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Robust three-dimensional object definition in CT and MRI.

This work describes the application of an object definition algorithm to the medical imaging environment for the task of automated detection of anatomical boundaries in three dimensions in the presence of low spatial frequency nonstationarities. We have chosen the Liou-Jain algorithm and have modified it for use with 3D medical image datasets and extended it by including a recruitment operator that corrects for the algorithm's inherent volume underestimation. The algorithm avoids problems in both traditional statistical segmentation and 2D techniques and elegantly bridges the gap between traditional gradient-based edge finding and regression-based segmentation techniques. Results are shown for MRI datasets from the human abdomen and brain and for a CT dataset of a liver tumor, as well as an MRI scan of a glioma in a rat brain. For comparison, the human abdomen dataset was processed by a multivariate, statistical classifier. The results demonstrate the statistical technique's susceptibility to low spatial frequency nonstationarities due to rf field inhomogeneity; the Liou-Jain algorithm is shown to be immune to this effect. Further, the results show spatial consistency as a result of inherent characteristics of the algorithm. Volumes identified by the algorithm are visualized and assessed qualitatively in three dimensions. Quantitative accuracy of the algorithm's volume estimates is assessed by the use of a phantom. This work demonstrates that this technique is effective in automatically detecting anatomical organ and lesion surfaces in 3D medical datasets that are corrupted by low spatial frequency nonstationarity and in obtaining volume estimates.

Algorithms↗

[Mortality and morbidity of low birth weight premature newborns in a French community from 1990 to 1994].

The development of new technologies in neonatal intensive care which appeared this last decade increased the viability of premature newborns and contributed to the increase in the number of admissions of very low birth weight (VLBW) newborns in the intensive neonatal care services (12.6% of admissions in 1987, 15.2% in 1996). In a retrospective epidemiology survey in French speaking Belgian Community, we collected the data of 1521 newborns whose birth weight was under 1500 g, from January 1990 to December 1994, in order to improve our knowledge or regional mortality and morbidity rates and to estimate the impact of new procedures. We do not notice any variation of annual mortality (+/- 20%), nor of morbidity (sequelae risks to survivors at the departure of the hospital +/- 23%) on the global population during the survey period. However the mortality of infants born between 30 and 33 weeks drops dramatically (17% in 1990, 3.6% in 1994). As it has been demonstrated in randomised surveys, we recover the beneficial effect of antenatal corticotherapy which allows us to reduce to more than 50% the mortality of newborns from treated mothers (11% mortality versus 24%). In comparison to figures of international literature, our survival rate without sequelae is at least 10% lower than Américan results for infants whose birth weight is < 1000 g and at least 5% lower for infants between 1000 and 1500 g. In conclusion, although the introduction of surfactant and high frequency ventilation during this period, mortality rate of VLBW infants doesn't seem to decrease significantly from 1990 to 1994. However, multivariate statistical study of predictable mortality and morbidity factors need to be performed in order to define or promote preventive strategy.

Belgium↗

Use of image cytometry to classify biliary and ampullary adenocarcinomas.

OBJECTIVE: To create an objective classification system to perform TNM classification of ampullary adenocarcinoma and cholangiocarcinoma using image cytometric data derived from Feulgen-stained tumor nuclei. STUDY DESIGN: Surgically resected cases of ampullary adenocarcinoma and cholangiocarcinoma with established TNM classifications were selected on the basis of available formalin-fixed, paraffin-embedded tissue. Fifteen numerical variables related to morphometric, densitometric and textural features of each tumor nucleus were recorded. We employed a methodology based on multivariate statistical tools to characterize the association of morphonuclear variables with TNM classification. The first step consisted of identifying and selecting representative nuclei of each T class. From this "purified" data set an objective classification system was created. The classification system was assessed using internal and external validation. RESULTS: Employing ANOVA, all 15 variables were significantly associated with T classification, 11 of 15 with N and 4 with M. Multivariate analysis was employed to distinguish between T1, T2 and T3 lesions. Our methodology correctly classified 76% of T1 nuclei, 47% of T2 nuclei and 84% of T3 nuclei. Heterogeneity within an individual tumor was defined in 61% of cases included in the training set. Complete concordance between pathologic classification and the classification system was observed in 71% of an independent validation.

Adenocarcinoma↗

Trends in breast cancer incidence and mortality in Denmark, 1943-1982.

The trend in breast cancer incidence and mortality was examined using data from the Danish Cancer Registry and the national mortality statistics respectively. The study population comprised 65,870 incident cases and 33,817 deaths from breast cancer in Denmark between 1943 and 1982. The incidence rate remained almost constant up to around 1960, whereafter it rose steadily. Comparatively little change was observed in mortality. Possible explanations for the differing trends in incidence and mortality include under-reporting of breast cancer from death certificates and improvement in survival. A multivariate statistical analysis showed that the increase in incidence was due mostly to a cohort effect, though calendar time may have had a slight effect as well.

Adult↗

Visual rating of white matter hyperintensities in Parkinson's disease.

Dementia is a common complication of Parkinson's disease (PD), but the cause is incompletely understood. In previous studies, dementia has been associated with an increase in hyperintense lesions in the cerebral white matter. The aim of this study was to explore whether white matter hyperintensities (WMH) on cerebral magnetic resonance imaging (MRI) are associated with dementia in PD. For this study, 35 patients with PD, 16 with dementia (PDD) and 19 without (PDND), and 20 control subjects were recruited. MRI scans of patients and controls were rated for WMH, blind to diagnosis, using the Scheltens visual rating scale. Both bivariate and multivariate statistical analyses were carried out. Cerebrovascular risk factors, education, gender, or age were similar across groups. Compared with the PDND group, the PDD group had significantly higher level of WMH in the deep white matter and in the periventricular areas. WMH in the deep white matter was the only variable that was associated significantly with Mini-Mental State Examination score and explained 38% of the variance in the multivariate linear regression analysis. Our findings suggest that WMH in the deep white matter may contribute to dementia in PD.

Aged↗

Covering events in eigenimages of biomolecules.

Multivariate statistical analysis of a large set of micrographs of biological macromolecules involves the computation of eigenimages representing principal features, on the basis of which similar views of the complexes can be grouped. It is not generally clear what these eigenimages represent physically and which ones should be used in the classification process. In this paper, hierarchical maximum entropy discretisation and event covering are used to (1) detect statistically significant relationships in the eigenimages, (2) select the most relevant eigenimages for classifying biomolecular projections, and (3) build a prototype of the biomolecular complex under study.

Algorithms↗

The bio-optical properties of CDOM as descriptor of lake stratification.

Multivariate statistical techniques are used to demonstrate the fundamental role of CDOM optical properties in the description of water masses during the summer stratification of a deep lake. PC1 was linked with dissolved species and PC2 with suspended particles. In the first principal component that the role of CDOM bio-optical properties give a better description of the stratification of the Salto Lake with respect to temperature. The proposed multivariate approach can be used for the analysis of different stratified aquatic ecosystems in relation to interaction between bio-optical properties and stratification of the water body.

Ecosystem↗

Multivariate analysis of the factors affecting duration of acute inpatient rehabilitation after hip and knee arthroplasty.

OBJECTIVE: To determine which factors predict length of stay at a rehabilitation hospital for total hip and knee arthroplasty patients. DESIGN: Length of stay at an acute rehabilitation hospital was analyzed with respect to demographic, surgical, and comorbidity factors using univariate and multivariate statistical techniques. Data were retrospectively collected of 808 hip and knee arthroplasty rehabilitation patients from years 2000 and 2001 at a large, urban, university-affiliated acute rehabilitation hospital. Demographic factors included age, insurance, marital status, sex, race, and body mass index. Surgical factors included knee/hip arthroplasty, unilateral/bilateral arthroplasty, and indication for surgery. Also, the 22 most prevalent comorbid illnesses for the patient group were analyzed for their association with length of stay. RESULTS: Significant factors for predicting length of stay were indication for surgery, number of comorbid illnesses, unmarried marital status, and black race. Also, advanced age and male sex approached significance. CONCLUSION: Length of stay in rehabilitation for total hip arthroplasty and total knee arthroplasty can be statistically modeled using various factors. These findings will help clinicians address prolonged length of stay and resource allocation issues.

Age Factors↗

Coronary vasospasm as a source of false positive results during dobutamine echocardiography.

BACKGROUND: Several studies have demonstrated a consistently high sensitivity of dobutamine echocardiography whereas test specificity in these series has been variable. The aim of this study was to evaluate whether coronary vasospasm--elicited by alpha1 adrenoreceptor stimulation--may be a significant source of false positive responses during dobutamine stress. METHODS: From the data bank of four institutions we selected 113 patients (75 males, 38 females, mean age 55 +/- 12 years) with dobutamine echocardiography performed (up to 40 micrograms/kg/min and atropine 1 mg if needed) before a coronary angiography showing normal or near normal (visually assessed stenosis severity < 50%) coronary arteries. The following variables--which were previously reported influencing dobutamine echo specificity--entered the multivariate statistical analysis: age, sex, heart rate at baseline and at peak stress, baseline echo, hypertension, site of asynergy, and spasm at coronary angiography. RESULTS: Twenty-five patients had a positive dobutamine test. The positivity occurred in the left coronary territory in 15 and in the right coronary territory in 10 cases. All the 6 patients with spontaneous spasm during angiography had a false positive stress test result. By multivariate analysis only coronary artery spasm during angiography (p = 0.0015) and history of hypertension (p = 0.0031) were significant predictors of false positive results of dobutamine stress echocardiography. CONCLUSIONS: Coronary artery spasm may be an important source of false positive results during dobutamine stress echocardiography.

Coronary Disease↗

[Left ventricular ejection time in aortic valve diseases. 1. Multidimensional relationship with biometric and physiologic findings].

The purpose of this work is to settle biometrical and physiological factors linked to changes in ejection time in aortic valvular disease. The relationship between the various considered variables is submitted to multivariate statistical analysis, and expressed by a prediction formula. Data are provided by a series of 160 aortic patients whose examination notably includes measurement of cardiac output and of pressures in left ventricle and aorta, a cineangiography in the ascending aorta, and a search for aortic valvular calcifications with an image intensifier. Moreover, the already published results of a reference series of 200 subjects without aortic disease, are also used. Multivariate relationship of ejection time appears to be, on the whole, similar in the reference series and in the aortic series, with besides, in the latter, a significant effect of aortic "gradient" and incompetence. Consequently these two marks of aortic disease may be indirectly predicted from the residuals of the reference formula applied to aortic patients.

Adolescent↗

Further evidence for prognostic significance of epidermal growth factor receptor gene amplification in patients with esophageal squamous cell carcinoma.

To determine the value of epidermal growth factor receptor (EGFR) gene amplification as a biological prognostic indicator in patients with esophageal squamous cell carcinoma, the EGFR gene amplification was determined by slot-blot hybridization using DNA extracted from formalin-fixed and paraffin-embedded blocks of tissues from 107 patients with esophageal squamous cell carcinoma who had undergone curative surgery. Results were analyzed by both univariate and multivariate statistical analysis. EGFR gene amplification greater than 3-fold was detected in the primary tumors of 13 (12%) of the 107 cases. The cumulative survival rate for patients with EGFR gene amplification in the primary tumors was significantly lower than that for patients without amplification (P < 0.001). A significant correlation was observed between extensive lymph node involvement at the time of surgery and EGFR gene amplification (P < 0.05). In the multivariate analysis, EGFR gene amplification (P = 0.015) and vascular invasion (P = 0.003) proved to retain independent prognostic values. These results suggest that EGFR gene amplification may be a useful biological marker for the prediction of lymph node metastasis and a poorer prognosis of esophageal squamous cell carcinoma.

Adult↗

Antibody pattern analysis in the Guillain-Barré syndrome and pathologic controls.

The Guillain-Barré Syndrome (GBS) is an acute inflammatory polyneuroradiculopathy, which is considered to be caused by autoimmune processes. A number of single antigenic structures has been suggested to be targeted by the immune system, but a conclusive etiological concept has not been evolved yet. We compared reactions of sera from GBS patients (N=28) and from both two pathological control groups, 25 Multiple sclerosis (MS) patients and 32 patients with other non-inflammatory peripheral polyneuropathies (ONP) and from sex- and age-matched healthy controls (N=30). Porcine peripheral nerve proteins were used as antigens in a Western blot procedure. The blots were analysed by densitometry, and a multivariate statistical comparison of the antibody repertoires was carried out. Antibody patterns of GBS patients differed significantly (p<0.001) from each of the control groups. Discriminant analysis indicated that the discrimination resulted from pattern differences of specific regions of the blots containing proteins with estimated molecular weights of 58-64 and 28-29 kDa. We conclude that statistical analysis of antibody patterns may be helpful both in clinical diagnosis and in further research concerning the pathogenesis of GBS.

Adult↗

Lung resistance and elastance in spontaneously breathing preterm infants: effects of breathing pattern and demographics.

Reported values of lung resistance (RL) and elastance (EL) in spontaneously breathing preterm neonates vary widely. We hypothesized that this variability in lung properties can be largely explained by both inter- and intrasubject variability in breathing pattern and demographics. Thirty-three neonates receiving nasal continuous positive airway pressure [weight 606-1,792 g, gestational age (GA) of 25-33 wk, 2-49 days old] were studied. Transpulmonary pressure was measured by esophageal manometry and airway flow by face mask pneumotachography. Breath-to-breath changes in RL and EL in each infant were estimated by Fourier analysis of impedance (Z) and by multiple linear regression (MLR). RL(MLR) (RL(MLR) = 0.85 x RL(Z) -0.43; r(2) = 0.95) and EL(MLR) (EL(MLR) = 0.97 x EL(Z) + 8.4; r(2) = 0.98) were highly correlated to RL(Z) and EL(Z), respectively. Both RL (mean +/- SD; RL(Z) = 70 +/- 38, RL(MLR) = 59 +/- 36 cm H(2)O x s x l(-1)) and EL (EL(Z) = 434 +/- 212, EL(MLR) = 436 +/- 210 cm H(2)O/l) exhibited wide intra- and intersubject variability. Regardless of computation method, RL was found to decrease as a function of weight, age, respiratory rate (RR), and tidal volume (VT) whereas it increased as a function of RR. VT and inspiratory-to-expiratory time ratio (TI/TE). EL decreased with increasing weight, age, VT and female gender and increased as RR and TI/TE increased. We conclude that accounting for the effects of breathing pattern variability and demographic parameters on estimates of RL and EL is essential if they are to be of clinical value. Multivariate statistical models of RL and EL may facilitate the interpretation of lung mechanics measurements in spontaneously breathing infants.

Airway Resistance↗

Health status of illiterate adults: relation between literacy and health status among persons with low literacy skills.

BACKGROUND: In nonindustrialized nations, illiteracy is independently associated with poor health. The objective of this research was to determine whether such a relation exists in the United States. METHODS: One hundred ninety-three persons were randomly selected from a group of adult students enrolled in a publicly funded literacy training program. Subjects' health status was measured with the Sickness Impact Profile (SIP), a behaviorally based measure of sickness-related dysfunction. Subjects' literacy skills were also measured. Multivariate statistical techniques were then used to evaluate the relation between health status and literacy level and to adjust for confounding sociodemographic factors. RESULTS: The physical health (measured by the SIP) of subjects with extremely low reading levels was poor compared with that of subjects with higher reading levels. The relation between reading level and physical health was statistically significant (P less than 0.002), even after adjusting for confounding sociodemographic variables. Psychosocial health (measured by the SIP) was poor across all levels of reading skills and was comparable with the psychosocial health of populations with severe psychosocial disability. The relation between reading level and psychosocial health was statistically significant (P less than 0.02) after adjusting for confounding variables. CONCLUSIONS: In the United States, illiteracy and poor health status are independently associated.

Adolescent↗

The brief symptom inventory and the positive and negative syndrome scale: discriminate validity between a self-reported and observational measure of psychopathology.

Concern within the literature has emerged from time to time arguing the poor validity of self-reported measures in psychopathology, namely, the reporting of psychotic experience. Although it is commonly believed that patients who have had a psychotic episode cannot accurately self-report their experience, very few studies have been conducted to measure the concordance between self-reported and observational measures of psychopathology using multivariate statistical techniques. Sixty-nine patients presenting their first psychotic episode were interviewed and assessed on the Positive and Negative Syndrome Scale (PANSS) and were asked to complete the Brief Symptom Inventory (BSI). By clustering symptom dimensions from the BSI into discriminate functions, the research demonstrated that these symptom dimensions could adequately classify high versus low scores on the PANSS subscales and total score. When the same clusters were entered into multivariate analysis of variance (MANOVA) models, they also demonstrated significant differences between high versus low observed symptomatology on the PANSS Positive and General Subscale Groups and Total Score Groups. The current findings shed some doubt on the supposition that those who experience psychosis are unable to report symptom dimensions that concord with those who observe the psychosis. It appears that models, operational definitions, and the language used in measuring psychopathology may differ significantly from those who experience the psychotic experience and those who observe it. Techniques such as multitrait multimethod are discussed as ways of overcoming these concerns.

Adult↗

Classification and correlation of St. John's wort extracts by nuclear magnetic resonance spectroscopy, multivariate data analysis and pharmacological activity.

The use of proton NMR spectroscopy allows the analysis of complex multi-component mixtures such as plant extracts by simultaneous quantification of all proton-bearing compounds and consequently all relevant substance classes. Since the spectra obtained are too complicated to be analysed visually, the classification of spectra was carried out using multivariate statistical methods. The spectroscopic data of various extracts of St. John's wort (Hypericum perforatum) samples derived from 4 different accessions extracted with 6 distinct solvents were chemometrically evaluated and calibrated using the partial least square (PLS) algorithm. In a first approach, we found a consistent correlation for the spectroscopic pattern of the extracts and the corresponding IC (50) values derived from non-selective binding to opioid receptors. Consequently, the multivariate data analysis was used to predict the pharmacological efficacy of further St. John's wort extracts on the basis of their proton NMR spectra. In a second approach a PLS 2 model was used to predict the biological activity for eight St. John's wort extracts based on two pharmacological data sets: (i) non-selective binding to opioid receptors and (ii) antagonist effect at corticotrophin-releasing factor type 1 (CRF (1)) receptors. The PLS 2 model confirmed the useful application of the presented approach to assess the quality of medicinal herbs and extracts by spectroscopic analysis derived from bioactivity-related quality parameters.

Humans↗

Parental beliefs about medications and medication adherence among urban children with asthma.

BACKGROUND: Although national guidelines recommend controller medications for children with persistent asthma, adherence is poor. Prior studies have begun to explore parental beliefs regarding controller asthma medications and their effect on adherence. OBJECTIVE: To describe parental beliefs about controller medications among a community-based sample of urban children with persistent asthma and to examine the relationship between parental beliefs and adherence. DESIGN/METHODS: Parents of 150 children with asthma completed a telephone survey as part of a larger asthma intervention. Parents of children using controller asthma medications were included in this study. A previously validated Beliefs About Medications Questionnaire (BMQ) was used, which included two subscales: necessity and concern. The relationship between parental beliefs about medications and medication adherence was assessed using bivariate linear regression and multivariate statistics. RESULTS: This study included 67 children with parental report of controller medication (54% male, 61% African American, 69% Medicaid). Overall, 75% of parents strongly believed that their child's medications were necessary for their health and 34% had strong concerns about the medications. Only 22% of parents reported being completely adherent with medications. Parents with greater concern about medications were more likely to have poor adherence (P < .05). In a multivariate analysis, including both BMQ subscales and asthma severity, concern about medications significantly predicted poor medication adherence (P = .03). CONCLUSIONS: Parental concerns about controller medications were associated with poor medication adherence for this population of urban children with asthma. These findings highlight the importance of addressing parental concerns at the time of medication prescription.

Anti-Asthmatic Agents↗

Analysis of tear-protein patterns as a diagnostic tool for the detection of dry eyes.

PURPOSE: To analyze the electrophoretic patterns of tear proteins from diabetic (DIDRY) and non-diabetic (DRY) patients with dry-eye disease in comparison with the patterns in healthy subjects (CTRL). The patterns were classified using multivariate statistical methods. METHODS: A total of 119 eyes were examined in this study (50 DIDRY, 39 DRY, 30 CTRL). The patients were primarily grouped according to the results of the basic secretory test (BST) and subjective symptoms (burning, foreign body sensations, tearing, "dryness" of the eyes). Patients with values < or = 10/5' plus subjective symptoms were classified as dry-eye patients. Tear proteins were separated by sodium-dodecyl-sulfate poly-acrylamide gel electrophoresis (SDS-PAGE). Digital image analysis was done using the ScanPacK (Biometra, Gottingen, Germany). A data set was created from each electrophoretic pattern. The data were analyzed by multivariate analysis of discriminance, k-means cluster analysis and with a factor analysis before k-means cluster analysis as a data reduction tool. RESULTS: The protein patterns of the three groups were significantly different (Wilks' lambda: 0.1425; P < 0.01): P < 0.05 (CTRL-DRY), P < 0.00005 (CTRL-DIDRY), and P < 0.0005 (DIDRY-DRY). There were more peaks/electrophoretic lane in the DRY and DIDRY groups (P < 0.05) than CTRL. Classification of all samples as DRY and CTRL gave the following results: known patterns 97% correct; unknown patterns 71.4% correct. Classification in DIDRY, DRY or CTRL was 92% correct for known patterns and 43% for unknown patterns. Using k-means cluster analysis, 72% of patients previously classified as "dry-eye" according to the BST value were classified as "dry-eye" based on their electrophoretic data too. CONCLUSIONS: Analysis of protein patterns and statistical evaluation are suitable for the detection of dry eyes. Tear-protein pattern analysis can provide more information on the pathogenesis of the disease. Thus, this new method might be more reliable than the BST value for both diagnostic and therapeutic purposes.

Diabetes Complications↗