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PubMedDate not supplied

Using delta/DRG diagrams and decision tree analysis to select a cost-effective surgery for cholecystitis.

BACKGROUND AND OBJECTIVES: Many studies have attempted cost analysis of laparoscopic cholecystectomy as compared to open cholecystectomy. However, these analyses have included costs, charges, expenses, etc., and at times they have been used interchangeably. This paper demonstrates how DRG diagrams containing charges and length-of-stay, preoperative prediction of conversion rates, decision-tree construction and sensitivity analysis can be used to select the most cost-efficient operation for a given patient with cholecystitis. METHODS: A Delta DRG analysis for complicated cholecystectomy (DRG 195) showed the hospital to be an extreme outlier in both charges and length of stay. Record review indicated that 55% of the cases were converted laparoscopic cholecystectomies and the remainder were aged or younger patients with advanced disease. Chart and literature review determined the causes and the probability of conversion. Data were then placed into decision-tree and sensitivity analyses. The most cost-effective operation for a given probability of conversion was demonstrated. RESULTS: Three preoperative findings and combinations of each predicted conversion rates and analysis showed that the charge of laparoscopic cholecystectomy must be held below the range of $5,361-$13,084 to make routine laparoscopic cholecystectomy cost-effective. CONCLUSIONS: This method demonstrated that using Delta/DRG, decision-tree and sensitivity analysis offers physicians, hospitals and other health-care providers a method of evaluating the treatment of DRG categories to determine the most cost-effective management.

Cholecystectomy↗
PubMed1991

Polycyclic aromatic hydrocarbon (PAH) concentrations in ambient airborne particles from local traffic and distant sources; variation of the PAH profile.

The temporal and spatial dependence of the PAH profile, i.e. the relative concentrations of polycyclic aromatic hydrocarbons, was investigated for ambient airborne particles during a period with moderate photochemical air pollution. The concentrations of 14 PAH were measured; they differed in volatility, sensitivity to atmospheric chemical conversion and contributing sources. Multivariate analysis (principal-component analysis and factor analysis) revealed that temporal dependence was predominantly determined by five factors clearly linked with volatility, reactivity and sources of the PAH, the first being by far the most important. The results, therefore, indicate that volatilization, conversion and a varying contribution of local sources were the major causes of the variation of the profile with time. The contribution of local sources was investigated by comparison of samples that were taken simultaneously at three different sites, one a background site and two sites downwind of traffic. A marked site dependence was found. The comparison suggested that the differences were not only determined by sources, but also by volatilization and/or conversion during residence of the particles in the air.

Air Pollutants↗
PubMed1984

Metabolism, DNA binding, and cytotoxicity of aflatoxin B1 in tracheal explants from Syrian hamster.

Metabolism, DNA binding and cytopathological effects of aflatoxin B1 (AFB1) were studied in isolated tracheal explants from Syrian golden hamsters. Explants were exposed to 0.1, 0.5 and 1.0 microM [14C]AFB1 in Dulbeccos's modified Eagle medium for 24 h, then analyzed for AFB1-DNA binding and AFB1 metabolism. Binding (pmol AFB1/mg DNA) was dose-related (16.3 +/- 1.9 to 180.8 +/- 16.1) and analysis of the culture medium revealed the metabolic conversion products aflatoxicol (AFL) and aflatoxin Q1 (AFQ1). Ultrastructural analysis of sections of tracheal epithelium revealed degenerative changes primarily in the non-ciliated epithelial cells. Autoradiographic analysis of the same treated explants, however, showed no discernible distribution of label with respect to either cell type or cell location, with the exception of increased grain densities overlying vacuoles containing dark droplets. In addition, S9 prepared from hamster trachea was shown to activate AFB1 to mutagens detectable by Salmonella typhimurium TA 98, but was approximately 70 times less active on a per mg protein basis than was S9 prepared from hamster liver. These results demonstrate the metabolic capabilities of tracheal epithelial cells in the activation of AFB1, thus indicating that AFB1 present in respiratory particles may be activated by pulmonary mixed-function oxidases, posing a hazard to those exposed.

Aflatoxin B1↗
PubMed2005

RNA-conjugated template-switching RT-PCR method for generating an Escherichia coli cDNA library for small RNAs.

The cDNA conversion of RNA molecules is a prerequisite for their analysis. In the case of prokaryotic RNAs, cDNA conversion is difficult due to a lack of the long poly(A) tails that are found in eukaryotic mRNAs. The full cDNAs for eukaryotic mRNAs can be amplified by the reverse transcription polymerase chain reaction (RT-PCR) using the template-switching method together with an oligo(dT) primer. To amplify the full cDNAs for prokaryotic RNAs, we modified the template-switching RT-PCR method by adopting an RNA linker at the 3' end of the target RNAs. Using this method, which we named as RNA-conjugated template-switching RT-PCR (RC/TS RT-PCR), we constructed a cDNA library for small RNAs from cold-shock-treated Escherichia coli cells. To confirm that the cDNAs were amplified by RC/TS RT-PCR without a loss of sequence information, clones carrying the 6S RNA sequence were analyzed from the cDNA library for small RNAs ranging from 130 to 350 nt. We found that the 6S RNA sequences were fully converted into the corresponding cDNAs, confirming that RC/TS RT-PCR is a useful method for constructing a cDNA library for small RNAs in E. coli. This method can be also used to construct a cDNA library for non-poly(A)-containing RNAs from eukaryotic cells.

Blotting, Northern↗
PubMed2002

Complexities in ETS-domain transcription factor function and regulation: lessons from the TCF (ternary complex factor) subfamily. The Colworth Medal Lecture.

The ETS-domain transcription factor family can be divided into a series of subfamilies. Elk-1 represents the founding member of the ternary complex factor (TCF) subfamily. By focusing on the TCF subfamily, we can demonstrate the complexities that exist in the function and regulation of ETS-domain transcription factors. This article focuses on Elk-1 in detail and summarizes the functions of other TCFs. The key themes covered include the domain structure of the TCFs, the mechanisms of complex formation with serum response factor, regulation of TCFs by mitogen-activated protein kinase cascades, and transcriptional regulatory properties of the TCFs. Finally, the emerging role of the TCFs in vivo is discussed. A picture is developing indicating that, while these proteins exhibit significant sequence and functional conservation, key differences in their structure and regulation are being identified which may relate to unique functions of these proteins in vivo.

Amino Acid Sequence↗
PubMed2005

The phylogenetic history of New World monkey beta globin reveals a platyrrhine beta to delta gene conversion in the atelid ancestry.

Orthologues of the beta globin gene locus from 10 New World monkey species were sequenced and aligned against available beta and delta globin sequences from rabbit and other primates. Where needed, additional primate sequencing was performed. Phylogenetic analysis identified a beta to delta conversion in the stem of the Anthropoidea, stretching from the 3' part of the proximal promotor to the 5' start of intron 2, consistent with earlier findings. No further conversion appeared to have occurred in the descent of the catarrhines. Within the New World monkey lineage that led to spider monkey and other atelids, another shorter gene conversion was found, spanning adjacent parts of exon 1 and intron 1. The analysis also confirmed that galago beta had replaced galago delta, that an earlier loriform-specific gene conversion extended over intron 2, and that gene conversion throughout the main gene conversion region occurred in the tarsiiform lineage. Platyrrhine phylogenetic relationships were investigated with beta sequences restricted to those that were not involved in gene conversions. This phylogeny generally agreed with results from other nuclear genes. The one exception was that the beta sequences did not place the callitrichine clade within the Cebidae but weakly joined the callitrichine and atelid clades.

Animals↗
PubMed1993

Laparoscopic cholecystectomy. A prospective analysis of the potential causes of failure.

Most experienced laparoscopic units suggest a rate of conversion to open cholecystectomy of about 5%. Some failures are predictable preoperatively. We have reviewed the prospective data collected on our first 285 laparoscopic cholecystectomies to provide a basis for advising patients about the likelihood of conversion (failure) if laparoscopic cholecystectomy is attempted. Risk factor analysis was performed to assess the effect on the conversion rate of clinical presentation, preoperative ultrasound features, previous abdominal surgery, and morbid obesity. The overall conversion rate was 4.9%. We identified three preoperative clinical parameters associated with a high risk of failure at laparoscopic cholecystectomy: a contracted gallbladder on ultrasound, gallstone pancreatitis, and a previous history of upper abdominal surgery. Factors that did not predict failure were: an ultrasound report of a thick gallbladder wall, morbid obesity, or acute cholecystitis. It is concluded that laparoscopic cholecystectomy is technically feasible in most patients, but those having the above-mentioned risk factors should be warned of a higher than usual chance of conversion to open cholecystectomy.

Cholecystectomy, Laparoscopic↗
PubMed1992

The influence of casting methods on the surface microhardness and crystalline formation of aluminum-copper alloys.

The influence of air/gas, oxygen/gas, and electric casting methods on the surface microhardness and crystalline formation of three aluminum-copper alloys was verified. The inclusion, wax elimination, and casting of the pattern were accomplished by using conventional techniques for thermal expansion investment. After metalographic polishing, the surface hardness analysis was verified with a penetrator. The penetrations were transformed in Knoop hardness with the conversion table, and computed by variance analysis. The test sample surfaces were then etched with a reactive solution composed of equal parts of hydrogen peroxide and ammonium hydroxide. The crystalline grains precipitated by solution were photographed with Kodak film 32 ASA. The results demonstrated that the surface microhardness of the alloys was modified according to the heat sources used, and the crystalline grain disposition was also adversely influenced by the heat sources, with the exception of Goldent alloy.

Acid Etching, Dental↗
PubMed2006

[Production of gastrodin through biotransformation of p-hydroxybenzaldehyde by cell suspension cultures of Datura tatula L].

The conversion of exogenous p-hydroxybenzaldehyde to p-hydroxy-methyl-phenol-beta-D-glucoside (gastrodin) was studied by using cell suspension culture of Datura tatula L. The chemical structure of this synthesized gastrodin was identified based on the spectral analysis and chemical evidence. The conversion procedure of p-hydroxybenzaldehyde into gastrodin by D. tatula L. cell suspension cultures was established. The synthesized gastrodin (II) was isolated from the ferment liquor and identified by spectral analysis. At the same time, the p-hydroxybenzyl alcohol (I) converted through biotransformation of p-hydroxybenzaldehyde by cell suspension cultures of D. tatula L. was also isolated and identified. The efficiency of glucosylation of p-hydroxybenzaldehyde was remarkably enhanced by adding salicylic acid (0.1 mg/L) and keeping the lower pressure (0.001MPa) in 25L airlift loop bioreactor. The biotransformation of exogenous p-hydroxybenzaldehyde to gastrodin by cell suspension culture of D. tatula L. is a promising approach.

Benzaldehydes↗
PubMed2005

Eliminating gene conversion improves high-throughput genetics in Saccharomyces cerevisiae.

Synthetic genetic analysis was improved by eliminating leaky expression of the HIS3 reporter and gene conversion between the HIS3 reporter and his3Delta1. Leaky expression was eliminated using 3-aminotriazole and gene conversion was eliminated by using the Schizosaccharomyces pombe his5+ gene, resulting in a 5- to 10-fold improvement in the efficiency of SGA.

Amitrole↗
PubMed1994

N5-carboxyaminoimidazole ribonucleotide: evidence for a new intermediate and two new enzymatic activities in the de novo purine biosynthetic pathway of Escherichia coli.

Conversion of aminoimidazole ribonucleotide (AIR) to 4-carboxyaminoimidazole ribonucleotide (CAIR) in Escherichia coli requires two proteins, PurE and PurK, previously thought to be subunits of a single enzyme, AIR carboxylase. Past studies revealing an ATP requirement for this reaction (Meyer et al., 1992), in conjunction with present studies, reveal that PurE and PurK possess independent catalytic activities. PurK is shown, by NMR spectroscopy, to catalyze the conversion of AIR in the presence of HCO3- and ATP to ADP, P(i), and the carbamate of AIR (designated N5-CAIR). PurE has been shown by NMR spectroscopy and kinetic analysis, to catalyze the reversible conversion of N5-CAIR and CAIR. N5-CAIR has a half-life of 0.9 min at pH 7.8 and 30 degrees C. Thus, two new enzymatic activities and a new intermediate have been discovered in the de novo purine biosynthetic pathway of E. coli.

Adenosine Diphosphate↗
PubMed2005

When do children convert from liquid antiretroviral to solid formulations?

BACKGROUND: Liquid formulations are usually regarded as the gold standard in paediatric formulation; but sometimes, liquid formulations have stability and taste problems as well as being inconvenient for travelling. Therefore, for the management of long-term illness, some older children, parents and clinicians would prefer to use solid formulations. However, there is a lack of studies to investigate the age at which children are converted from liquid to solid formulations. OBJECTIVES: (1) To investigate the age range at which children convert from liquid antiretroviral drug formulations to solid formulations, the formulations are abacavir, didanosine, lamivudine, stavudine, and zidovudine. (2) To calculate how long children stay on each of five UK liquid formulations (retention time) and factors affecting the retention times of the above liquid formulations. METHOD: This was a retrospective medical records survey at Great Ormond Street Hospital for Children, London, United Kingdom. Patients' treatment details were entered into SPSS for Windows v. 11.0 and the retention times for the above liquid formulations were calculated i.e., from initiation of the liquid treatment to conversion to solid preparation. The retention times of different preparations were then compared using Cox regression analysis. RESULTS: A total of 92 patients are included in the analysis. The overall average age at conversion was 7.3 years (95% CI 6.3-8.2). Patients on stavudine were more likely to switch to the corresponding solid dose form than the other four medicines (P < 0.001); more than 50% of patients on stavudine switched to solid formulation after nine months of treatment, however, less than 25% of patients on other formulations switched during the same period. CONCLUSION: Children taking antiretroviral liquid preparations change to solid dose forms at approximately seven years of age. However, for stavudine, children are more likely to take the solid form at an earlier age.

Age Factors↗
PubMed1999

Contribution of renal secreted complement C3 to the circulating pool in humans.

Complement C3 produced within the kidney may be an important mediator of local inflammatory and immunological injury. The overall level of renal C3 production and consequently its contribution to the total circulating C3 level are, however, unknown. This was investigated by using the conversion of C3 from recipient to donor allotype following renal transplantation. The C3 F and S allotypes of 80 consecutive renal donor-recipient pairs (148 individuals) were determined by amplification refractory mutation system analysis. The extent of allotype conversion in C3 F/S mismatched recipients was quantified at different stages after transplantation, using an enzyme-linked immunosorbent assay specific for the HAV 4-1 polymorphism of C3 that is strongly associated with C3F. Twenty-one of the eighty recipients were potentially informative, i.e., were C3 SS recipients of C3 FF or FS donor kidneys. In the early postoperative period, donor-derived C3 (HAV 4-1-positive) was undetectable, increasing to 9.6% of the total circulating C3 at times of acute allograft rejection. When graft dysfunction occurred from causes other than rejection, donor C3 remained undetectable. After stable graft function was attained (3-13 mo after transplantation), donor C3 made up 4.5% of the total circulating C3 pool. Our findings demonstrate that human transplant kidney in the resting state is a significant source of extrahepatic C3. Its heightened local synthesis during rejection episodes suggests a possible pathogenic role for C3 in this immunological process.

Adolescent↗
PubMed1998

Application of micro-electrospray liquid chromatography techniques to FT-ICR MS to enable high-sensitivity biological analysis.

A microbore electrospray (ESI) injection system has been adapted to our 9.4-tesla ESI FT-ICR mass spectrometer, greatly enhancing the stability and sensitivity of the system. Spray was generated from micro-ESI needles made from sharply tapered, polished fused silica capillaries of 25 to 50 microns inner diameter. Micro-ESI permits low-level sample analysis by constant infusion at sub-microL/min flow rate over a wide range of solvent conditions in both positive- and negative-ion mode. The system is flexible and allows rapid conversion to allow routine LC/MS analysis on low-level mixtures presented in biological media. LC/MS analyses were accomplished by replacing micro-ESI needles with capillaries packed with reverse phase retention media to permit analyte concentration and purification prior to analysis (micro-ESI/LC). A unique nano-flow LC pumping system was developed, capable of producing a true unsplit solvent gradient at flow rates below 1 microL/min. The micro-ESI/LC FT-ICR system produces mass spectra from a mixture of three neuroactive peptides at a concentration of 500 amol/microL (5 fmol each total loaded) in biological salts with baseline separation, signal-to-noise ratio of > 10:1 and mass resolving power > 5000. These results represent a reduction in detection limit by a factor of approximately 2 x 10(6) over the best previously published LC/FT-ICR MS data.

Endorphins↗
PubMed2006

Multifocal visual evoked potential latency analysis: predicting progression to multiple sclerosis.

OBJECTIVE: To monitor the difference in conversion rates to multiple sclerosis (MS) in 46 patients with optic neuritis between patients with multifocal visual evoked potential latency delay and those with normal latency. DESIGN: Prospective case series. SETTING: Metropolitan neuro-ophthalmology clinic. PARTICIPANTS: Forty-six patients with optic neuritis who did not have a diagnosis of MS on enrollment in the study. MAIN OUTCOME MEASURES: Conversion to MS according to the McDonald criteria. RESULTS: Analysis revealed that only 22 subjects had multifocal visual evoked potential latency delay. Over 1 year, 36.4% of patients with optic neuritis with latency delays progressed clinically to MS compared with 0% of those with normal latencies (P = .03, chi2). CONCLUSION: This may indicate that multifocal visual evoked potential latency delay can assist in predicting progression to future MS.

Analysis of Variance↗
PubMed1985

How does flow cytometry express Gaussian distributed biological information?

The analogue-to-digital conversion step in flow cytometric analysis introduces a positive skew into the distribution of any measured parameter. In this communication we describe a semi-analytical method to determine if a distribution skewed by the analogue-to-digital conversion step is compatible with a Gaussian origin. The procedure involves determining the errors associated with calculating the coefficient of variation from the skewed distribution and applying systematic corrections. The method was tested with a number of experimental data sets and is illustrated with 3 distributions. One of these was not compatible with a Gaussian origin, but the other 2 were, in spite of considerable positive skewness in the data.

Blood Cell Count↗
PubMed1995

[Analysis of heart rhythm variability in evaluation of treatment for unstable angina pectoris].

Unstable angina pectoris is accompanied by several unfavourable autonomic disturbances. A noninvasive assessment of the autonomic cardiac control is possible by means of heart rate variability analysis (HRV). 26 patients with unstable angina pectoris were enrolled in the study. All patients received obligatory nitroglycerin and heparin intravenously within two days, and gallopamil (G) or metoprolol (M) together with aspirin or ticlopidine orally randomly, which were continued for 3 month or shorter if coronary revascularization was earlier performed. 512 R-R intervals was registered in each patient at 7th day of hospitalization and in 14th at the time of admission. Kardioassist v.1.0 system was used for heart rate variability analysis. After analog to digital conversion, with 12 bit resolution and 1000 Hz of sampling rate, seriogram of R-R intervals was obtained, and then power spectrum density was computed with the Fast Fourier Transform. Time-domain analysis provided mean (basic) R-R interval (BCL) and its standard deviation (SD-RR). In frequency-domain the following spectral variables were analysed: power spectral density (s2/Hz) of the high frequency component (aHF, 0.15-035 Hz), low frequency component (aLF, 0.05-0.15 Hz) and very low frequency component (aVLF, 0.004-0.05 Hz), percentage power of respective components (%HF, %LF and %VLF) and autonomic balance indices: aLF:aHF and %LF:%HF. These variables were compared in patients treated with G (13 patients) against those with M (13 patients). Additionally, the effects of treatment regimen was evaluated also in 14 patients, in whom HRV analysis was performed at admission and 7 days later.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

[Impulsive behaviors in attention-deficit/hyperactivity disorder].

The notion that difficulty in behavioral inhibition is the essential impairment of attention-deficit/hyperactivity disorder (AD/HD) has been prevailing. In this study, we assessed impulsive behaviors with regard to emotion, rule, and inattentiveness, by developing an impulsiveness scale and applying it for 103 parents of a boy with AD/HD. Exploratory factor analysis (EFA) of 18 items identified four primary factors: labeled emotion expression, social rule, rule in conversation, and inattentiveness. A covariance structural analysis was performed to extract response bias from latent constructs, and the fitness of the model was examined. In the finally adopted model on impulsive behaviors, the four factors extracted in EFA was explained by two independent second-order latent variables: labeled general impulsivity and cognitive impairment. Cognitive impairment significantly influenced on inattentiveness only, while general impulsivity on all the four factors. Furthermore, the scores of primary four factors were compared between two groups of a normal class group (n = 20) and three AD/HD subtypes:combined type (n = 37), predominantly hyperactive-impulsive type (n = 14), and predominantly inattentive type (n = 18). The results suggest differences in impulsive behaviors among the AD/HD subtypes.

Adolescent↗