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Protein sidechain conformer prediction: a test of the energy function.

BACKGROUND: Homology modeling is an important technique for making use of the rapidly increasing number of protein sequences in the absence of structural information. The major problems in such modeling, once the alignment has been made, concern the positions of loops and the orientations of sidechains. Although progress has been made in recent years for sidechain prediction, current methods appear to have a limit on the order of 70% in their accuracy. It is important to have an understanding of this limitation, which for energy-based methods could arise from inaccuracies of the potential function. RESULTS: A test of the CHARMM function for sidechain prediction was performed. To eliminate the multiple-residue search problem, the minimum energy positions of individual sidechains in ten proteins were calculated in the presence of all other sidechains in their crystal orientations. This test provides a necessary condition that any energy function useful for sidechain placement must satisfy. For chi1 x chi2 rotations, the accuracies were 77.4% and 89.5%, respectively, and in the presence of crystal waters were 86.5% and 94.9%, respectively. If there was an error, the crystal structure usually corresponded to an alternative local minimum on the calculated energy map. Prediction accuracy correlated with the size of the energy gap between primary and secondary minima. CONCLUSIONS: The results indicate that the errors in current sidechain prediction schemes cannot be attributed to the potential energy function per se. The test used here establishes a necessary condition that any proposed energy-based sidechain prediction method, as well as many statistically based methods, must satisfy.

Crystallography, X-Ray↗

The dexamethasone provocative test: a predictive tool for glaucoma?

A retrospective follow-up study of 134 patients (84 women and 50 men) tested for their responsiveness to topically administered corticosteroids was carried out. Of the 134 patients tested, 34 (25.4%) had a high response (IOP rise greater than or equal to 16 mmHg), 66 (49.3%) an intermediate (IOP rise 6-15 mmHg) and 34 (25.4%) a low response (IOP rise less than or equal to 5 mmHg) to topically administered 0.1% dexamethasone eye drops. Follow-up time varied from 5 to 15 years (mean 7.1 years). During the follow-up period 29 (21.6%) patients developed glaucoma. Of these, 9 (31.0%) were high responders and 7 (24.0%) had a low response to corticosteroids. Log-linear analysis showed no correlation between corticosteroid response and development of glaucoma in the study eye (SD = 0.232, DF = 2, P = 0.890), the control eye (SD = 1.234, DF = 2, P = 0.540) or both eyes (SD = 0.618, DF = 2, P = 0.734). At the final examination 75 patients (56%) had an IOP of greater than or equal to 22 mmHg. Of these ocular hypertensive patients 28 (37.3%) were high responders, and 15 (20%) had a low response to corticosteroids. Of the whole material of 134 patients 44 had a family history of glaucoma. Eleven (25.1%) of these were high responders and 14 (31.8%) low responders. Of the 29 patients who developed glaucoma 8 had a family history of glaucoma. Of these 3 were high responders and 3 low responders. The results indicate that the dexaprovocative test yielded relatively limited value in the screening of patients for glaucoma.

Administration, Topical↗

Controlling for stimulus dominance effects in the Fused Dichotic Words Test when predicting speech lateralization in children.

A log-linear analysis (Grimshaw et al., 1994) of Fused Dichotic Words Test data was examined in a sample of 28 children with epilepsy who had undergone the intracarotid amobarbital procedure to determine the nature of speech representation. The analysis yields a measure of ear dominance (lambda*) that controls for stimulus dominance confounds. Most patients with unilateral speech obtained statistically significant ear advantages, whereas most with bilateral speech displayed no significant ear advantage. Despite controlling for stimulus dominance confounds, some of the scores from patients with left-hemisphere speech overlapped with those from patients with bilateral speech representation.

Child↗

Impaired memory and general intelligence related to severity and duration of patients' disease in Type A posttraumatic stress disorder.

Studies of short-term memory and general intelligence associated with duration and severity of posttraumatic stress disorder (PTSD) on observed Type A scores are rare. The authors' aim was to assess Type A behavior and identify subgroups of patients who performed most poorly on memory and intelligence tests and Type A scores related to the severity and duration of their disease. They administered nonverbal memory and intelligence tests to 30 men with PTSD and 20 men without PTSD who responded. During their initial contact with the participants, 2 experts assessed 3 major coronary-prone characteristics (hyperalertness, tight facial musculature, and explosive speech). They found significant differences between the PTSD and control groups in total Type A scores. Those with the most severe PTSD performed most poorly on visual retention tests and showed the highest scores on self-reported and subjective diastolic blood pressure reactivity during magnetic resonance imaging. In the PTSD group, high error scores on the visual retention test predicted Type A behavior and low scores on the picture memory block design tests predicted high Type A scores. A significant positive correlation was found between Type A and clinician-assessed subjective distress, whereas the correlations were significantly negative between picture memory and Type A behavior Suppressed fear is commonly associated with PTSD; decades of research on Type A behavior have isolated fear as a crucial factor in cardiovascular disease.

Adult↗

In vitro chemosensitivity test to predict chemosensitivity for paclitaxel, using human gastric carcinoma tissues.

BACKGROUND: Therapy guided by chemotherapy sensitivity and resistance assays may lead to rational treatment decisions. Paclitaxel, one of several new drugs for gastric carcinoma, has not been extensively evaluated by in vitro chemosensitivity tests. METHODS: Chemosensitivity testing by histoculture drug response assay (HDRA) was performed with fresh specimens of primary tumor from 113 patients with gastric carcinoma. The test was performed in medium containing paclitaxel at three different concentrations for the initial 45 samples. Correlations between the results of chemosensitivity testing, determined at the optimal concentration, and the patients' clinicopathologic factors and outcome were then assessed for all patients. RESULTS: By analyzing the initial 45 samples, 10 microg/ml was considered the optimal concentration of paclitaxel for this test. HDRA was successfully performed for 100 of 113 samples and chemosensitivity, calculated as the percentage of optical density of a tumor treated with anticancer drugs in relation to the optical density of the tumor cultured in the medium only, was distributed widely at this concentration. No significant correlation was observed between chemosensitivity and age, sex, clinical stage, histopathologic type, and outcome of patients with gastric carcinoma. CONCLUSION: A histoculture drug response assay can now be performed to predict the chemosensitivity of paclitaxel at the concentration found in the current study. The accuracy of the assay to actually predict survival needs to be validated by a prospective clinical trial involving patients who have received paclitaxel in the postoperative adjuvant setting.

Adult↗

The role of in vitro chemosensitivity tests to predict the clinical efficacy of antineoplastic agents in genito-urinary tumors.

OBJECTIVE: To develop an in vitro screening system to predict the response to treatment of common malignancies of the genito-urinary tract. MATERIAL AND METHODS: Flow cytometric analysis and cytotoxicity assays (trypan blue and lactic dehydrogenase colorimetric tests) were performed on hormone resistant prostate cancer cell line PC-3 and primary transitional cell carcinoma samples treated with different antineoplastic agents and their combinations. Apoptosis induced by different agents was also investigated by previously established criteria. RESULTS: There were 9 bladder tumors (47.4%) in the study group that displayed drug resistance to at least one antineoplastic agent. When the drugs were examined individually, there was resistance to cis-platinum in 3 patients (15.8%), methotrexate in 6 (31.6%), vinblastine in 7 (36.8%), epirubicin in 2 and adriamycin in 2 patients (10.5%). Stratification of patients according to the stage of the tumor revealed statistically significant difference between the superficial and invasive tumors in terms of drug resistance (p < 0.05). In prostate cancer cell line vinblastine treatment resulted in a significant increase in S phase fraction. Percent cytotoxicity by trypan blue exclusion test was 26.1% and was significantly higher than the control group (8.7%, p < 0.002). Also, an increase in apoptotic index after the treatment was observed (44.4% and 12.1%, respectively; p < 0.0001). CONCLUSION: Both toxicity assays showed a very good correlation (p < 0.005) and can be used to evaluate the effects of different antineoplastic agents on individual tumors.

Adult↗

[Criteria for the use of the linear allothermal short-time test in predicting stability (author's transl)].

Three selected model substances of varying activation energy (naphazoline, 109 kJ/mole; acetylsalicylic acid, 72 kJ/mole; and phenobarbital, 60 kJ/mole) were studied to determine the conditions under which the allothermal short-time test according to Zoglio (linear increase in temperature) will yield stability predictions which are consistent with those provided by the isothermal short- or long-time test. The error of the determination method should be less than or equal to 1%. It is advantageous to use for the calculation as many data as the analytical facilities will permit to obtain. The actual value for the respective temperature should differ from the desired value by < +/- 0.2%. The increase in temperature should be very slow 1-2 degrees C/h at best). This is particularly true for substances of low activation energy, because more the energy values calculated on the basis of the allothermal test differ from the isothermally determined values, the flatter is the curve provided by the arrhenius equation. The temperature range should be chosen as large as possible, from 30-90 degress C, and the experiment should be continued until at least a 10% decomposition is achieved. On calculating the collision factor A and the reaction-rate constant for any temperature, it has proved useful to continue the experiment isothermally at the final point of the allothermal test.

Aspirin↗

Role of HPV DNA testing in predicting cervical intraepithelial lesions: comparison of HC HPV and ISH HPV.

Human papillomavirus (HPV) is widely accepted as the primary agent involved in the development of squamous intraepithelial neoplasia and cervical carcinoma. Several commercial tests are available for detecting HPV DNA. This study compares the efficacy of INFORM HPV (in situ hybridization [ISH] HPV) and HCII (HC HPV) in predicting cervical lesions. A total of 762 sequential Papanicolaou (Pap) smears determined by cytologic examination to be either atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL) were tested by both Hybrid Capture (HC) HPV and ISH HPV; 250 follow-up biopsies were reviewed as the reference standard for presence or absence of a lesion. ISH HPV and HC HPV differed significantly in accurately predicting biopsy findings from ASC-US and LSIL cases. The overall sensitivity and specificity of ISH HPV were 97% (28/29) and 86% (191/221); and HC HPV was 79% (23/29) and 56% (123/221). The positive predictive value (PPV) of ISH HPV was 48% (28/58) vs HC HPV value of 19% (23/121). Negative predictive value (NPV) was also better with ISH HPV at 99% (191/192) and HC HPV at 95% (123/129). Of equal importance, ISH HPV demonstrated a lower false-positive rate compared to HC HPV, 12% (30/250) vs 39% (98/250), as well as having a slightly lower false-negative rate 0.4% (1/250) vs 2.4% (6/250). ISH HPV is more predictive of biopsy histopathology in patients with detectable cervical lesions than is HC HPV. Effective triage of patients by HPV analysis using ISH HPV as compared to HC HPV has the potential of significant public health impact by reducing unnecessary colposcopies, as well as adverse medical, social, and psychological patient consequences.

Adolescent↗

United Kingdom experience with presymptomatic testing of individuals at 25% risk for Huntington's disease.

Between 1994 and 1998, the 23 UK genetics departments, which form the UK Huntington's Disease Consortium, have undertaken 161 direct mutation adult predictive tests on individuals whose at-risk parent was alive or had died without showing signs of Huntington's disease (HD) (5.7% of total UK tests). This study describes the number of requests for 25% risk predictive testing for HD in 1994 (the first year in which direct testing was available in the UK), and also a descriptive survey of the first 85 tests. In total, 85 tests were performed in the first 2 years of direct mutation testing, ten (11.8%) tests were mutation positive, 73 (85.91%) were negative and two (2.3%) were equivocal. The at-risk parent was alive in 54 (63.5%) cases. Four of the ten mutation positive candidates had parents who were alive and therefore received a prediction through their child. All centres included a discussion about the effect of testing on the 50% at-risk parent and all offered to see the parent for counselling. Of the 87 applicants for testing during 1994, 31 (35.6%) withdrew, this is higher than the 25% withdrawal rate for the 50% risk candidates. The candidates who withdrew were significantly younger and had more parents who were alive than those who continued with testing. Seven of the 31 candidates who withdrew from testing had at-risk parents who decided to be tested in the first instance. During the counselling process, issues were raised relating to pre-test agreements and family secrecy. This study indicates the importance of pre-test counselling and the involvement of the parent in the counselling process. 25% risk testing for HD is now being offered in the majority of UK centres. As more genes are identified for late-onset conditions, it is important that the complexities of 25% risk testing for late-onset conditions are not underestimated. This limited survey does not investigate how individual families cope with the psychological and social issues raised by this study and further research in this area is needed.

Adult↗

The triple-marker test in predicting fetal aneuploidy: a compromise between sensitivity and specificity.

OBJECTIVE: to review the contribution of unconjugated estriol in Down's syndrome detection, and influence of maternal age, cut-off choice, and population specificity on the balance between triple-marker test sensitivity and specificity. STUDY DESIGN: Prenatal karyotyping was performed in 2833 pregnant women, 73% of them over the age of 34. Duration of gestation was determined by ultrasound in 98% of women. Prior to amniocentesis, the serum levels of alpha-fetoprotein, human chorionic gonadotropin and unconjugated estriol were evaluated and corrected for weight. The risk of trisomy 21 was calculated for the first 986 subjects using default medians, and for 1847 by our population-specific medians. The cut-off was initially 1:300 at term, but the 1:100 and 1:200 risks were also tested. Down syndrome risk was calculated with alpha-fetoprotein and human chorionic gonadotropin combination as well. Linear logistic regression model was performed to test the ability of aneuploidy markers to classify patients into normal and trisomic groups. RESULTS: There were twelve cases of Down's syndrome, seven of trisomy 18, four of trisomy 13, and one trisomy 22. Four cases of aneuploidy (16.7%) referred to women younger than 35. With the cut-off risk of 1:300, detection rate was 87.5% and specificity 63.3%, and with 1:100, 66.7% and 79.5%, respectively. The sensitivity for Down's syndrome was from 75% for cut-off=1:100 to 92% for cut-off=1:300, while detection of other trisomies was less successful (58% and 83%, respectively). Exclusion of unconjugated estriol MoM from the risk calculations reduced detection rate by 33% and improved specificity by 4% independently of cut-off choice. Linear logistic regression analysis showed that only unconjugated estriol was able to correctly classify patients between normal and trisomy 21 (p=0.011, odds ratio=1.445), and normal and trisomy 18 (p=0.0023, odds ratio=1.96) groups. CONCLUSIONS: The unconjugated estriol significantly contributes in Down's syndrome detection with cost of slightly reduced specificity. The 1:300 risk caused an unfavorable compromise between sensitivity and specificity. A higher cut-off, 1:100, would indicate performance of amniocentesis in women aged 39 years and older, and in those aged 35-39 only after the screen-positive result.

Adult↗

Automated responsiveness test (ART) predicts loss of consciousness and adverse physiologic responses during propofol conscious sedation.

BACKGROUND: The authors evaluated a device designed to provide conscious sedation with propofol (propofol-air), or propofol combined with 50% nitrous oxide (N2O; propofol-N2O). An element of this device is the automated responsiveness test (ART), a method for confirming that patients remain conscious. The authors tested the hypotheses that the ART predicts loss of consciousness and that failure to respond to the ART precedes sedation-induced respiratory or hemodynamic toxicity. METHODS: The protocol consisted of sequential 15-min cycles in 20 volunteers. After a 15-min control period, propofol was infused to an initial target effect-site concentration of 0.0 microg/ml with N2O or 1.5 microg/ml with air. Subsequently, the propofol target effect-site concentration was increased by a designated increment (0.25 and 0.5 microg/ml) and the process repeated. This sequence was continued until loss of consciousness, as defined by an Observer's Assessment of Alertness/Sedation (OAA/S) score of 10/20 or less, or until an adverse physiologic event was detected. RESULTS: The OAA/S score at which only 50% of the volunteers were able to respond to the ART (P50) during propofol-N2O was 11.1 of 20 (95% confidence interval [CI]: 10.6-11.8); the analogous P50 was 11.8 of 20 (95% CI: 11.4-12.3) with propofol-air. Failure to respond to the ART occurred at a plasma propofol concentration of 0.7 +/- 0.6 microg/ml with propofol-N2O and 1.6 +/- 0.6 microg/ml with propofol-air, whereas loss of consciousness occurred at 1.2 +/- 0.8 microg/ml and 1.9 +/- 0.7 microg/ml, respectively. There were no false-normal ART responses. CONCLUSION: The ART can guide individual titration of propofol because failure to respond to responsiveness testing precedes loss of consciousness and is not susceptible to false-normal responses. The use of N2O with propofol for conscious sedation decreases the predictive accuracy of the ART.

Adult↗

Early risk assessment of severe preeclampsia: admission battery of symptoms and laboratory tests to predict likelihood of subsequent significant maternal morbidity.

OBJECTIVE: This study was undertaken to investigate the utility of an admission battery of findings and laboratory data in the discrimination of patients with severe preeclampsia with or without HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome at high risk for development of significant maternal morbidity. STUDY DESIGN: The clinical and laboratory findings at hospital admission for 970 patients with severe preeclampsia with or without HELLP syndrome were studied retrospectively to develop parameters associated with low, moderate, and high risks for the subsequent development of significant maternal morbidity involving the hematologic and coagulation, cardiopulmonary, and hepatorenal systems. RESULTS: Nausea and vomiting and epigastric pain are independent risk factors for complicated severe preeclampsia. Results of a panel of tests with values including lactate dehydrogenase level >1400 IU/L, aspartate aminotransferase level >150 IU/L, alanine aminotransferase level >100 IU/L, uric acid level >7.8 mg/dL, serum creatinine level >1.0 mg/dL, and 4+ urinary protein by dipstick can be used to discriminate the patient at high risk for significant maternal morbidity. Concentrations of lactate dehydrogenase, aspartate aminotransferase, and uric acid above these cut points have the strongest predictive value and are risk additive with worsening thrombocytopenia. CONCLUSION: The presence of nausea and vomiting, epigastric pain, or both in association with admission laboratory values that are in excess of the cutoffs for lactate dehydrogenase, aspartate aminotransferase, and uric acid concentrations or for all 6 tests is predictive of high risk of morbidity for the patient with severe preeclampsia. These factors are independent of and additive with the rising maternal risk associated with decreasing platelet count.

Alanine Transaminase↗

Dipyridamole-thallium tests are predictive of severe cardiac arrhythmias in patients with left ventricular hypertrophy.

In a population of patients with chronic renal failure (CRF) and a high prevalence of left ventricular hypertrophy (LVH) undergoing chronic hemodialysis, we investigated the association between the results of dipyridamole-thallium tests (DTTs) and the occurrence of ventricular arrhythmias. We observed a positive significant association between positive DTTs and the occurrence of severe forms of ventricular arrhythmias. A significant association was also observed between the presence of severe LVH and the occurrence of severe ventricular arrhythmias. However, no association was found between the presence of LVH and the positivity of the DTT. As most of our patients with positive DTTs had unimpaired coronary circulations, we conclude that positive DTTs, although falsely indicative of impaired myocardial blood supply, does have an important clinical relevance, indicating increased risk of morbidity (and, possibly, mortality) due to ventricular arrhythmias in a population of CRF patients submitted to chronic renal function replacement program.

Adolescent↗

Specificity of allergen skin testing in predicting positive open food challenges to milk, egg and peanut in children.

BACKGROUND: The specificity of allergen skin prick testing to diagnose clinically relevant food allergy is controversial. OBJECTIVES: To determine the specificity of the allergen weal diameter to correctly identify children who react on formal open food challenges. METHODS: Over a 9-year period children referred to a tertiary allergy clinic for the evaluation of suspected food allergy were prospectively studied. Allergen skin prick testing to cow milk, egg white and peanut extracts (Dome-Hollister-Stier, Spokane, WA, USA) was undertaken using a lancet technique. All children underwent open food challenges to the relevant food(s) in a hospital clinic. Challenges were classified as positive, if objective signs were seen; negative, if the child could tolerate normal quantities of the food, daily, for one week; or inconclusive if none of the former criteria were met. RESULTS: Five hundred and fifty-five challenges were undertaken in 467 children: 339 challenges to cow milk, 121 to egg, and 95 to peanut. Fifty-five percentage of challenges were positive, 37% negative, and 8% inconclusive. For each food it was possible to identify a skin weal diameter at, and above, which negative reactions did not occur: cow milk, 8 mm; egg, 7 mm; peanut, 8 mm. In contrast, positive reactions could occur with a skin wheal diameter of 0 mm. CONCLUSIONS: In this high risk referral population it was possible to define skin weal diameters to egg, milk and peanut above which open oral food challenges were positive (100% specificity). By utilizing these measurements the need for formal food challenges can be reduced.

Animals↗

New screening test to predict the potential impact of ivermectin-contaminated cattle dung on dung beetles.

According to European Union recommendations, a test method has been developed to evaluate the effects of veterinary pharmaceuticals on dung feeding insects. This test method was evaluated with the dung beetle Aphodius constans by using fecal residues of ivermectin after a pour-on administration. Dung of different age (and thus containing different concentrations of ivermectin) as well as mixtures of highly-contaminated spiked dung with untreated control dung were studied in five test runs in two laboratories. The concentration of ivermectin (active substance; a.s.) in the dung samples was verified analytically. The main test endpoint was the survival of first instar larvae. The LC50 using dung directly obtained from treated cattle ranged from 470 to 692 microg a.s. kg(-1) dung (dry weight; d.w.) and 67 to 97 microg a.s. kg(-1) dung (fresh weight; f.w.). Using mixtures, the outcome of two tests was almost identical: 770 to 781 microg a.s. kg(-1) dung (d.w.); 109 to 132 microg a.s. kg(-1) dung (f.w.). In comparison to the LC50 values obtained when ivermectin was spiked in control dung at several concentrations (LC50 880-985 microg a.s. kg(-1) dung (d.w.)), the LC50 values were again very similar. Three conclusions can be drawn from these results. The proposed test method seems to be robust and allows for the initiation of an international validation process (including ringtesting). Because of only small differences found in tests in which the test substance was spiked into control dung and those in which dung from treated cattle was applied, the use of a standard test method is proposed. The effects of ivermectin on ecologically relevant dung beetles obtained in a standardised test method reflect the results from field studies and are in the range of environmentally relevant concentrations.

Animals↗

Antenatal testing to predict outcome in pregnancies with unexplained antepartum haemorrhage.

OBJECTIVE: To investigate whether Doppler studies of placental perfusion and antenatal tests for fetal hypoxia can identify reduced placental functional reserve in women with unexplained antepartum haemorrhage (APH). DESIGN: A prospective, longitudinal study. SETTING: Fetal Surveillance Unit, King's College Hospital, London. SUBJECTS: 48 women with bleeding from the genital tract after 26 weeks gestation without a clinical diagnosis of abruption or ultrasound evidence of placenta praevia. INTERVENTIONS: Fetal surveillance by Doppler measurements of the umbilical and uterine arteries, biophysical profile scoring and computerized measurement of the mean minute range of FHR variation. MAIN OUTCOME MEASURES: A poor outcome was defined by one or more of the following: (i) birthweight greater than 2SD below the normal mean for gestational age and sex, (ii) abnormal FHR pattern in labour resulting in operative delivery, (iii) umbilical vein blood pH at delivery less than 7.15, (iv) a 5-min Apgar score less than 7. RESULTS: Fifteen of the 48 pregnancies had a poor outcome; seven occurred in the 10 women delivered preterm (less than 37 weeks) and eight in the 36 women delivered between 37 and 42 weeks. Two women were delivered after 42 weeks and both infants had a good outcome. The results of Doppler studies of uterine and umbilical arteries, fetal biophysical profile or FHR variation were not significantly different between the two outcome groups. The 36 pregnancies delivered between 37 and 42 weeks were matched retrospectively for maternal age, parity and race with 36 pregnancies without APH; there was no significant difference in outcome between the women with unexplained APH and the matched comparison group. CONCLUSION: Morbidity related to unexplained APH is associated with preterm delivery rather than with damage to utero-placental function.

Female↗