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[An index based on the age and free thyroxine rate predicts the likelihood of Graves' disease in hyperthyroidism].

PURPOSE: Graves' disease patients are generally younger and have more severe symptoms than other thyrotoxic patients. We established an index based on the normalized free thyroxine rate and age, capable of predicting Graves' disease in thyrotoxic patients. METHODS: The predictive index was established from a discriminant analysis from a retrospective population of 114 thyrotoxic patients and its predictivity was confirmed by cross-validation on the same population. RESULTS: The index IGD = 41.38 - age + 37.05 x in (normalized free T4) classifies accurately 80.7% of the patients (CI 95%: 72.2-87.5). Sensitivity is 78.5% (CI 95%: 66.5-87.7). Specificity is 83.7% (CI 95%: 70.3-92.7). Predictive positive value is 86.4% (CI 95%: 75.0-94.0). Negative predictive value is 74.5% (CI 95%: 61.0-85.3). Likelihood ratio of Graves' disease in case of prediction by the index is 4.81 (CI 95%: 2.66-9.32). Likelihood ratio of Graves' disease in case of non-prediction by the index is 0.26 (IC 95%: 0.16-0.40). CONCLUSION: A simple index based on the normalized free thyroxine rate and age provides an early diagnosis orientation toward Graves' disease in thyrotoxic patients who are waiting for complementary investigations.

Adult↗

Predictive value of Singh index and bone mineral density measured by quantitative computed tomography in determining the local cancellous bone quality of the proximal femur.

OBJECTIVE: The purpose of this study was to assess the predictive value of the Singh index as well as quantitative computed tomography for the in vitro local mechanical competence of the cancellous bone of the proximal femur. DESIGN: An experimental study examining the relation between mechanical properties and bone mineral density of the femoral neck determined in vitro and the clinical estimated Singh index on X-rays. BACKGROUND: Evaluation of the predictive value of the Singh index, an inexpensive and simple technique for the mechanical properties of the cancellous bone of the proximal femur. METHODS: The bone quality of the proximal femur of 34 patients undergoing total hip replacement was estimated by roentgenography using the Singh index. Bone mineral density was quantified by quantitative computed tomography using cylindrical cancellous bone biopsies harvested during the total hip replacement procedure by a new biopsy method. The mechanical properties of the bone specimens (Young's modulus, strength and maximum energy absorption E(max)) were measured by mechanical testing of the bone biopsies. RESULTS: A strong correlation of the Singh index versus material properties of cancellous bone was noted (r=0.66 for Young's modulus, r=0.73 for strength and r=0.69 for E(max), P<0.0001). The correlations of bone mineral density measured by quantitative computed tomography versus Young's modulus, strength and energy absorption E(max) were significant. Strength was predicted best (r=0.82; P<0.0001), followed by E(max) (r=0.79; P<0.0001) and Young's Modulus (r=0.73; P<0.0001). CONCLUSIONS: We conclude, that assessment of bone mineral density by quantitative computed tomography is a reliable and precise method for the estimation of cancellous bone material properties. The Singh index provides a rough estimate for the mechanical competence of the proximal femur. It is inexpensive, simply to assess and can in some cases replace the measurement of bone mineral density, notably in cases of marked decrease in bone density.

Aged↗

Structure determination of tubular crystals of membrane proteins. I. Indexing of diffraction patterns.

Indexing of diffraction patterns is the starting point of every crystallographic analysis. The diffraction patterns from helical particles consist of a series of layer-planes, the indexing of which involves the assignment of the start numbers of the helices that contribute to the layer-planes. The indexing could be challenging if the diameter of the helical particle is large and if the conventional indexing methods based on selection rule is used. Presented here is a tutorial on how to index them using (h, k; n) indexing method, which is particularly useful for tubular crystals of membrane proteins.

Calcium-Transporting ATPases↗

A conformal index (COIN) to evaluate implant quality and dose specification in brachytherapy.

PURPOSE: To propose a new index (COIN) that can be easily understood and computed to assess high dose rate (HDR) brachytherapy interstitial implant quality and dose specification and is an improvement on existing indexes. METHODS AND MATERIALS: The COIN index is based on an extension of dose-volume histograms and employs an analogous concept to that of cost-benefit analysis, which has already been applied to quality-of-life assessments for two alternative treatment protocols. The COIN index calculation methodology is shown for two cases: with and without critical structures. An analysis is given of dose distributions for two planning treatment volumes (PTV) of simple geometrical shape, applying both the rules of the Paris system and that of the "Offenbach" system. 40 patients who have received interstitial implants form the clinical material. With current HDR brachytherapy technology both for dose delivery, using remote afterloaders, and for three-dimensional (3D) treatment planning, it is now possible to relatively easily plan conformal brachytherapy treatments that would have been impossible with manual afterloading techniques and two-dimensional (2D) treatment planning. RESULTS: Examples of the use of the COIN index are presented for experimental and clinical data. CONCLUSIONS: The results show that COIN is a useful and practical index to improve the quality of treatment of interstitial brachytherapy implants. Further work will be undertaken with a larger population of implanted cancer patients and a subdivision of the results by treatment site.

Algorithms↗

An echocardiographic index for separation of right ventricular volume and pressure overload.

Abnormal motion of the interventricular septum has been described as an echocardiographic feature of both right ventricular volume and pressure overload. To determine if two-dimensional echocardiography can separate these two entities and distinguish them from normal, geometry and motion of the interventricular septum in short-axis views of the left ventricle were evaluated in 12 normal subjects and 35 patients undergoing cardiac catheterization. Thirteen of the 35 patients had uncomplicated atrial septal defect with associated right ventricular volume overload, but no elevation in pulmonary artery pressure. The 22 remaining patients had a pulmonary artery systolic pressure greater than 40 mm Hg and, thus, constituted the group with right ventricular pressure overload. An eccentricity index, defined as the ratio of the length of two perpendicular minor-axis diameters, one of which bisected and was perpendicular to the interventricular septum, was obtained at end-systole and end-diastole. In all normal subjects, the eccentricity index at both end-systole and end-diastole was essentially 1.0, as would be expected if the left ventricular cavity was circular in the short-axis view. In patients with right ventricular volume overload, the eccentricity index was approximately 1.0 at end-systole, but was significantly increased at end-diastole (mean eccentricity index = 1.26 +/- 0.12) (p less than 0.001). In patients with right ventricular pressure overload, the eccentricity index was significantly greater than 1.0 at both end-systole and end-diastole (1.44 +/- 0.16 and 1.26 +/- 0.11, respectively) (p less than 0.001). These results suggest that an index of eccentric left ventricular shape which reflects abnormal motion of the interventricular septum can be defined.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Use of an anesthesia cerebral monitor bispectral index to assess burst-suppression in pentobarbital coma.

A seven-year-old child with generalized status epilepticus who was placed in a barbiturate coma was monitored with the bispectral index monitor in addition to the standard full channel electroencephalogram. This child had a low bispectral index number and high suppression ratio on the bispectral index monitor when the desired level of pentobarbital coma was induced. There was excellent correlation of the bispectral index monitor to the suppression ratio. The burst rate also correlated well to the bispectral index number and to the suppression ratio. Therefore the bispectral index monitor could allow the patient in barbiturate coma to leave the intensive care unit for diagnostic or therapeutic procedures and may one day replace the full-channel electroencephalogram in the management of patients in barbiturate coma.

Anesthesia↗

Correlation of the Tei index with invasive measurements of ventricular function in a porcine model.

BACKGROUND: The Doppler myocardial performance (Tei) index has been reported to be clinically useful in assessing left ventricular systolic and diastolic function in both adults and children. However, there are limited data to compare the Tei index with invasive measurements of ventricular function. We used a porcine model to directly correlate the Tei index with invasive indices of systolic and diastolic function. METHODS: Pressure volume loops were obtained from 10 pigs (32-45 kg). A micromanometer and a conductance catheter were placed in the left ventricle to record pressure and volume, respectively. A flow probe was placed around the ascending aorta to record cardiac output. Baseline pressure volume loops were generated during preload reduction through caval occlusion. Epicardial echocardiograms were performed just before the caval occlusion. Invasive indices including preload recruitable stroke work, ventricular stiffness constant, and cardiac output were assessed, as were noninvasive echocardiographic indices including Tei index and ejection fraction. An ischemic insult, ventricular fibrillation, was induced to alter ventricular function. After cardioversion and 40 minutes of reperfusion, echocardiographic and invasive measurements were repeated. RESULTS: There was a statistically significant inverse relationship between the percent change in Tei and the percent change in preload recruitable stroke work after ventricular fibrillation (r = -0.70, P =.02), although the correlation between the actual values of Tei and preload recruitable stroke work were not statistically significant. There was a statistically significant inverse relationship between the percent change in Tei and the percent change in cardiac output (r = -0.65, P =.03). There was a direct correlation between the value of Tei and the ventricular stiffness constant at baseline (r = 0.63, P <.05). As anticipated, the value of Tei was inversely related to ejection fraction by epicardial echocardiogram at baseline (r = -0.85, P <.001). The percent change in Tei was inversely related to the percent change in ejection fraction as well (r = -0.69, P <.05). CONCLUSIONS: This animal model is one of the first studies to demonstrate a direct correlation between the Tei index and systolic and diastolic invasive measurements of ventricular function. This supports the clinical use of this index as a measure of global ventricular function.

Animals↗

Comparison of velocity and volumetric indexes of left ventricular filling during increased heart rate with exercise and amyl nitrite.

Physiologic variables, such as heart rate, affect the noninvasive indexes of left ventricular filling, complicating the interpretation of these indexes for clinical assessment of diastolic function. We compared the effect in normal subjects of increased heart rate provoked by both exercise and amyl nitrite on noninvasive velocity and volumetric indexes of left ventricular filling. Velocity indexes were affected in a different pattern with exercise compared with amyl nitrite because peak E wave velocity and relative atrial contribution to filling increased with exercise. In contrast, the volumetric index of rapid left ventricular filling increased similarly with both mechanisms. These findings demonstrate the importance of recognizing the different effects on indexes of left ventricular filling when heart rate is increased by different methods.

Adult↗

Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements.

A simple, reproducible, noninvasive Doppler index for the assessment of overall cardiac function has been described previously. The purpose of this study was to correlate the Doppler index with accepted indexes of cardiac catheterization of left ventricular performance. Thirty-four patients with ischemic heart disease or idiopathic dilated cardiomyopathy prospectively underwent a simultaneous cardiac catheterization and Doppler echocardiographic study. Invasive measurements of peak +dP/dt, peak -dP/dt, and tau were obtained from the high-fidelity left ventricular pressures. A Doppler index of myocardial performance was defined as the summation of isovolumetric contraction and relaxation time divided by ejection time. There was a correlation between Doppler measurement of isovolumetric contraction time and peak +dP/dt (r = 0.842; p < 0.0001) and Doppler measurement of isovolumetric relaxation time and peak -dP/dt (r = 0.638; p < 0.001). Left ventricular ejection time correlated with both peak +dP/dt (r = 0.539; p < 0.001) and peak -dP/dt (r = 0.582; p < 0.001). The Doppler index correlated with simultaneously recorded systolic peak +dP/dt (r = 0.821; p < 0.0001) and diastolic peak -dP/dt (r = 0.833; p < 0.001) and tau (r = 0.680; p < 0.0001). This study documents that a simple, easily recordable, noninvasive Doppler index of myocardial performance correlates with invasive measurement of left ventricular systolic and diastolic function and appears to be a promising noninvasive measurement of overall cardiac function.

Aged↗

Spontaneous regression of merkel cell carcinoma: a comparative study of TUNEL index and tumor-infiltrating lymphocytes between spontaneous regression and non-regression group.

Some Merkel cell carcinomas (MCC) have been reported to regress spontaneously. To clarify the mechanisms of spontaneous regression (SR) of MCC, we analyzed the TUNEL index, the labeling index of proliferating cell nuclear antigen (PCNA), the labeling index of bcl-2 protein, and the expression of p53 of the tumor cells. We also evaluated the number of infiltrating lymphocytes surrounding the tumor in the tissue specimens. Among seven patients with MCC (SR: n=4; non-regression (NR): n=3), the TUNEL index in the SR group was significantly higher than that in NR group (5.2 and 2.0%, respectively). In addition, the number of lymphocytes around the tumor nests was also significantly increased in the SR group compared to NR group (1576 and 663 cells/mm(2), respectively). Most of the infiltrating lymphocytes were UCHL-1 positive T-cells. There were no significant differences of the PCNA labeling index, the bcl-2 protein labeling index, and the expression p53 between SR and NR group. These results indicate that apoptosis and local T-cell mediated immune response might be involved in spontaneous regression of MCC.

Aged↗

Use of the PI index in predicting toxicity of nitrobenzene derivatives.

The PI Index is a Szeged-like topological index developed very recently. It has useful applications in chemistry which are yet to be investigated thoroughly. Herein, we report quantitative structure-toxicity relationship (QSTR) study using the PI Index. We have used 41 monosubstituted nitrobenzene for this purpose. The results have shown that the PI Index alone is not an appropriate index for modelling toxicity of nitrobenzene derivatives. Combinations of the PI Index with other distance-based topological indices resulted into statistically significant models and excellent results are obtained in pentaparametric models. The predictive potential of the models is discussed on the basis of cross-validation method, as well as by estimating root-mean-square error (RMS).

Animals↗

The size index as a motor unit identifier in electromyography examined by numerical calculation.

A computer simulation was performed to investigate the size index as a motor unit identifier in electromyography. The size index calculated from the amplitude and area of the simulated motor unit action potential (MUP) was plotted against the distance between the needle electrode and current source to show how the index changes as a function of the distance. The index of the MUP also was plotted against the number of muscle fibers belonging to a single motor unit, the size of the motor unit territory, and the diameter of the muscle fibers in order to establish the major determinants of the index. The index was relatively constant for the distance less than 2 mm between the needle electrode and closest edge of the current source. It changed logarithmically with the number of muscle fibers and with the diameter of the fibers.

Computer Simulation↗

Early intervention after severe oxygenation index elevation improves survival following lung transplantation.

BACKGROUND: Reperfusion injury and technical problems following lung transplantation may result in life-threatening pulmonary dysfunction that requires intervention with either extracorporeal membrane oxygenation or reoperation. Early intervention in these patients could prevent complications associated with delayed or emergent intervention and may improve survival. The oxygenation index [(mean airway pressure x percent of inspired oxygen)/partial pressure of arterial oxygen] provides a rapid assessment of pulmonary function in the critical phase of reperfusion. Our hypothesis was that the oxygenation index could be used as an early predictor for severe respiratory failure requiring acute intervention. METHODS: Analysis of 136 consecutive lung transplant operations revealed 18 patients (reperfusion injury in 16 and technical complications in 2) with an oxygen index of > or = 30. Of those patients with reperfusion injury, 9 had fibrotic lung disease, 4 had obstructive lung disease, and 3 had primary pulmonary hypertension. RESULTS: Patients undergoing transplantation for fibrotic lung diseases were more likely to develop severe reperfusion injury (oxygenation index > or = 30) compared to patients with obstructive lung diseases (9 of 42 or 21% vs 4 or 80 or 5%, p = 0.005). The 5 patients with early intervention (< or = 2 hours) after an oxygenation index elevation above 30 had significantly improved survival compared to the 13 with no or late intervention (80% vs 15% survival, p = 0.02). CONCLUSION: Oxygenation index elevation > or = 30 following lung transplantation is an early predictor of severe respiratory failure requiring acute intervention. Early intervention in these patients improves survival.

Adult↗

A comparison of clinical index and ejection fractions in predicting cardiac complications following infrarenal aortic reconstruction.

OBJECTIVE: To compare the Detsky clinical cardiac risk index with ejection fraction measurements in predicting postoperative cardiac events. DESIGN: Prospective study. SETTING: District General Hospital. MATERIALS: 48 patients undergoing infrarenal aortic reconstruction. CHIEF OUTCOME MEASURES: Ejection fractions were measured both by echocardiography and a technetium 99 MUGA scan. MAIN RESULTS: Three patients developed four major cardiac events (LVF three, fatal myocardial infarction one). Fourteen patients experienced 15 minor cardiac events (arrhythmia 11, ST segment depression four). The clinical index predicted postoperative cardiac problems (p = 0.0001). There was no correlation between ejection fraction measurement and postoperative cardiac events nor between ejection fraction measurements and the clinical index. Combining the index with ejection fraction measurement provided no additional information over the index alone. CONCLUSIONS: Calculation of a clinical index before aortic reconstruction is a simple and reliable way of selecting patients who are at risk of developing postoperative cardiac events.

Adult↗

Parasite specialization from a phylogenetic perspective: a new index of host specificity.

The host specificity of a parasite is not merely a function of how many host species it can exploit, but also of how closely related these host species are to each other. Here, a new index of host specificity is proposed, one that takes into account the average taxonomic or phylogenetic distance between pairs of host species used by a parasite. The index is derived from measures of taxonomic distinctness used in biodiversity studies. It is easy to compute and interpret, ranging from a minimum value of 1 when all host species are members of the same genus, to a maximum of 5, when all host species belong to different classes. The variance of this measure can also be computed, and provides additional information on the taxonomic or phylogenetic structure of the host assemblage. Using data on helminth parasites of Canadian freshwater fishes, we show that the new index, unlike the mere number of known host species, is independent of study effort i.e. the number of published records of a parasite. Although the index and the number of known hosts are not entirely independent statistically, each captures a different aspect of host specificity. For instance, although acanthocephalans infect significantly more host species than trematodes, cestodes or nematodes, there is no difference in the average index value among these 4 helminth taxa, suggesting that the average taxonomic distances between the host species of a parasite do not vary among these higher taxa. We recommend the use of our new index in future comparative studies of host specificity, in particular when the focus is on the evolutionary history of parasites and of their past colonizations of host lineages.

Animals↗

Flurbiprofen does not change the bispectral index and 95% spectral edge frequency during total intravenous anaesthesia with propofol and fentanyl.

BACKGROUND AND OBJECTIVE: Previous studies have shown that general anaesthetic agents modulate the production of hypothalamic prostaglandins (PG) D2 and E2, which are mediators of sleep and wakefulness respectively. Although flurbiprofen, a cyclo-oxygenase inhibitor, is used clinically as a non-steroidal anti-inflammatory agent and postoperative analgesic, it reduces prostaglandin production. Thus, this agent may affect the depth of sedation during general anaesthesia. In this study, we examined if flurbiprofen affects the bispectral index, which correlates with sedation levels. METHODS: Fifteen patients who underwent elective surgery under total intravenous anaesthesia with propofol and fentanyl were studied. The sedation level was monitored using a bispectral index monitor. On attainment of stable haemodynamics and a bispectral index, patients were given flurbiprofen axetil 50 mg intravenously. A bispectral index and 95% spectral edge frequency were recorded before and 5, 10, 15, 20 and 30 min after flurbiprofen axetil intravenously. RESULTS: Bispectral indexes of 51.7 (95% CI: 47.3-56.8), 51.7 (47.1-56.3), 51.3 (46.3-56.3), 50.3 (45.8-54.2), 48.9 (43.6-54.1) and 50.3 (45.5-55.2) at 0, 5, 10, 15, 20, 30 min after flurbiprofen axetil intravenously were observed. There was no change in this or 95% spectral edge frequency. CONCLUSIONS: Clinical dose of flurbiprofen axetil does not alter the bispectral index and 95% spectral edge frequency under total intravenous anaesthesia with propofol and fentanyl.

Analysis of Variance↗

Trendelenburg positioning after cardiac surgery: effects on intrathoracic blood volume index and cardiac performance.

BACKGROUND AND OBJECTIVE: The efficacy of the Trendelenburg position, a common first step to treat suspected hypovolaemia, remains controversial. We evaluated its haemodynamic effects on cardiac preload and performance in patients after cardiac surgery. METHODS: Twelve patients undergoing mechanical ventilation of the lungs who demonstrated left ventricular 'kissing papillary muscles' by transoesophageal echocardiography, thus suggesting hypovolaemia, were positioned 30 degrees head down for 15 min immediately after cardiac surgery. Cardiac output by thermodilution, central venous pressure, pulmonary artery occlusion pressure, left ventricular end-diastolic area by transoesophageal echocardiography and intrathoracic blood volume by thermo- and dye dilution were determined before, during and after this Trendelenburg manoeuvre. RESULTS: Trendelenburg's manoeuvre was associated with increases in central venous pressure (9 +/- 2 to 12 +/- 3 mmHg) and pulmonary artery occlusion pressure (8 +/- 2 to 11 +/- 3 mmHg). The intrathoracic blood volume index increased slightly (dye dilution from 836 +/- 129 to 872 +/- 112 mL m(-2); thermodilution from 823 +/- 129 to 850 +/- 131 mL m(-2)) as did the left ventricular end-diastolic area index (7.5 +/- 2.1 to 8.1 +/- 1.7 cm2 m(-2)), whereas mean arterial pressure and the cardiac index did not change significantly. After supine repositioning, the cardiac index decreased significantly below baseline (3.0 +/- 0.6 versus 3.5 +/- 0.8 L min(-1) m(-2)) as did mean arterial pressure (76 +/- 12 versus 85 +/- 11 mmHg), central venous pressure (8 +/- 2 mmHg) and pulmonary artery occlusion pressure (6 +/- 4 mmHg). The intrathoracic blood volume index and left ventricular end-diastolic area index did not differ significantly from baseline. CONCLUSIONS: Trendelenburg's manoeuvre caused only a slight increase of preload volume, despite marked increases in cardiac-filling pressures, without significantly improving cardiac performance.

Blood Volume↗

Bispectral index-guided administration of anaesthesia: comparison between remifentanil/propofol and remifentanil/isoflurane.

BACKGROUND AND OBJECTIVE: The bispectral index of the electroencephalogram is a measure of the hypnotic component of anaesthesia and can be used to guide the administration of anaesthesia. This study compares bispectral index-guided anaesthesia with remifentanil and either propofol or isoflurane. METHODS: Eighty consenting patients were randomly assigned to two groups. Following induction with propofol and remifentanil, anaesthesia was maintained with remifentanil/propofol or remifentanil/isoflurane. Remifentanil infusion rates were guided by haemodynamic responses--maintaining mean arterial pressure and heart rate within 20% of baseline. Propofol and isoflurane administration was guided using the bispectral index (45-60). Thirty minutes before the end of surgery, morphine was administered (0.15 mg kg(-1) intravenously). Fifteen minutes before end of surgery, propofol and isoflurane were reduced (bispectral index 60-75). At the end of surgery, the anaesthetic agents were discontinued. Groups were compared for recovery, remifentanil doses and signs of inadequate anaesthesia using the chi2-test and ANOVA (P < 0.05). RESULTS: The duration of surgery was longer in the propofol/remifentanil group (121 +/- 53 versus 94 +/- 40 min). Recovery data were not different between groups. The remifentanil infusion rate was significantly lower with additional isoflurane (0.18 +/- 0.06 microg kg(-1) min(-1)) than with additional propofol (0.31 +/- 0.20 microg kg(-1) min(-1)). The propofol infusion rate was 123 +/- 48 microg kg(-1) min(-1); isoflurane concentration was 0.66 +/- 0.13%. CONCLUSIONS: Bispectral index-guided anaesthesia with remifentanil plus propofol or isoflurane results in the absence of postoperative recall and a fast recovery with both drug combinations. In our patients, at comparable bispectral index-levels, haemodynamic control requires higher doses of remifentanil with propofol than with isoflurane.

Adolescent↗