total of twenty decision screens. Subjects used soft-buttons on a computer touch-screen monitor to: a) advance to the next display; b) differentiate a non-shock state from a shock state; and, c) select the etiology of shock state represented by the display (Figure 2). Data collection was automatic, using the internal clock and memory of the computer. RESULTS: Eleven anesthesiologists participated in this study. They completed a total of 3060 diagnostic decisions, half with each display format. Performance measures were time to decision and diagnostic accuracy. The object display improved no-shock recognition by 1.0 second and shock etiology determination by 1.4 seconds (p < 0.05). The object display also significantly improved accuracy for shock recognition by 1.4% and etiology determination by 4.1% (p < 0.05). Testing was completed in a time interval of <45 min per 10 trials. CONCLUSIONS: The primary finding of this study was that anesthesiologists using the object display format committed significantly fewer diagnostic errors when interpreting physiologic data. In addition, both the recognition of no-shock and the diagnosis of shock etiology were completed more rapidly when the object display was used. The major limitation of this initial trial is the simplicity of the test. Future investigation of the impact of the display on clinical decision making will require more realistic clinical scenarios with partial or full simulation to better understand the potential clinical impact.

Anesthesiology↗

MAPMAN: a user-driven tool to display genomics data sets onto diagrams of metabolic pathways and other biological processes.

MAPMAN is a user-driven tool that displays large data sets onto diagrams of metabolic pathways or other processes. SCAVENGER modules assign the measured parameters to hierarchical categories (formed 'BINs', 'subBINs'). A first build of TRANSCRIPTSCAVENGER groups genes on the Arabidopsis Affymetrix 22K array into >200 hierarchical categories, providing a breakdown of central metabolism (for several pathways, down to the single enzyme level), and an overview of secondary metabolism and cellular processes. METABOLITESCAVENGER groups hundreds of metabolites into pathways or groups of structurally related compounds. An IMAGEANNOTATOR module uses these groupings to organise and display experimental data sets onto diagrams of the users' choice. A modular structure allows users to edit existing categories, add new categories and develop SCAVENGER modules for other sorts of data. MAPMAN is used to analyse two sets of 22K Affymetrix arrays that investigate the response of Arabidopsis rosettes to low sugar: one investigates the response to a 6-h extension of the night, and the other compares wild-type Columbia-0 (Col-0) and the starchless pgm mutant (plastid phosphoglucomutase) at the end of the night. There were qualitatively similar responses in both treatments. Many genes involved in photosynthesis, nutrient acquisition, amino acid, nucleotide, lipid and cell wall synthesis, cell wall modification, and RNA and protein synthesis were repressed. Many genes assigned to amino acid, nucleotide, lipid and cell wall breakdown were induced. Changed expression of genes for trehalose metabolism point to a role for trehalose-6-phosphate (Tre6P) as a starvation signal. Widespread changes in the expression of genes encoding receptor kinases, transcription factors, components of signalling pathways, proteins involved in post-translational modification and turnover, and proteins involved in the synthesis and sensing of cytokinins, abscisic acid (ABA) and ethylene revealing large-scale rewiring of the regulatory network is an early response to sugar depletion.

Abscisic Acid↗

Clearspeech: a display reader for the visually handicapped.

Many domestic appliances and much office equipment is controlled using a keypad and a small digital display. Programming such devices is problematical for the blind and visually handicapped. In this paper, we describe a device that may be used to read the displays on these devices. The device is designed to accept a description of the display being read, which specifies the types and locations of elements of the display. Images are captured using a handheld webcam. Images are processed to remove the distortions due to the camera orientation. The elements of the screen are interpreted and a suitable audio output is generated. In suitably illuminated scenes, the display data is interpreted correctly in approximately 90% of the cases investigated.

Communication Devices for People with Disabilities↗

Microcomputer-controlled laboratory system for field potential experiments.

A microcomputer-controlled laboratory system for hippocampal field potential experiments was constituted. This system realized the quasi-simultaneous processing of execution of stimulation, data acquisition, data display and data analysis by means of a microcomputer for the first time. To attain this quasi-simultaneous processing, a new algorithm for drawing a tangent on the wave-form of the potential was contrived, which enabled rapid analysis of an arbitrary population spike even in the case of generation of double spikes. The system has the following functions: (1) execution of the programmed stimulation paradigm, (2) analog/digital (A/D) conversion of the evoked field potential with a sampling interval of more than 50 microseconds per channel, (3) display of the A/D converted wave-form data on a CRT and storage of the data on a floppy disk, (4) on-line analysis of the population excitatory postsynaptic potential (EPSP) and population spike, (5) more detailed off-line analysis of the field potentials, and (6) output of the wave-form data and measured values through a printer and an X-Y plotter.

Action Potentials↗

Data-fusion display system with volume rendering of intraoperatively scanned CT images.

In this study we have designed and created a data-fusion display that has enabled volumetric MIP image navigation using intraoperative C-arm CT data in the operating room. The 3D volumetric data reflecting a patient's inner structure is directly displayed on the monitor through video images of the surgical field using a 3D optical tracking system, a ceiling-mounted articulating monitor, and a small size video camera mounted at the back of the monitor. The system performance was validated in an experiment carried out in the operating room.

Computer Graphics↗

Relationship between villous shape and mural structure in neutron irradiated small intestine.

Previous work on irradiation of mouse small intestine has assessed the changes produced by counting crypts/microcolonies, scoring villous shape or examining morphological changes in specific parts of the wall. This paper used scanning and transmission electron microscopy to study the effects of whole body irradiation with 5 Gy neutrons on the surface and internal features of the intestinal wall of CFLP mice, 1 day, 3 days and 7 days after treatment. Empirical scores from the ultrastructural findings were inserted into a Morphological Index display calculated from analytical data based on cell counts and area measurements obtained from resin histology sections. The final data display showed that the neutron irradiation produced marked structural changes in different cells and tissues by 1 day. These changes were maximal at 3 days with substantial improvement by 7 days. When this data display was compared with scores taken from scanning electron microscopy of the mucosal surface, the change in villous shape from erect fingerlike projections to lower profiles less suited to absorption was seen to correlate more with changes in the smooth muscle than with the epithelial cryptal compartment.

Animals↗