Automatic annotation of matrix-assisted laser desorption/ionizationN-glycan spectra

Matrix-assisted laser desorption/ionization-mass spectrometry (MALDI-MS) is the pre-eminent technique for mass mapping of glycans. In order to make this technique practical for high-throughput screening, reliable automatic methods of annotating peaks must be devised. We describe an algorithm called Cartoonist that labels peaks in MALDI spectra of permethylated N-glycans with cartoons which represent the most plausible glycans consistent with the peak masses and the types of glycans being analyzed. There are three main parts to Cartoonist. (i) It selects annotations from a library of biosynthetically plausible cartoons. The library we currently use has about 2800 cartoons, but was constructed using only about 300 archetype cartoons entered by hand. (ii) It determines the precision and calibration of the machine used to generate the spectrum. It does this automatically based on the spectrum itself. (iii) It assigns a confidence score to each annotation. In particular, rather than making a binary yes/no decision when annotating a peak, it makes all plausible annotations and associates them with scores indicating the probability that they are correct.

A case of rofecoxib-associated stevens-johnson syndrome with corneal and conjunctival changes

PURPOSE

To report a case of rofecoxib (Vioxx)-associated Stevens-Johnson syndrome with corneal and conjunctival changes.

DESIGN

Interventional case report.

METHODS

Case report of a 62-year-old woman with systemic lupus erythematosus (SLE) taking rofecoxib for arthritis for 3 weeks.

RESULTS

Stevens-Johnson syndrome after 3 weeks of rofecoxib therapy.

CONCLUSION

This case report suggests that oral rofecoxib may trigger Stevens-Johnson syndrome, potentially causing symblepharons, corneal neovascularization and cicatricial ectropions.

Hepatitis C: who is at risk and how do we identify them?

The transmission of, and screening for, HCV infection varies considerably throughout the world; differences between resource-poor and resource-rich countries are particularly pronounced. The perspective of this review, principally, is that of resource-rich countries. The UK, particularly Scotland, experience is drawn on.

Assessing the prevalence of depression in Punjabi and English primary care attenders: the role of culture, physical illness and somatic symptoms

Previous studies exploring the prevalence of depression among South Asians reported inconsistent findings. Research artefacts due to sampling bias, measurements errors and a failure to include ethnographic methods may all explain this. We estimated the prevalence of depression, and variations of prevalence with culture, cultural adaptation, somatic symptoms and physical disability in a cross-sectional primary care survey of Punjabi and English attendees. We included a culture specific screening instrument, culturally adapted the instruments and offered bilingual interviews. We found that, compared with their English counterparts, depressive diagnoses were more common among Punjabis, Punjabi women, Punjabis with physical complaints and, contrary to expectation, even Punjabis with low scores for somatic symptoms.

HIV-1 subtype in Scotland: the establishment of a national surveillance system

Historically, subtype B viruses in men who have sex with men (MSM) and injecting drug users (IDU) dominated the HIV epidemic in the United Kingdom, whereas non-B heterosexual infections dominate globally. Heterosexual contact is now the most common route of transmission in the United Kingdom. Here we monitor HIV subtype in Scotland, and link it to origin of infection. HIV-1 sequence was generated from new diagnoses and the subtype thus obtained linked with demographic data. Virus was subtyped from 80% (137/171) of all new diagnoses in Scotland. Of 58 individuals infected by heterosexual contact, 74% (43) harboured non-B viruses, contrasting with 7% (5/68) of those infected by IDU or MSM. Eighty-four per cent of non-Bs (46/55) were probably acquired outside the United Kingdom, but nine individuals probably acquired their non-B infection in the United Kingdom. Non-B subtypes of HIV-1 predominate in recently diagnosed, heterosexually acquired infections in Scotland and are present in all risk groups, even those with no exposure outside the United Kingdom.

Genome-wide linkage analysis of a composite index of neuroticism and mood-related scales in extreme selected sibships

There is considerable evidence to suggest that the genetic vulnerabilities to depression and anxiety substantially overlap and quantitatively act to alter risk to both disorders. Continuous scales can be used to index this shared liability and are a complementary approach to the use of clinical phenotypes in the genetic analysis of depression and anxiety. The aim of this study (Genetic and Environmental Nature of Emotional States in Siblings) was to identify genetic variants for the liability to depression and anxiety after the application of quantitative genetic methodology to a large community-based sample (n = 34,371), using four well-validated questionnaires of depression and anxiety. Genetic model fitting was performed on 2658 unselected sibships, which provided evidence for a single common familial factor that accounted for a substantial proportion of the genetic variances and covariances of the four scales. Using the parameter estimates from this model, a composite index of liability (G) was constructed. This index was then used to select a smaller--but statistically powerful--sample for DNA collection (757 individuals, 297 sibships). These individuals were genotyped with more than 400 microsatellite markers. After the data were checked and cleaned, linkage analysis was performed on G and the personality scale of neuroticism using the regression-based linkage program MERLIN-REGRESS. The results indicated two potential quantitative trait loci (QTL): one on chromosome 1p (LOD 2.2) around 64 cM (43-70 cM) near marker D1S2892 and another on chromosome 6p (LOD 2.7) around 47 cM (34-63 cM) near marker D6S1610. Further exploratory sex-specific analyses suggested that these QTLs might have sex-limited effects.

Recent trends in HIV and other STIs in the United Kingdom: data to the end of 2002

Sexual health in the United Kingdom has deteriorated in recent years with further increases in HIV and other sexually transmitted infections (STIs) reported in 2002. This paper describes results from the available surveillance data in the United Kingdom from the Health Protection Agency and its national collaborators. The data sources range from voluntary reports of HIV/AIDS from clinicians, CD4 cell count monitoring, a national census of individuals living with HIV, and the Unlinked Anonymous Programme, to statutory reports of STIs from genitourinary medicine (GUM) clinics and enhanced STI surveillance systems. In 2002, an estimated 49500 adults aged over 15 years were living with HIV in the United Kingdom, of whom 31% were unaware of their infection. Diagnoses of new HIV infections have doubled from 1997 to 2002, mainly driven by heterosexuals who acquired their infection abroad. HIV transmission also continues within the United Kingdom, particularly among homo/bisexual men who, in 2002, accounted for 80% of all newly diagnosed HIV infections acquired in the United Kingdom. New diagnoses of syphilis have increased eightfold, and diagnoses of chlamydia and gonorrhoea have doubled from 1997 to 2002 overall; STI rates disproportionately affect homo/bisexual men and young people. Effective surveillance is essential in the provision of timely information on the changing epidemiology of HIV and other STIs; this information is necessary for the targeting of prevention efforts and through providing baseline information against which progress towards targets can be monitored.

Cost-effectiveness of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial

BACKGROUND

Cognitive-behavioural therapy (CBT) is effective for treating anxiety and depression in primary care, but there is a shortage of therapists. Computer-delivered treatment may be a viable alternative.

AIMS

To assess the cost-effectiveness of computer-delivered CBT.

METHOD

A sample of people with depression or anxiety were randomised to usual care (n=128) or computer-delivered CBT (n=146). Costs were available for 123 and 138 participants, respectively. Costs and depression scores were combined using the net benefit approach.

RESULTS

Service costs were 40 British pounds (90% CI - 28 British pounds to 148 British pounds) higher over 8 months for computer-delivered CBT. Lost-employment costs were 407 British pounds (90% CI 196 British pounds to 586 British pounds) less for this group. Valuing a 1-unit improvement on the Beck Depression Inventory at 40 British pounds, there is an 81% chance that computer-delivered CBT is cost-effective, and it revealed a highly competitive cost per quality-adjusted life year.

CONCLUSIONS

Computer-delivered CBT has a high probability of being cost-effective, even if a modest value is placed on unit improvements in depression.

Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial

BACKGROUND

Preliminary results have demonstrated the clinical efficacy of computerised cognitive-behavioural therapy (CBT) in the treatment of anxiety and depression in primary care.

AIMS

To determine, in an expanded sample, the dependence of the efficacy of this therapy upon clinical and demographic variables.

METHOD

A sample of 274 patients with anxiety and/or depression were randomly allocated to receive, with or without medication, computerised CBT or treatment as usual, with follow-up assessment at 6 months.

RESULTS

The computerised therapy improved depression, negative attributional style, work and social adjustment, without interaction with drug treatment, duration of preexisting illness or severity of existing illness. For anxiety and positive attributional style, treatment interacted with severity such that computerised therapy did better than usual treatment for more disturbed patients. Computerised therapy also led to greater satisfaction with treatment.

CONCLUSIONS

Computer-delivered CBT is a widely applicable treatment for anxiety and/or depression in general practice.

Mailings timed to patients' appointments: a controlled trial of fecal occult blood test cards

BACKGROUND

Fecal occult blood testing (FOBT) programs cost-effectively reduce colon cancer mortality. To improve the rate of colon cancer screening with FOBT, we tested the effect of mailing FOBT cards timed to appointments on the rates of completion of FOBT.

DESIGN

Controlled trial.

SETTING/PARTICIPANTS

A total of 119 patients with primary care appointments scheduled in May or June 2000 for an urban, public hospital clinic that serves predominantly low-income, African Americans with chronic diseases. The patients in the study were selected by linking a quality improvement registry, the appointment system database, and an FOBT database to generate a list of clinic patients who had not completed an FOBT in the preceding year.

INTERVENTION

Subjects were assigned to either a system of mailing FOBT cards and reminders 2 weeks prior to a scheduled appointment or usual care.

MAIN OUTCOME MEASURES

The primary outcomes were the rate of screening at the index appointment and during the year beginning with the date of the index appointment.

RESULTS

The rate of return of the FOBT cards during the year beginning with the index appointment was 40.7% for the intervention group compared to 5% for the usual care group (odds ratio [OR]=13.0, p <0.001). The difference was accounted for largely by increases in screening at the index appointment (35.6% compared to 3.3%, OR=16.0, p <0.001).

CONCLUSIONS

Using computer databases to generate a list of patients due for FOBT and then mailing FOBT cards timed to a scheduled appointment significantly increased the rate of colon cancer screening. This may be an efficient approach to increasing colon cancer screening with FOBT.

Sleep deprivation for pediatric sedated procedures: not worth the effort

OBJECTIVE

Sleep deprivation is commonly used to enhance the effectiveness of pediatric sedation and to decrease sedation failures. We reviewed our sedation database to evaluate the efficacy of sleep deprivation.

METHODS

The entire pediatric sedation unit database (n = 5640) was reviewed retrospectively. Patients without complete data sets were excluded. The remaining patients were separated into 2 groups: 3272 patients who underwent noninvasive procedures and 1210 who underwent invasive procedures. A subgroup of noninvasive procedure patients <2 years old (n = 1398) was also analyzed. The sedation failure rate (%) and nursing care hours for both sleep-deprived and non-sleep-deprived patients were analyzed.

RESULTS

In the noninvasive procedure group, the sedation failure rate was 5.7% for the sleep-deprived patients and 5.6% for the non-sleep-deprived patients, whereas the sedation failure rate for children <2 years old was 4.2% for sleep-deprived patients and 4.7% for non-sleep-deprived patients. The sedation failure rate in the invasive procedure group was 7.5% for sleep-deprived patients and 7.2% for non-sleep-deprived patients. Nursing care hours in the noninvasive procedure group were significantly longer for the sleep-deprived patients (4.5 +/- 1.6 hours) versus the non-sleep-deprived patients (3.8 +/- 1.6 hours). This finding was true also for the subgroup of children <2 years old (sleep-deprived patients: 4.2 +/- 1.4 hours; non-sleep-deprived patients: 3.5 +/- 1.4 hours). No difference was noted in nursing care hours for the invasive procedure group.

CONCLUSIONS

Sleep deprivation had no effect in reducing the pediatric sedation failure rate. The patients having noninvasive procedures who were sleep deprived required significantly more nursing care hours than their non-sleep-deprived counterparts. Routine use of sleep deprivation for pediatric sedation should be critically reevaluated.

Hepatitis A virus and injecting drug misuse in Aberdeen, Scotland: a case-control study

To describe an epidemiological investigation of an outbreak of hepatitis A virus (HAV) infection among injecting drug users in Aberdeen, Scotland. A case-control study to determine whether transmission was facilitated by poor personal hygiene or through sharing injecting equipment. Cases were more likely to report not washing their hands after using the toilet [odds ratio (OR) = 12.9, 95% confidence interval (CI) = 1.58-105.89] or before preparing food (OR = 4.0, 95% CI = 1.01-15.8), and less likely to have washed their hands prior to preparing drugs (OR = 10.67, 95% CI = 2.14-53.07). Cases were also more likely to report recipient sharing of needles/syringes (OR = 8.27, 95% CI = 1.68-40.57), and to have had injecting contact with someone who was jaundiced (OR = 29.4, 95% CI = 3.18-271.44). The results indicate that the lack of hygiene within the context of individuals gathering to prepare and inject drugs provides ample opportunity for the transmission of HAV. Although the promotion of good hygiene and the avoidance of sharing injecting equipment are important measures in preventing HAV transmission, they are unlikely to effect major behavioural change. Such measures should, therefore, be reinforced by routinely offering HAV vaccine to injectors.

Automatic classification of protein crystallization images using a curve-tracking algorithm

An algorithm for automatic classification of protein crystallization images acquired from a high-throughput vapor-diffusion system is described. The classifier uses edge detection followed by dynamic-programming curve tracking to determine the drop boundary; this technique optimizes a scoring function that incorporates roundness, smoothness and gradient intensity. The classifier focuses on the most promising region in the drop and computes a number of statistical features, including some derived from the Hough transform and from curve tracking. The five classes of images are `Empty', `Clear', `Precipitate', `Microcrystal Hit' and `Crystal'. On test data, the classifier gives about 12% false negatives (true crystals called `Empty', `Clear' or `Precipitate') and about 14% false positives (true clears or precipitates called `Crystal' or `Microcrystal Hit').

Incidence of hepatitis C virus infection and associated risk factors among Scottish prison inmates: a cohort study

To gauge the incidence of hepatitis C virus (HCV) infection and associated risk factors among inmates during their imprisonment, the authors recruited adult males in a long-stay Scottish prison into a cohort study between April 1999 and October 2000. On two occasions (at 0 and 6 months), saliva was collected for anonymous HCV antibody testing and risk behavior data were obtained through a self-administered questionnaire. The participation rate was 85% at both initial recruitment (612/719) and follow-up (375/441; 171 men were ineligible for follow-up). For inmates who reported never having injected drugs, ever having injected drugs, having injected drugs during follow-up, and having shared needles/syringes during follow-up, HCV incidences per 100 person-years of incarceration risk were 1, 12, 19, and 27, respectively. Ever having injected drugs (relative risk = 13.0, 95% confidence interval: 1.5, 114.3) and having shared needles/syringes during follow-up (relative risk = 9.0, 95% confidence interval: 1.1, 71.7) were significantly associated with HCV seroconversion. The effectiveness of existing interventions, including the provision of bleach tablets for sterilizing injection equipment, was suboptimal. The development of methadone maintenance programs in prisons and the creation of drug courts to keep offending drug injectors out of prison might help to reduce transmission in this setting.

The feasibility and acceptability of collecting oral fluid from healthy children for anti-HCV testing

This pilot study investigated the feasibility of surveying, anonymously, HCV infection among healthy children using an oral fluid specimen. Seventy seven per cent of children provided their assent, or where appropriate, consent to participate; 2.8% were anti-HCV positive. Oral fluid collection is acceptable to children and more extensive studies are indicated.

Vulnerability, destabilization and restitution in anxious depression

OBJECTIVE

To summarize what is known about vulnerability and resilience to common mental disorders, and the psychosocial factors associated with speed of recovery.

METHOD

Recent genetic factors are summarized, and taken together with known facts about social factors encouraging or reducing likelihood of an episode.

RESULTS

Multiple genes are likely, controlling both vulnerability and resilience, with the manifestation in phenotype modified by environmental factors. Restitution must be thought of separately from vulnerability.

CONCLUSION

Instead of specific genes causing specific mental disorders, we need a more complex model.

Establishment of a database of diagnosed HCV-infected persons in Scotland

To provide a comprehensive understanding of the epidemiology of hepatitis C virus (HCV) infection in Scotland, a database of all persons known to have been infected with HCV in Scotland was established. Non-identifying data, held on the computers and requests forms in Scotland's principal and confirmatory HCV testing laboratories, were entered onto a National Database at the Scottish Centre for Infection and Environmental Health. As at December 2001, records from 13,519 persons in Scotland known to have been infected with HCV had been entered on to the database (one in 378 of Scotland's population). Of the 13,519, 69% were male and 90% of the 9,092 for whom risk factor information was available had injected drugs; 37% were from Greater Glasgow. Fifty-six per cent of the 13,519 were diagnosed between 1998 and 2001; 1,727 (23%) of the new diagnoses from 1998 to 2001 were aged under 25 years. The data provide an insight into the epidemiology of HCV infection in Scotland. They support other data, which indicate that the current major risk factor for HCV in the country is injecting drug use.

Growth differences and growth hormone expression in male and female European eels [Anguilla anguilla (L.)]

In this study, we examined the growth differences of males and females following a sex reversion, and the growth hormone (GH) expression variation between sexes of European eels [Anguilla anguilla (L.)]. A high percentage of females (88%) was found in the group fed with estradiol 17beta compared to the control group (comprised of only 6% female eels), which was defined as the male population. Significant differences between growth rate and size were found following 480 days of growth, whereby the males reached 60+/-4.3 g (means+/-SE) in size and the females 73.4+/-5.9 (g+/-SE); after 600 days, the males reached 114.1+/-4.3 and the females 171+/-11.7 (g+/-SE). A cDNA coding for the complete growth hormone of the European eel A. anguilla (eeGH) was cloned by RACE PCR using several sets of degenerate oligonucleotides. The eeGH cDNA coding region is 627 bp long. A sequence comparison of eeGH with Anguilla japonica GH (jeGH) cDNA showed a 98% identical base. Comparison of the deduced amino acid sequence revealed 99% identical residues, meaning that a difference exists in only two of the 209 residues. In both cases, the differing residues in the eeGH amino acid sequence are lysine. We measured the mRNA levels of growth hormone in the pituitaries of male and female eels growing at different rates. A significantly higher expression of eeGH was found in the female eels in comparison to the males. These results show that different levels of GH transcription eeGH can explain the growth rate differences between male and female European eels.

Multicenter study of noninvasive radiofrequency for periorbital tissue tightening

BACKGROUND AND OBJECTIVES

This 6-month study evaluated the efficacy and safety of treatment with a nonablative radiofrequency (RF) device.

STUDY DESIGN/MATERIALS AND METHODS

Eighty-six subjects received a single treatment with the ThermaCool TC System (Thermage, Inc., Hayward, CA) and were evaluated for 6 months after treatment.

RESULTS

Independent scoring of blinded photographs resulted in Fitzpatrick wrinkle score improvements of at least 1 point in 83.2% (99/119) of treated periorbital areas. Treating physicians, without reference to pre-treatment photographs, noted improvements in 28.9% (48/166) of treatment areas. Fifty percent (41/82) of subjects reported being satisfied or very satisfied with periorbital wrinkle reductions. Objective photographic analysis showed that 61.5% (40/65) of eyebrows were lifted by at least 0.5 mm. Rates and duration of edema/erythema were very low (e.g., vs. ablative procedures). Overall 2nd-degree burn incidence was 0.36% (21 per 5,858 RF applications). Three patients had small areas of residual scarring at 6 months.

CONCLUSIONS

A single treatment with this RF tissue tightening (RFTT) device produces objective and subjective reductions in periorbital wrinkles, measurable changes in brow position, and acceptable epidermal safety. These changes were indicative of a thermally induced early tissue-tightening effect followed by additional tightening over a time course consistent with a thermal wound healing response.

Psychiatry and primary care

There is now almost universal recognition that primary care is the place where most mentally distressed people first present for help. However, the pace at which the health system has adapted to this reality varies greatly from country to country, depending on the amount of resource devoted to mental illness services, the way in which primary care physicians have organized their practice, and the inertia of the system. Here we present several models from developed and developing countries and address briefly the issue of training of health workers.

Cloning of European eel (Anguilla anguilla) FSH-β subunit, and expression of FSH-β and LH-β in males and females after sex determination

The European eel (Anguilla anguilla) is a catadromic teleost species with a complex life cycle, both in sea and freshwater environments. The sex determination phase of gonadal development occurs in a freshwater environment. Polymorphism occurs in increasing rates with respect to gender. While males stop growing at approximately 150 g, females continue to grow to being much larger. In this study, we cloned the cDNA FSH-beta subunit of the European eel (A. anguilla), and measured the mRNA levels of FSH-beta and LH-beta in males and females after sex determination. The FSH-beta subunit cDNA consisted of 1068 bp, encoding a 127 amino acid peptide. A comparison between European and Japanese eels of the FSH-beta amino acid sequence showed 98% similarity.

Investigating the source of hepatitis C virus infection among individuals whose route of infection is undefined: a study of ten cases

Hepatitis C virus (HCV) transmission is predominantly parenteral via infected blood products or shared injecting equipment. Many infected individuals, however, deny these risk factors. This study set out to determine whether an in-depth interview would determine the likely source of infection for those whose route of infection was undefined. Between May 1999 and July 1999, risk factor information was sought, through in-depth interview, from 10 patients whose source of hepatitis C infection was undefined. The clinical notes of the patients were scrutinized to complement the information provided through the questionnaire. Despite undertaking an in-depth interview, it was not possible to establish the likely route of infection for 9 of the 10 individuals studied as they reported several risk events. There is little benefit to interviewing routinely those HCV-infected people who have no history of injecting drugs or having received a contaminated blood/blood product transfusion, to ascertain their likely source or time of infection; at best, such effort might only increase one's confidence that infection was acquired through means other than these 2 routes.