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Computation of affinity and selectivity: binding of 2,4-diaminopteridine and 2,4-diaminoquinazoline inhibitors to dihydrofolate reductases.

Binding energy calculations for complexes of mutant and wild-type human dihydrofolate reductases with 2,4-diaminopteridine and 2,4-diaminoquinazoline inhibitors are reported. Quantitative insight into binding energetics of these molecules is obtained from calculations based on force field energy evaluation and thermal sampling by molecular dynamics simulations. The calculated affinity of methotrexate for wild-type and mutant enzymes is reasonably well reproduced. Truncation of the methotrexate glutamate tail results in a loss of affinity by several orders of magnitude. No major difference in binding strength is predicted between the pteridines and the quinazolìnes, while the N-methyl group present in methotrexate appears to confer significantly stronger binding. The recent improvement, which is used here, of our linear interaction energy method for binding affinity prediction, as well as problems with treating charged and flexible ligands are discussed. This approach should be suitable in a drug discovery context for prediction of binding energies of new inhibitors prior to their synthesis, when some information about the binding mode is available.

Computer Simulation↗

A comparison of methods for estimating individual pharmacokinetic parameters.

Characteristics of the methods for estimating individual pharmacokinetic parameters are compared both theoretically and numerically. The methods examined represent the range of most of modern methods and include the ordinary least squares, iteratively reweighted least squares, extended least squares, generalized least squares, maximum quasi-likelihood and its extended scheme, and minimum relative entropy methods. When the function representing the mean itself is used as a variance function, which may be then related to a Poisson distribution, the iteratively reweighted least squares estimator and maximum quasi-likelihood estimator are both identical to that of the minimum relative entropy method. These methods work by minimizing a kind of relative entropy between observed data and corresponding theoretical values. Furthermore, these methods guarantee agreement between the sum of the observed values and the estimate of the sum. This relation does not hold in general for the other estimators. The sum can, in a sense, be viewed as an approximation of the area under the curve. In addition, it is shown by numerical study that these methods are robust against the misspecification of the variance model and work as effectively as such sophisticated methods as the extended least squares, generalized least squares, and maximum extended quasi-likelihood methods. These sophisticated methods require complicated numerical optimization techniques and should be used only in cases where the estimation of the variance function is demanded. In the other cases, the method of minimum relative entropy or its equivalent is sufficient or even preferable for estimating individual pharmacokinetic parameters.

Computer Simulation↗

Pharmacokinetic-based minibolus delivery as an alternative to continuous infusion for drugs that exhibit a biophase lag.

The presence of a biophase compartment in a pharmacokinetic model indicates that the response to an administered dose of drug is damped such that the time to peak effect occurs after the peak concentration in the bloodstream. This phenomenon, which is common to most intravenous anesthetic agents, can be exploited by a drug delivery method that administers minibolus doses of drug rather than a continuous infusion. Through analysis of the frequency response behavior of the biophase compartment, a bolus magnitude and dose frequency or interval (1/frequency) can be chosen such that the oscillation in drug effect is minimized even though the plasma concentration may be changing significantly with each supplemental dose. A pharmacokinetic and pharmacodynamic based method for calculating the bolus dose size and dosing interval is presented. The trade-off between dose interval and change in drug effect is exemplified through computer simulation of this strategy applied to delivery of the neuromuscular blocking agent pancuronium. The method provides a repetitive perturbation to the pharmacokinetic and pharmacodynamic system that can aid in model parameter identification during closed loop applications.

Body Fluid Compartments↗

Paper and electronic diaries: Too early for conclusions on compliance rates and their effects--Comment on Green, Rafaeli, Bolger, Shrout, and Reis (2006).

This commentary discusses 4 issues relevant to interpretation of A. S. Green, E. Rafaeli, N. Bolger, P. E. Shrout, and H. T. Reis's (2006) article: (a) Self-reported compliance in medical settings has generally been substantially higher than verified compliance, suggesting that this is not a rare phenomenon; (b) none of the studies reported in Green et al. explicitly verified paper diary compliance; (c) the impact of participant motivation on diary compliance is unknown, and it may be difficult for researchers to accurately assess it in their own studies; and (d) without objective verification of diary compliance, analysis of the effects of noncompliance on data quality is difficult to interpret. The authors conclude that compliance in paper diaries and the effects of noncompliance on data quality are still unsettled issues.

Adolescent↗

Dear diary, is plastic better than paper? I can't remember: Comment on Green, Rafaeli, Bolger, Shrout, and Reis (2006).

In this commentary, the authors discuss the implications of A. S. Green, E. Rafaeli, N. Bolger, P. E. Shrout, and H. T. Reis's (2006) diary studies with respect to memory. Researchers must take 2 issues into account when determining whether paper-and-pencil or handheld electronic diaries gather more trustworthy data. The first issue is a matter of prospective memory, and the second is a matter of reconstructive memory. The authors review the research on these issues and conclude that regardless of the type of diary researchers use, several factors can conspire to produce prompt--but inaccurate--data.

Adolescent↗

MRI volumetric analysis in rasmussen encephalitis: a longitudinal study.

PURPOSE: Rasmussen encephalitis is a progressive inflammatory process with difficult-to-control focal or lateralized seizure activity, leading to hemispheric dysfunction and atrophy in advanced stages. Anatomic changes of atrophy may be subtle in earlier phases of the disease, and progressive changes on serial scans may be difficult to detect. We report a case of early-stage Rasmussen encephalitis with a relatively stable clinical course in whom we performed magnetic resonance imaging (MRI)-based volumetric analysis over an interval of 1 year, to assess for volumetric changes. METHODS: Volumetric analysis was performed on two successive MRI scans obtained at age 5 and 6 years, by using the CARDVIEWS program (J Cogn Neurosci, 1996). The images were segmented into gray- and white-matter structures according to signal intensity of their borders semiautomatically, with manual corrections. The cerebral cortex was further subdivided into smaller parcellation units according to anatomic landmarks identifiable on MRI. RESULTS: Stable left cerebral hemispheric atrophy and progressive atrophy in the left precentral gyrus, left inferior frontal gyrus, and left cerebellar atrophy were detected over the 1-year interval. CONCLUSIONS: Volumetric analysis enables early detection and quantification of anatomic changes, identification of focal involvement, and assists in determining the severity of disease and timing for surgical interventions such as hemispherectomy.

Atrophy↗

[Anthropometric 3D-body scanning in idiopathic scoliosis].

PURPOSE: A new, non-invasive method of 3D-measurement is presented which allows the spatial recording of the entire body surface in scoliotic deformities. The application of the system is examined to raise automatically anthropometric data of patients with scoliosis. METHOD: 32 patients with idiopathic scoliosis were examined (average age 15.3 years, 25 girls and 7 boys, Cobb angles between 11 and 72 degrees). The whole body recording is carried out with a 3D laser scanner. During the measuring process the patient is standing in a frame. Within the measuring time of 15 seconds the body surface is registered by lasers and four cameras. The measured values are converted to a digital 3D model. The resolution is up to 1 mm. On the digital 3D model an automatic calculation of defined anthropometric parameters were carried out. Each patient was measured twice. RESULTS: In all patients a virtual 3D model with a high surface accuracy was obtained. Was the model the typical body asymmetries in scoliotic deformities were visible. The automatic calculation shows a mean deviation of the second measurements between 0.23 and 0.71 cm. The reproducibility depended on the type of the measured parameters. CONCLUSIONS: The laser scanning system allows a rapid, touchless and accurate 3D measurement of the whole body in scoliotic deformities. To determine anthropometric parameters the reproducibility of the automatic calculation is sufficient in most parameters.

Adolescent↗

An adjusted two one-sided t-test for the assessment of bioequivalence with multiple doses.

In medical practice, it has been realized that noncompliance may have an impact on the therapeutic effect of a drug therapy, regardless of race, gender, and education of patients. Therefore, it is of interest to study the impact of noncompliance on drug absorption through in vivo testing. Efron and Feldman examined dose-response relationship when noncompliance is an issue. In this paper, we study bias and variation induced by noncompliance for pharmacokinetic parameters such as the area under the curve (AUC). We use bioequivalence testing as an example to demonstrate that a false conclusion could be drawn if one ignores the effect of noncompliance. We propose a new test for the assessment of bioequivalence in multiple doses. The proposed test appears to have a substantial improvement over the usual two one-sided tests based on a simulation study.

Area Under Curve↗

A study of the image discrepancies due to object time-dependence in transmission and emission tomography.

In conventional computed tomography (CT) imaging of a point object, projection filtering causes the back-projected contributions to image positions away from the point to sum to zero. If the point object intensity is time-dependent, and all the projections are not acquired simultaneously, this cancellation cannot be complete and artefacts result. Loss of spatial invariance makes a general linear-systems approach to the problem impossible. We have studied the properties of such artefacts by the computer simulation of decaying exponential time-dependence in three different spatial distributions and four transmission and emission CT geometries. Spatially complex time-dependent objects typically produce artefacts that can be treated as an additional broad-spectrum noise source with a power comparable to that of other CT noises. Artefacts from broad ranges of similar time-dependence can add coherently to cause patches of artefact, particularly in geometries with a strong correlation between projection acquisition time and projection angle. As expected, artefacts are reduced for all geometries as scan duration is reduced. In our model, with a most rapid decay constant of 1.2 min-1, negligible artefacts were observed for a six second scan duration.

Computers↗

FDTD calculations of the whole-body averaged SAR in an anatomically realistic voxel model of the human body from 1 MHz to 1 GHz.

This paper presents finite-difference time-domain (FDTD) calculations of the whole-body averaged SAR in an anatomically realistic voxel model of the human body. This model, NORMAN, consists of approximately 9 million voxels, of 2 mm dimension in the adult phantom, segmented into 37 tissue types. SAR values are presented for an adult phantom and for scaled 10, 5 and 1 year old models, grounded and isolated in air from 1 MHz to 1 GHz for plane wave exposure. External electric field values corresponding to a whole-body averaged SAR of 0.4 W kg-1 are also presented.

Absorption↗

A sticker-based model for DNA computation.

We introduce a new model of molecular computation that we call the sticker model. Like many previous proposals it makes use of DNA strands as the physical substrate in which information is represented and of separation by hybridization as a central mechanism. However, unlike previous models, the stickers model has a random access memory that requires no strand extension and uses no enzymes; also (at least in theory), its materials are reusable. The paper describes computation under the stickers model and discusses possible means for physically implementing each operation. Finally, we go on to propose a specific machine architecture for implementing the stickers model as a microprocessor-controlled parallel robotic workstation. In the course of this development a number of previous general concerns about molecular computation (Smith, 1996; Hartmanis, 1995; Linial et al., 1995) are addressed. First, it is clear that general-purpose algorithms can be implemented by DNA-based computers, potentially solving a wide class of search problems. Second, we find that there are challenging problems, for which only modest volumes of DNA should suffice. Third, we demonstrate that the formation and breaking of covalent bonds is not intrinsic to DNA-based computation. Fourth, we show that a single essential biotechnology, sequence-specific separation, suffices for constructing a general-purpose molecular computer. Concerns about errors in this separation operation and means to reduce them are addressed elsewhere (Karp et al., 1995; Roweis and Winfree, 1999). Despite these encouraging theoretical advances, we emphasize that substantial engineering challenges remain at almost all stages and that the ultimate success or failure of DNA computing will certainly depend on whether these challenges can be met in laboratory investigations.

Computer Simulation↗

Progressive striatal and cortical dopamine receptor dysfunction in Huntington's disease: a PET study.

We have studied the progression of striatal and extrastriatal post-synaptic dopaminergic changes in a group of 12 patients with Huntington's disease using serial (11)C-raclopride PET, a specific marker of D2 dopamine receptor binding. All patients had two (11)C-raclopride PET scans 29.2 +/- 12.8 months apart, and six of them had a third scan 13.2 +/- 3.9 months later. We found a mean annual 4.8% loss of striatal (11)C-raclopride binding potential (BP) between the first and second scans, and a 5.2% loss between the second and third scans. Statistical Parametric Mapping (SPM) localized significant baseline reductions in (11)C-raclopride BP in both striatal and extrastriatal areas, including amygdala, temporal and frontal cortex in Huntington's disease compared with normal subjects matched for age and sex. When the (11)C-raclopride scans performed 29 months after the baseline scans were considered, SPM revealed further significant striatal, frontal and temporal reductions in (11)C-raclopride BP in Huntington's disease. Cross-sectional Unified Huntington's Disease Rating Scale (UHDRS) scores correlated with (11)C-raclopride binding, but there was no correlation between individual changes in UHDRS motor scores and changes in striatal binding. Performance on all neuropsychological measures deteriorated with time but only the accuracy score of the one-touch Tower of London test correlated significantly with striatal and putamen D2 binding. In summary, serial (11)C-raclopride PET demonstrates a linear progression of striatal loss of D2 receptors in early clinically affected Huntington's disease patients over 3 years. SPM also revealed a progressive loss of temporal and frontal D2 binding. Changes over time in clinical scores and in neuropsychological assessments, except for measures of planning, did not correlate with striatal D2 binding. This probably reflects both contributions from other affected brain structures and high variance in these measures.

Adult↗

Do general practice computer systems assist in medical audit?

This study was designed to assess the capabilities of current general practice computer software to perform medical audit. A total of 43 general practice clinical software suppliers were asked to complete a questionnaire consisting of general questions concerning their systems' responses to 85 audit questions that a practice might wish to ask in the areas of quality of care and contractual compliance. It was assumed that all systems had full patient data. Fourteen installations representing 14 systems that had been randomly selected from the responders were visited to validate the suppliers' responses. Thirty-two (74%) suppliers responded to the questionnaire and they represented 7696 installations. One supplier marketed two distinct systems giving 33 systems for analysis. The majority (52%) of responding suppliers had between 0 and 50 installations. Many shortfalls in auditing capability were demonstrated, e.g. 24% of systems were unable to audit the clinical content of a patient review, 48% were unable to audit the numbers of acute and repeat prescriptions, 51% were unable to audit emergency admissions, 70% were unable to audit the length of time a drug had been prescribed for and 85% were unable to audit the continuity of patient care. Limitations in the ability to perform even basic medical audits were demonstrated among current general practice computer systems. These have implications for the development of medical audit. Seven (21%) of the systems had no facilities for statistical analysis including percentages and 8 (24%) had no graphical abilities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Lesion formation in radiofrequency surgery of the tongue base.

OBJECTIVES: Temperature controlled radiofrequency volumetric tissue reduction (RFVTR) of the tongue base is a minimally invasive technique for the treatment of obstructive sleep apnea. But despite its widespread use, little is yet known about in vivo effects in humans. Such knowledge would be essential for evidence-based criteria in the selection of energy application. METHODS: In a preparatory in vitro study, porcine tongues were preserved in growing medium. Lesions with different amounts of energy were applied, and maximum diameters were assessed. In the in vivo study, 11 patients were treated with RFVTR at the tongue base by employing different energy levels (800, 600, 400, or 200 J) on two application sites. Magnetic resonance imagery scans were performed 4 to 6, 8 to 10, and 24 hours after surgery. An inversion recovery technique was used to visualize the lesions. RESULTS: RFVTR created lesions at the porcine tongue from 50 J and higher. Maximum lesion sizes were achieved with 400 J. In vivo, all the lesions were clearly visible in the postoperative scans. Lesion size increased with the amount of energy applied. Maximum diameters were created from 600 J and higher. Higher amounts of energy only resulted in a slight increase in lesion length. CONCLUSIONS: The application of 600 J at 85 degrees C leads to optimal lesion sizes. Higher amounts of energy will not lead to a relevant increase in tissue necrosis. With regard to the time needed for application, 600 J appears to be the ideal adjustment for energy delivery in the treatment of the human tongue.

Airway Obstruction↗

Building messaging substrates for Web and Grid applications.

Grid application frameworks have increasingly aligned themselves with the developments in Web services. Web services are currently the most popular infrastructure based on service-oriented architecture (SOA) paradigm. There are three core areas within the SOA framework: (i) a set of capabilities that are remotely accessible, (ii) communications using messages and (iii) metadata pertaining to the aforementioned capabilities. In this paper, we focus on issues related to the messaging substrate hosting these services; we base these discussions on the NARADABROKERING system. We outline strategies to leverage capabilities available within the substrate without the need to make any changes to the service implementations themselves. We also identify the set of services needed to build Grids of Grids. Finally, we discuss another technology, HPSEARCH, which facilitates the administration of the substrate and the deployment of applications via a scripting interface. These issues have direct relevance to scientific Grid applications, which need to go beyond remote procedure calls in client-server interactions to support integrated distributed applications that couple databases, high performance computing codes and visualization codes.

Computer Simulation↗

Reliable multicast for the Grid: a case study in experimental computer science.

In its simplest form, multicast communication is the process of sending data packets from a source to multiple destinations in the same logical multicast group. IP multicast allows the efficient transport of data through wide-area networks, and its potentially great value for the Grid has been highlighted recently by a number of research groups. In this paper, we focus on the use of IP multicast in Grid applications, which require high-throughput reliable multicast. These include Grid-enabled computational steering and collaborative visualization applications, and wide-area distributed computing. We describe the results of our extensive evaluation studies of state-of-the-art reliable-multicast protocols, which were performed on the UK's high-speed academic networks. Based on these studies, we examine the ability of current reliable multicast technology to meet the Grid's requirements and discuss future directions.

Computer Simulation↗

A collocation--Galerkin finite element model of cardiac action potential propagation.

A new computational method was developed for modeling the effects of the geometric complexity, nonuniform muscle fiber orientation, and material inhomogeneity of the ventricular wall on cardiac impulse propagation. The method was used to solve a modification to the FitzHugh-Nagumo system of equations. The geometry, local muscle fiber orientation, and material parameters of the domain were defined using linear Lagrange or cubic Hermite finite element interpolation. Spatial variations of time-dependent excitation and recovery variables were approximated using cubic Hermite finite element interpolation, and the governing finite element equations were assembled using the collocation method. To overcome the deficiencies of conventional collocation methods on irregular domains, Galerkin equations for the no-flux boundary conditions were used instead of collocation equations for the boundary degrees-of-freedom. The resulting system was evolved using an adaptive Runge-Kutta method. Converged two-dimensional simulations of normal propagation showed that this method requires less CPU time than a traditional finite difference discretization. The model also reproduced several other physiologic phenomena known to be important in arrhythmogenesis including: Wenckebach periodicity, slowed propagation and unidirectional block due to wavefront curvature, reentry around a fixed obstacle, and spiral wave reentry. In a new result, we observed wavespeed variations and block due to nonuniform muscle fiber orientation. The findings suggest that the finite element method is suitable for studying normal and pathological cardiac activation and has significant advantages over existing techniques.

Action Potentials↗

Quantification analysis of 123I-IPT single photon emission computed tomography uptake in the striatum of parkinsonism with the standard magnetic resonance template.

This study evaluated the striatal specific binding ratio (SBR), the anterior to posterior ratio of the striatum (APR) and its reproducibility by employing a template-based registration (TBR) method using the coregistered to the standard T1 magnetic resonance (MR) template (SMRT) as a replacement for the MR image of each patient. The 123I-IPT single photon emission computed tomography (SPECT) images of 30 patients with Idiopathic Parkinson's disease (IPD) and 11 normal controls were analyzed. The region of interest (ROI) was positioned manually in the same slice showing the highest striatal activity using the manual ROI method, while the ROI were positioned automatically in the mid striatal slice of the SPECT image coregistered to the SMRT. The SBR obtained using the TBR method showed a strong correlation with those using the manual method in all groups: normal controls (r = 0.851, P = 0.001), early IPD (r = 0.841, P < 0.001), and severe IPD (r = 0.702, P = 0.007). The APR obtained by the TBR correlated with those using the manual method in only the early IPD (r = 0.72, P = 0.001), while those obtained using the manual method showed no correlation in the three groups (P > 0.05). The reproducibility (rmsCV) of the TBR method was 7.2% (normal controls, 5.2%; mild IPD, 4.2%; severe IPD, 10.8%), while the reproducibility of the manual method was 31% (normal controls, 19.7%; mild IPD, 21.7%; severe IPD, 46.2%). This shows that the use of 123I-IPT SPECT for assessing IPD is affected by the method used to position the striatal ROI. This study showed that the TBR method using the SMRT is useful in diagnosing the IPD and assessing the disease severity with a high reproducibility, indicating a possibility of using the TBR method as a good replacement for the manual method.

Adult↗