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PubMed1998

Recovery of respiratory functional defects after war injuries to the chest.

AIM: Assessment of lung function before, during, and after surgical treatment of war injuries to the chest, and comparison of conservative and operative surgical approach. PATIENTS AND METHODS: A retrospective study of 439 patients with war injuries to the chest inflicted during the wars in Croatia and Bosnia and Herzegovina was performed. Patients were classified by injury mechanism and by physiologic scoring on admission, according to the cardiovascular-respiratory elements of the Injury Severity Score (ISS). "Conservative" surgical treatment with chest tube drainage, appropriate fluid therapy, and antimicrobial and atelectasis prophylaxis was performed in 358 (81.5%) and operations in 81 (18. 5%) patients. Blood gases were analyzed before, during, and after surgical treatments. Pulmonary function was assessed after the stabilization of patients' clinical condition and 3-6 months after the injury. RESULTS: On admission, blood gas profiles showed slight to moderate hypoxemia with consecutive hypercapnia related to the severity of injuries. Surgical treatment left a minimum degree restrictive disorder of ventilation without an obstructive pattern. Definitive repair of lung function presented with normalization of blood gas data, and significantly improved restrictive pattern (p<0.05). There was no difference in definitive lung function between conservatively and operatively treated patients. Mortality was 2%. CONCLUSION: The success of surgical resuscitation was related to ISS scoring. Recovery of respiratory function defects after the injury was not significantly related to the mechanism of injury or the patient's condition at arrival. The recovery of lung function was similar in conservatively and operatively treated patients.

Adult↗
PubMed2005

The prediction of stress by values and value conflict.

The authors investigated the relationships among stress, values, and value conflict. Data collected from 400 people working in a variety of companies in Flanders indicated that the values of openness to change, conservation, self-transcendence, and self-enhancement were important predictors of stress. Participants open to change reported less stress, whereas participants who had high scores on conservation, self-enhancement, and self-transcendence perceived more stress. People who reported high value conflict also experienced more stress. Separate analyses for men and women showed that there were gender differences in the relationships observed between the 4 value types and stress. These data have noteworthy theoretical and practical implications.

Adult↗
PubMed2000

[Clinical classification of diabetic foot as a guideline for selection of treatment].

Foot ulceration in patients with diabetes mellitus is always a serious risk factor for lower limb amputation. To amputate or to continue conservative treatment is usually a very difficult decision and not without mistakes. The main objective of the study was assessment of the diabetic wound depth as a clinical guideline for decision-making of conservative or aggressive surgical treatment. Local foot ulceration and results of management of 62 diabetics were analysed. Lower leg amputations were performed in 40% of the patients. The foot wound was evaluated according to University of San Antonio or Wagner's scoring system. Conservative treatment resulted in failure in 19% of patients of grade I, 54% of grade II, 60% of grade III and 87% of grade IV according to Wagner's. Using the San Antonio classification there were 20% of amputations in grade I, 58% in grade II and 65% in grade III. Taking into account infection and peripheral vascular disease there were 37% of amputations in stage B, 41% in stage C and 80% in stage D. Data analysis of the study suggests better clinical usefulness of the San Antonio classification system in prognosis of limb salvage. There is high probability of failure in conservative treatment of diabetic foot lesion of grade II and III and in stage D according to University of San Antonio scoring system.

Adult↗
PubMed1988

Physicians' values and experience during adolescence. Their effect on adolescent health care.

The values and experience of physicians as adolescents can effect their care of adolescent patients. Eighty residents were studied using extensive personal data gathered from a structured interview, a questionnaire of perceived clinical skills, and a videotape with a simulated patient. A "values" and "risk-taking during adolescence" score was constructed and related to the resident's perceived skills for and attitudes about adolescent health care. Residents with higher values scores (more conservative) were more likely to be pediatric than internal medicine residents and less likely to prescribe birth control pills to an adolescent. Residents with higher risk-taking scores considered themselves more skilled in dealing with substance abuse and sexually transmitted diseases and in recognizing psychologic problems. Values or risk-taking scores were not related to the resident's perceived skill in areas such as evaluating hypertension or performing Tanner staging. These data suggest that certain values and experiences may be influential in the physician's ability and approach to dealing with certain issues related to adolescent health care.

Adolescent↗
PubMed2001

Conserved key amino acid positions (CKAAPs) derived from the analysis of common substructures in proteins.

An all-against-all protein structure comparison using the Combinatorial Extension (CE) algorithm applied to a representative set of PDB structures revealed a gallery of common substructures in proteins (http://cl.sdsc.edu/ce.html). These substructures represent commonly identified folds, domains, or components thereof. Most of the subsequences forming these similar substructures have no significant sequence similarity. We present a method to identify conserved amino acid positions and residue-dependent property clusters within these subsequences starting with structure alignments. Each of the subsequences is aligned to its homologues in SWALL, a nonredundant protein sequence database. The most similar sequences are purged into a common frequency matrix, and weighted homologues of each one of the subsequences are used in scoring for conserved key amino acid positions (CKAAPs). We have set the top 20% of the high-scoring positions in each substructure to be CKAAPs. It is hypothesized that CKAAPs may be responsible for the common folding patterns in either a local or global view of the protein-folding pathway. Where a significant number of structures exist, CKAAPs have also been identified in structure alignments of complete polypeptide chains from the same protein family or superfamily. Evidence to support the presence of CKAAPs comes from other computational approaches and experimental studies of mutation and protein-folding experiments, notably the Paracelsus challenge. Finally, the structural environment of CKAAPs versus non-CKAAPs is examined for solvent accessibility, hydrogen bonding, and secondary structure. The identification of CKAAPs has important implications for protein engineering, fold recognition, modeling, and structure prediction studies and is dependent on the availability of structures and an accurate structure alignment methodology. Proteins 2001;42:148-163.

Algorithms↗
PubMed1990

Postabortion dysphoria and religion.

This study explores psychosocial factors, especially religion, in women identified as dysphoric 1 to 15 years after abortion. The Millon Clinical Multiaxial Inventory (MCMI) and a demographic questionnaire were mailed to patient-led support groups for women who had poorly assimilated a previous abortion experience. Of the 150 surveys mailed, 71 (47%) were returned. Thirty-three women (46%) stated they had changed to a Fundamentalist or Evangelical church. On the MCMI, members of these conservative denominations scored significantly lower on the subscales for passive-aggressive behavior, ethanol abuse, and avoidance. Religion was strongly perceived by the women as playing a healing role. These findings suggest that conservative personal values may be more critical in understanding attitudes toward abortion than other demographic characteristics. Previous follow-up studies that reported no change in postabortion religiosity may have been too short to detect changes in religion. Implications for treatment of postabortion dysphoria include sensitivity to patients' religious beliefs, with support for the healing aspects of their religion.

Abortion, Induced↗
PubMed2003

[Complex fractures of the humeral head: which long-term results can be expected?].

BACKGROUND: Although improved techniques of internal fixation and prosthetic replacement were introduced successfully in the field of operative fracture care, treatment of complex fractures of the proximal humerus also involving the humeral head remains to be a challenge to the trauma surgeon. We therefore investigated clinical and radiological long-term results after humeral head preserving procedures. METHODS: 41 patients with a three or four part fracture of the humeral head were evaluated on average 6.6 years (min. 4.4 y; max. 9.0 y) after the trauma. The evaluation was based on the Constant- and HSS score clinically and on the Neer score radiologically. Nine patients were treated conservatively (group A), 13 patients had primarily an operative treatment (group B) and another 19 were operated upon after failure of conservative means. 24 of the patients were female and 17 male, with an average age of 52 years (min. 14.4 y; max. 71.2 y). According to Neers 's fracture classification of humeral head fractures we saw 14 type IV, 25 times a combination of type IV and V and in another 2 cases a type VI fracture. RESULTS: In group A (conservative) the Constant score showed on average 82.0 points for the injured and 95.3 points for the contralateral shoulder, the HSS score revealed 73.6 points and Neer's x-ray score 5.6 points. Group B (operated) showed also good results on average according to a Constant score of 72.1 points (fractured humerus) compared with 98.1 points of the contralateral shoulder. HSS score was 64.7 points. The radiological results reached 4.0 points. Group C (conservatively failed, secondary operation) achieved 68.2 points for the injured side and 95.8 points for the contralateral side according to Constant and 59.5 points according to HSS score. The x-ray evaluation showed 5.3 points. Fracture type did not influence the outcome in any of the groups. There was no humeral head necrosis in group A, one in group B (2.4 %) and four in group C (9.8 %). CONCLUSION: These data show that regarding to clinical and radiological long-term results also complex fractures of the humeral head should be treated by head preserving procedures.

Adolescent↗
PubMed1995

The cognitive development of pre-school children treated for chronic renal failure.

Chronic renal failure in young children is associated with impaired cognitive development, but recent studies present a more optimistic perspective. An important question is whether the earlier initiation of renal replacement therapy (RRT) might prevent the reported developmental retardation. The cognitive development of 31 patients (age < 5 years with a serum creatinine clearance of < 20% of normal) undergoing different treatment modalities was monitored by repeated measurements during a prospective 3-year study. Fifteen patients received conservative treatment and 16 patients were on dialysis treatment at the start of the project. We were able to evaluate the effect of the onset of RRT on 12 patients who were transferred from conservative treatment to dialysis. At the beginning of the study, the cognitive development of the total group was significantly delayed (mean developmental index = 78.5, SD = 19.5) compared with a normal population. Patients undergoing conservative treatment scored significantly higher (P < 0.01) than those on dialysis. The effect of starting dialysis treatment appeared to be positive, but only a significant short-term improvement was observed. Follow-up evaluation of 7 patients on conservative treatment and of 9 dialysis patients over a 2-year period did not show any significant change in a positive or negative direction. The present study revealed that pre-school dialysis patients are at risk with respect to their cognitive development. This is particularly true for the group with concomitant disorders. Less severe disease in the group on conservative treatment may be assumed to be a positive contributing factor to the more normal performance of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomarkers↗
PubMed2005

[Acute coronary syndromes in Italy: observations from the BLITZ-2 study].

The hospital admission of patients with acute coronary syndromes without ST-segment elevation is increasing in the real world. The aim of the BLITZ-2 study, carried out in May 2003, was to investigate the epidemiology and management of patients admitted with a diagnosis of non-ST-elevation myocardial infarction. The study enrolled 1888 patients with a mean age of 68 years. Among the involved hospitals a cath-lab was available in 67.7% in northern Italy vs 37 and 39.8% in central and southern Italy, respectively. Only 44 and 55% of patients underwent coronary angiography during the first hospital admission in central and southern Italy, respectively, against 68% of patients in northern Italy. The type of strategy was more influenced by the availability of a cath-lab than by the TIMI risk score. A conservative strategy was applied in 45% of patients (26% in hospitals with a cath-lab) whereas an invasive approach was used in 55% of patients (74% in hospitals with a cath-lab). There was no difference in the TIMI risk score between the groups. Age was predictor of coronary angiography: 71% in patients < 55 years, 63% in patients 55-74 years, and 44% in patients > or = 75 years. The in-hospital mortality was 1.2% (1% in northern Italy, 1.4% in central Italy, 1.4% in southern Italy) and was higher in high-risk patients (1.5% with TIMI risk score > 5) and in older patients (3% in those > or = 75 years). The 1-month mortality and reinfarction was 2.4 and 3.6%, respectively. The total in-hospital stay was 8.8 days (coronary care unit stay 3.9 days). The contemporary management of Italian patients with acute coronary syndrome turned out to be influenced by resource availability, and elderly patients and subjects at higher risk are undertreated.

Acute Disease↗
PubMed1990

Determining neuropsychological cut scores for older, healthy adults.

Three age groups (20-31, 37-49, and 55-67 years) of healthy men and women were compared on tests from the Halstead-Reitan neuropsychological test battery. Age-cohort differences in performance were observed for every measure (except Finger Tapping) and for overall indices of cognitive functioning, the Average Impairment Rating (AIR) and the Halstead-Reitan Impairment Index (HR II). When traditional cut scores (developed with age-heterogeneous samples) were used, alarmingly high percentages of subjects in the oldest group were defined as brain damaged. These findings were not attributable to higher levels of psychometrically-assessed anxiety and depression in the older groups or for the impaired subjects. Slightly more conservative criteria (fewer diagnoses of brain impairment) were then employed. The first, AIR greater than or equal to 2.00, resulted in a low and more reasonable base rate of brain impairment for the oldest group. The second, AIR greater than 2.00, resulted in age-parity in incidence of brain impairment. The heuristic value of more conservative AIR scores was discussed as were possible uses in applied clinical research settings. The limitations of this approach were noted with regard to its exclusive focus on the problem of false positive diagnoses. It was emphasized that, from a neuropsychological diagnostic perspective, cut scores based on healthy aging samples must ultimately be tested in the context of traditional neuropsychological studies in which external validation with neurosurgical and neurological criteria is employed.

Adult↗
PubMed2003

Predicting reliable regions in protein alignments from sequence profiles.

For applications such as comparative modelling one major issue is the reliability of sequence alignments. Reliable regions in alignments can be predicted using sub-optimal alignments of the same pair of sequences. Here we show that reliable regions in alignments can also be predicted from multiple sequence profile information alone. Alignments were created for a set of remotely related pairs of proteins using five different test methods. Structural alignments were used to assess the quality of the alignments and the aligned positions were scored using information from the observed frequencies of amino acid residues in sequence profiles pre-generated for each template structure. High-scoring regions of these profile-derived alignment scores were a good predictor of reliably aligned regions. These profile-derived alignment scores are easy to obtain and are applicable to any alignment method. They can be used to detect those regions of alignments that are reliably aligned and to help predict the quality of an alignment. For those residues within secondary structure elements, the regions predicted as reliably aligned agreed with the structural alignments for between 92% and 97.4% of the residues. In loop regions just under 92% of the residues predicted to be reliable agreed with the structural alignments. The percentage of residues predicted as reliable ranged from 32.1% for helix residues to 52.8% for strand residues. This information could also be used to help predict conserved binding sites from sequence alignments. Residues in the template that were identified as binding sites, that aligned to an identical amino acid residue and where the sequence alignment agreed with the structural alignment were in highly conserved, high scoring regions over 80% of the time. This suggests that many binding sites that are present in both target and template sequences are in sequence-conserved regions and that there is the possibility of translating reliability to binding site prediction.

Algorithms↗
PubMed2005

A word-oriented approach to alignment validation.

MOTIVATION: Multiple sequence alignment at the level of whole proteomes requires a high degree of automation, precluding the use of traditional validation methods such as manual curation. Since evolutionary models are too general to describe the history of each residue in a protein family, there is no single algorithm/model combination that can yield a biologically or evolutionarily optimal alignment. We propose a 'shotgun' strategy where many different algorithms are used to align the same family, and the best of these alignments is then chosen with a reliable objective function. We present WOOF, a novel 'word-oriented' objective function that relies on the identification and scoring of conserved amino acid patterns (words) between pairs of sequences. RESULTS: Tests on a subset of reference protein alignments from BAliBASE showed that WOOF tended to rank the (manually curated) reference alignment highest among 1060 alternative (automatically generated) alignments for a majority of protein families. Among the automated alignments, there was a strong positive relationship between the WOOF score and similarity to the reference alignment. The speed of WOOF and its independence from explicit considerations of three-dimensional structure make it an excellent tool for analyzing large numbers of protein families. AVAILABILITY: On request from the authors.

Algorithms↗
PubMed1998

Prevalence estimates of cognitive impairment in medical model adult day health care programs.

Despite an increasing emphasis on adult day health care (ADHC) programs as alternatives to institutional care for persons with dementia, little research based on direct assessment of clients' cognitive status has been conducted in such settings. The goal of this analysis was to estimate the prevalence of cognitive impairment among ADHC clients using commonly used screening measures. Age-adjusted and non-age-adjusted prevalence estimates of cognitive impairment in New York State ADHC programs were developed using a probability sample of 336 clients. Estimates were made using traditional cutting scores on standard cognitive screening measures, such as the Mini-Mental State Examination (MMSE), as well as latent class analyses applied to the same item sets. Average prevalence estimates of cognitive impairment were 55% across age cohorts and 60% for persons aged 65 and over. The MMSE yielded a prevalence estimate of 58% across age cohorts and 63% for those aged 65 and over. Using a more conservative cut score, the estimate for the MMSE was 33%; latent class estimates of moderate to severe impairment indicate that approximately 30% of the ADHC clients had cognitive impairment suggestive of probable or definite dementia. Community alternatives to institutional care for the elderly are increasing in popularity. These findings suggest that 1. While institutions are serving the most severely cognitively impaired, age-adjusted prevalence ratios for the ADHC sample approach the bounds of the institutional estimates. 2. The institutional setting will continue to be an important mode of care for the more severely impaired individuals. 3. Daycare is serving a high proportion of the mildly and moderately cognitively impaired individuals. It follows, therefore, that such programs need to address the needs of these individuals by developing specialized care plans and tracks targeted for the cognitively impaired.

Adult↗
PubMed2026

A reinforcement learning-enhanced fuzzy multi-objective equilibrium optimization framework for multiple sequence alignment.

Multiple sequence alignment (MSA) is a fundamental task in bioinformatics, underpinning comparative genomics, structural analysis, and evolutionary inference. However, MSA remains a challenging multi-objective optimization problem due to the need to simultaneously maximize alignment accuracy, preserve conserved regions, and control gap proliferation, particularly in large and heterogeneous sequence collections. In this work, we propose MOFSACEO-MSA, a novel hybrid optimization framework for multiple sequence alignment that integrates a fuzzy multi-objective evaluation scheme with the Equilibrium Optimizer (EO) and a Soft Actor-Critic (SAC)-based adaptive control mechanism. The proposed framework formulates MSA as a dynamic multi-objective optimization problem, in which alignment quality is assessed using complementary residue-level and column-level criteria, including Sum-of-Pairs score, column conservation, entropy, and gap statistics. Fuzzy membership functions are employed to harmonize competing objectives into a unified optimization landscape, while EO provides robust global exploration. To further enhance adaptability, SAC dynamically regulates key EO parameters during the search process, enabling an effective balance between exploration and exploitation across datasets of varying size and heterogeneity. Extensive experiments werew conducted on diverse biological sequence datasets, with a primary focus on RNA benchmarks, including structured families from Rfam, large-scale repositories from RNAcentral and GenBank, and organism-specific tRNA datasets from GtRNAdb. Comparative evaluations against classical alignment tools (ClustalW, MAFFT, MUSCLE, PRANK, KAlign, and T-Coffee), metaheuristic methods (SAGA, Sequoya and EAFSA), and a reinforcement learning-based approach (RLALIGN) demonstrate that MOFSACEO-MSA consistently achieves competitive or superior Sum-of-Pairs scores while significantly reducing gap proportions and maintaining compact alignment lengths. Notably, the proposed framework exhibits improved robustness on large and highly heterogeneous datasets, where existing methods often suffer from excessive gap insertion or unstable convergence. Overall, MOFSACEO-MSA provides a flexible and extensible optimization paradigm that effectively bridges evolutionary search and reinforcement learning for high-quality multiple sequence alignment, with demonstrated effectiveness on challenging RNA alignment tasks.

Sequence Alignment↗
PubMed2004

Cochlear implants for children with significant residual hearing.

BACKGROUND: Previous research suggests that children with pure-tone averages of greater than 90 dB hearing level and/or open-set sentence perception of less than 30% may derive significant benefit from cochlear implantation. OBJECTIVE: To evaluate postoperative speech perception benefit and bilateral-bimodal benefit for 16 children whose preimplant speech perception scores exceeded conservative candidacy guidelines. STUDY DESIGN: Preimplant and postimplant repeated-measure design. METHODS: Sixteen child subjects who obtained 30% or greater on preimplant open-set sentence material, presented live voice audition alone, were selected for this study. Preimplant pure-tone averages ranged from 73 to 110 dB in the better aided ear. Preimplant and postimplant open-set word and sentence testing was completed in quiet and with competing background noise for separate ear and binaural conditions. RESULTS: Fourteen of 16 subjects had improved speech perception scores across all test materials after implantation. Group means were significantly higher for all test materials. Results in the bimodal-bilateral condition were significantly higher than implant alone for open-set word tests (scored for phonemes) and open-set sentences in quiet. CONCLUSION: The results of this study suggest that, with appropriate counseling and management, some children with significant residual hearing benefit from cochlear implantation, in particular improved speech understanding due to bimodal-bilateral hearing.

Adolescent↗
PubMed1993

[Renal trauma].

An analysis is presented of 70 patients treated for renal trauma in the I Department of Urology in Katowice in the years 1974-1989. Renal damage was evaluated according to a three-grade scoring system. Conservative treatment was given to 43 patients (61.4%), including 14 patients with I degree trauma, 12 with II degrees, and 17 with III degrees trauma. Nephrectomy was performed in 17 cases, and 10 sparing operations were carried out--one combined with splenectomy.

Adolescent↗
PubMed2005

The ConSurf-HSSP database: the mapping of evolutionary conservation among homologs onto PDB structures.

The HSSP (Homology-Derived Secondary Structure of Proteins) database provides multiple sequence alignments (MSAs) for proteins of known three-dimensional (3D) structure in the Protein Data Bank (PDB). The database also contains an estimate of the degree of evolutionary conservation at each amino acid position. This estimate, which is based on the relative entropy, correlates with the functional importance of the position; evolutionarily conserved positions (i.e., positions with limited variability and low entropy) are occasionally important to maintain the 3D structure and biological function(s) of the protein. We recently developed the Rate4Site algorithm for scoring amino acid conservation based on their calculated evolutionary rate. This algorithm takes into account the phylogenetic relationships between the homologs and the stochastic nature of the evolutionary process. Here we present the ConSurf-HSSP database of Rate4Site estimates of the evolutionary rates of the amino acid positions, calculated using HSSP's MSAs. The database provides precalculated evolutionary rates for nearly all of the PDB. These rates are projected, using a color code, onto the protein structure, and can be viewed online using the ConSurf server interface. To exemplify the database, we analyzed in detail the conservation pattern obtained for pyruvate kinase and compared the results with those observed using the relative entropy scores of the HSSP database. It is reassuring to know that the main functional region of the enzyme is detectable using both conservation scores. Interestingly, the ConSurf-HSSP calculations mapped additional functionally important regions, which are moderately conserved and were overlooked by the original HSSP estimate. The ConSurf-HSSP database is available online (http://consurf-hssp.tau.ac.il).

Algorithms↗
PubMed1987

[A study on the diagnosis and treatment of the infertile patient with endometriosis externa by scoring].

Though the conservative treatment of infertility associated with endometriosis has undergone a significant evolution, clinical diagnostic problems still remain. In order to evaluate the efficacy and diagnostic value of the non-surgical scoring method, personal histories, symptoms, signs, hysterosalpingographic findings and routine infertility test results for 63 patients with endometriosis diagnosed laparoscopically were compared with those of 63 controls. 8 findings specific to endometriosis and the scores were as follows: Dysmenorrhea (1), dyspareunia (3), retroverted uterus (3), cul-de-sac nodularities (3), atonic (1) and marginal irregularity (1) of uterus, and perifimbrial adhesion (2) in hysterosalpingography, and unexplained infertility (2). The results obtained retrospectively revealed that the probability of endometriosis was seen in the cases in which the total scores ranged 0-4, 5-8, and 9-16; the incidence being approximately 10%, 60%, and 90% respectively. These results were confirmed by a prospective study. After completing a course of treatment, the pregnancy rate was 55% in patients with endometriosis. This fertility rate was higher than that of controls (23%). Thus, infertile women whose total scores ranged 0-4, 5-8, and 9-16 will be required to undergo re-examination of other sterility factors other than endometriosis, diagnostic laparoscopy and treatment for endometriosis, respectively.

Antigens, Neoplasm↗