Mathematically aggregating experts' predictions of possible futures

Structured protocols offer a transparent and systematic way to elicit and combine/aggregate, probabilistic predictions from multiple experts. These judgements can be aggregated behaviourally or mathematically to derive a final group prediction. Mathematical rules (e.g., weighted linear combinations of judgments) provide an objective approach to aggregation. The quality of this aggregation can be defined in terms of accuracy, calibration and informativeness. These measures can be used to compare different aggregation approaches and help decide on which aggregation produces the "best" final prediction. When experts' performance can be scored on similar questions ahead of time, these scores can be translated into performance-based weights, and a performance-based weighted aggregation can then be used. When this is not possible though, several other aggregation methods, informed by measurable proxies for good performance, can be formulated and compared. Here, we develop a suite of aggregation methods, informed by previous experience and the available literature. We differentially weight our experts' estimates by measures of reasoning, engagement, openness to changing their mind, informativeness, prior knowledge, and extremity, asymmetry or granularity of estimates. Next, we investigate the relative performance of these aggregation methods using three datasets. The main goal of this research is to explore how measures of knowledge and behaviour of individuals can be leveraged to produce a better performing combined group judgment. Although the accuracy, calibration, and informativeness of the majority of methods are very similar, a couple of the aggregation methods consistently distinguish themselves as among the best or worst. Moreover, the majority of methods outperform the usual benchmarks provided by the simple average or the median of estimates.

An "EAR" on Environmental Surveillance and Monitoring: A Case Study on the Use of Exposure-Activity Ratios (EARs) to Prioritize Sites, Chemicals, and Bioactivities of Concern in Great Lakes Waters

Current environmental monitoring approaches focus primarily on chemical occurrence. However, based on concentration alone, it can be difficult to identify which compounds may be of toxicological concern and should be prioritized for further monitoring, in-depth testing, or management. This can be problematic because toxicological characterization is lacking for many emerging contaminants. New sources of high-throughput screening (HTS) data, such as the ToxCast database, which contains information for over 9000 compounds screened through up to 1100 bioassays, are now available. Integrated analysis of chemical occurrence data with HTS data offers new opportunities to prioritize chemicals, sites, or biological effects for further investigation based on concentrations detected in the environment linked to relative potencies in pathway-based bioassays. As a case study, chemical occurrence data from a 2012 study in the Great Lakes Basin along with the ToxCast effects database were used to calculate exposure-activity ratios (EARs) as a prioritization tool. Technical considerations of data processing and use of the ToxCast database are presented and discussed. EAR prioritization identified multiple sites, biological pathways, and chemicals that warrant further investigation. Prioritized bioactivities from the EAR analysis were linked to discrete adverse outcome pathways to identify potential adverse outcomes and biomarkers for use in subsequent monitoring efforts.

[Avoidable visual impairment among residents in care institutions: lessons from an intervention project in the Den Bosch region]

INTRODUCTION

Many elderly in care institutions in The Netherlands are visually impaired (visual acuity < 0.3). They fall more frequently, are more depressed and require more care. In this project visually impaired residents were identified and referred for adequate eye care. The aim of this study is to evaluate the intervention, including validation of the screening, assessment of the prevalence and causes of visual impairment as well as the outcome of the treatment. The effectiveness of the care chain is also evaluated.

MATERIALS AND METHODS

640 residents were offered a basic eye examination and 210 of them were referred, via their general practitioner, to an optometrist (10), ophthalmologist (98), or centre for visually impaired persons (1).

RESULTS

Compliance in this study was poor. The prevalence of visual impairment (24%) was lower than in comparable studies. Cataract was the main cause in 51%. Overall 17 (8.1%) residents were treated by ophthalmologists and nine (4.3%) were referred to optical shops. Constraints in the care chain are identified.

DISCUSSION

Vision screening in care institutions for elderly is feasible and useful. The care chain should be shorter and simpler. That will increase the effectiveness of this intervention, and thereby the quality of life for many residents.

Central trigeminal involvement in multiple sclerosis using high-resolution MRI at 3 T

Trigeminal neuralgia and sensory disturbance is common in multiple sclerosis (MS). Recent literature suggests that signal abnormalities in the cisternal trigeminal nerve and pontine root entry zone are seen in approximately 3% of MS patients, using conventional diagnostic MRI. The objective of this study was to determine the prevalence of trigeminal lesions using high-resolution MRI at 3T. Forty-seven patients with clinically definite MS, chosen at random from the outpatient population of a neuroscience centre underwent MRI on a Siemens 3T Trio machine. Three 3D sequences of T2 TSE (turbo spin echo), T2 FLAIR (fluid attenuated inversion recovery) and T1 IR (inversion recovery) were acquired in the coronal plane. The sequences were of contiguous 1 mm slices with in-plane resolution of up to 0.5 mm by 0.5 mm. Images were read by both a neurologist and a neuroradiologist. Any clinical history of trigeminal symptoms was determined for all subjects. The results showed that 11 patients (23%) had high signal in the trigeminal root entry zone and either the trans-cisternal nerve or pontine nucleus; example images are given. MRI changes did not correspond to clinical symptoms (chi square probability 1.000). The study concludes that high-resolution MRI at 3T yielded a high prevalence of detectable trigeminal abnormality in the MS sample studied. MRI involvement did not correspond to trigeminal symptoms.

Magnetic resonance image findings in the early post-operative period after anterior cervical discectomy

If early neurological deterioration occurs following anterior cervical discectomy, the patient should be evaluated by urgent MRI scanning. In order to interpret such a scan it is essential to know what the normal post-operative MRI appearance is following an uncomplicated procedure. In the lumbar spine it is well recognized that early post-operative imaging following discectomy is difficult to interpret with a high rate of false positive scans. The normal appearance of MRI in the early post-operative period was evaluated prospectively in 15 patients undergoing anterior cervical discectomy without fusion for either cervical radiculopathy or myelopathy. MRI was performed on the first post-operative day, at 6 weeks and 6 months. The successful outcome of the procedure was validated by uniform improvement of Visual Analogue Scale measurement for neck and arm pain, the Neck Disability Index and European Myelopathy Score as appropriate. In contrast to the established findings following lumbar discectomy, only two cases showed a persistent epidural mass in the first post-operative scan and this had completely resolved at 6 months. All patients had foraminal narrowing and root or cord compression pre-operatively. Sixty six percent of cases showed persistent foraminal narrowing on sequential imaging up to 6 months despite showing good symptomatic improvement. All cases demonstrated high signal in the operated disc space on T2 weighted imaging on the first post-operative day and this finding persisted in 13 of 15 scans performed at 6 weeks. Post contrast imaging demonstrated no enhancement of operated disc space and adjacent vertebral body on the first post-operative day, whereas all scans at 6 weeks showed enhancement and such enhancement persisted at 6 months in 50%. Persistent epidural filling defects are uncommon following successful anterior cervical discectomy but persistence of foraminal narrowing is common despite successful outcome. Enhancement of the disc space is also common and does not in itself imply infection.

An aerial netting study of insects migrating at high altitude over England

Day and night sampling of windborne arthropods at a height of 200 m above ground was undertaken at Cardington, Bedfordshire, UK, during July 1999, 2000 and 2002, using a net supported by a tethered balloon. The results from this study are compared with those from the classic aerial sampling programmes carried out by Hardy, Freeman and colleagues over the UK and North Sea in the 1930s. In the present study, aerial netting was undertaken at night as well as daytime, and so the diel periodicity of migration could be investigated, and comparisons made with the results from Lewis and Taylor's extensive survey of flight periodicity near ground level. In some taxa with day-time emigration, quite large populations could continue in high-altitude flight after dark, perhaps to a previously underrated extent, and this would greatly increase their potential migratory range. Any trend towards increases in night temperatures, associated with global warming, would facilitate movements of this type in the UK. Observations on the windborne migration of a variety of species, particularly those of economic significance or of radar-detectable size, are briefly discussed.

A national survey of attitudes towards the use of MRI in patients known to have intracranial aneurysm clips

The objective of this study was to determine the attitudes and practice of neuroradiology centres across the UK regarding the use of MRI in patients known to have intracranial aneurysm clips. A postal survey comprising three questions and a comments section was sent to 35 neuroradiology centres across the UK. There were 32 (91%) respondents to the single questionnaire. 16 (50%) respondents said that they would not consider performing MRI on a patient with an intracranial aneurysm clip. Of the remaining 50%, all said that identification of the clip type and assurance of its safety would be needed prior to scanning the patient. The magnetic strength of the system did not appear to affect the decision regarding whether or not to perform MRI on such patients. There was a variation in attitude towards the use of MRI in such patients between different regions. Neuroradiology centres are equally divided in their attitude and practice about whether it is safe to use MR to image a patient known to have an intracranial aneurysm clip. This is most probably due to the conflicting literature, as well as uncertainty about the identification and ferromagnetic properties of individual clips.

A new technique in nasal-tip reduction surgery

This article presents a technique for the reduction of the overprojected nasal tip with a proportional reduction of the nostril-margin circumference. To achieve these reductions, a modified open rhinoplasty technique is used, which is unique in that it involves the total transection of the columella through the medial crura of the alar cartilage. The alar cartilage is raised with the flap. The technique was first developed and introduced by the senior author (R.A.S.) 25 years ago and has since been refined through the execution of several thousand rhinoplasties. The results continue to be consistent and pleasing from both the patients' and the surgeon's points of view.

Purification and characterization of an iron-nickel hydrogenase from Thermococcus celer

Thermococcus celer cells contain a single hydrogenase located in the cytoplasm, which has been purified to apparent homogeneity using three chromatographic steps: Q-Sepharose, DEAE-Fast Flow, and Sephacryl S-200. In vitro assays demonstrated that this enzyme was able to catalyze the oxidation as well as the evolution of H2. T. celer hydrogenase had an apparent MW of 155,000+/-30,000 by gel filtration. When analyzed by SDS polyacrylamide gel electrophoresis a single band of 41,000+/-2,000 was detected. Hydrogenase activity was also detected in situ in a SDS polyacrylamide gel followed by an activity staining procedure revealing a single band corresponding to a protein of apparent Mr 84,000+/-3,000. Measurements of iron and acid-labile sulfide in different preparations of T. celer hydrogenase gave values ranging from 24 to 30 g-atoms Fe/mole of protein and 24 to 36 g-atoms of acid-labile sulfide per mole of protein. Nickel is present in 1.9-2.3 atoms per mole of protein. Copper, tungsten, and molybdenum were detected in amounts lower than 0.5 g-atoms per mole of protein. T. celer hydrogenase was inactive at ambient temperature, exhibited a dramatic increase in activity above 70 degrees C, and had an optimal activity above 90 degrees C. This enzyme showed no loss of activity after incubation at 80 degrees C for 28 h, but lost 50% of its initial activity after incubation at 96 degrees C for 20 h. Hydrogenase exhibited a half-life of approximately 25 min in air. However, after treating the air-exposed sample with sodium dithionite, more than 95% of the original activity was recovered. Copper sulfate, magnesium chloride and nitrite were also inactivators of this enzyme.

Direct electrochemical characterization of hyperthermophilic Thermococcus celer metalloenzymes involved in hydrogen production from pyruvate

The reduction potentials of the metalloproteins pyruvate ferredoxin oxidoreductase (POR), ferredoxin, and hydrogenase isolated from hyperthermophilic Thermococcus celer (Topt = 88 degrees C) were determined as a function of temperature from 10 to 85 degrees C. Square-wave voltammetry experiments were carried out on 15 microL samples directly at an unmodified "edge-polished" pyrolytic graphite electrode using MgCl2 as an electrode promoter. POR exhibited two voltammetric waves with peaks at -280 and -403 mV at room temperature, indicating multiple redox centers, and a single wave at -420 mV at 85 degrees C. These waves displayed different temperature-dependent peak positions and peak heights, indicating that these redox centers have different thermodynamic and kinetic properties. Ferredoxin displayed a single linear temperature-dependent voltammetric wave at -280 mV at room temperature and -327 mV at 85 degrees C. Hydrogenase displayed a single biphasic temperature-dependent voltammetric wave at -197 mV at room temperature and -211 mV at 85 degrees C. Thermodynamic parameters associated with electron transfer, namely standard enthalpies and entropies for the redox centers in the various proteins, are reported.

Modulation of the redox potential of the [Fe(SCys)(4)] site in rubredoxin by the orientation of a peptide dipole

Rubredoxins (Rds) may be separated into two classes based upon the correlation of their reduction potentials with the identity of residue 44; those with Ala44 have reduction potentials that are approximately 50 mV higher than those with Val44. The smaller side chain volume occupied by Ala44 relative to that occupied by Val44 has been proposed to explain the increase in the reduction potential, based upon changes in the Gly43-Ala44 peptide bond orientation and the distance to the [Fe(SCys)(4)] center in the Pyrococcus furiosus (Pf) Rd crystal structure compared to those of Gly43-Val44 in the Clostridium pasteurianum (Cp) Rd crystal structure. As an experimental test of this hypothesis, single-site Val44 <--> Ala44 exchange mutants, [V44A]Cp and [A44V]Pf Rds, have been cloned and expressed. Reduction potentials of these residue 44 variants and pertinent features of the X-ray crystal structure of [V44A]Cp Rd are reported. Relative to those of wild-type Cp and Pf Rds, the V44A mutation in Cp Rd results in an 86 mV increase in midpoint reduction potential and the [A44V] mutation in Pf Rd results in a 95 mV decrease in midpoint reduction potential, respectively. In the crystal structure of [V44A]Cp Rd, the peptide bond between residues 43 and 44 is approximately 0.3 A closer to the Fe center and the hydrogen bond distance between the residue 44 peptide nitrogen and the Cys42 gamma-sulfur decreases by 0.32 A compared to the analogous distances in the wild-type Cp Rd crystal structure. The results described herein support the prediction that the identity of residue 44 alone determines whether a Rd reduction potential of about -50 or 0 mV is observed.

Redox properties of mesophilic and hyperthermophilic rubredoxins as a function of pressure and temperature

The formal equilibrium reduction potentials of recombinant electron transport protein, rubredoxin (MW = 7500 Da), from both the mesophilic Clostridium pasteurianum (Topt = 37 degrees C) and hyperthermophilic Pyrococcus furiosus (Topt = 95 degrees C) were recorded as a function of pressure and temperature. Measurements were made utilizing a specially designed stainless steel electrochemical cell that easily maintains pressures between 1 and 600 atm and a temperature-controlled cell that maintains temperatures between 4 and 100 degrees C. The reduction potential of P. furiosus rubredoxin was determined to be 31 mV at 25 degrees C and 1 atm, -93 mV at 95 degrees C and 1 atm, and 44 mV at 25 degrees C and 400 atm. Thus, the reduction potential of P. furiosus rubredoxin obtained under standard conditions is likely to be dramatically different from the reduction potential obtained under its normal operating conditions. Thermodynamic parameters associated with electron transfer were determined for both rubredoxins (for C. pasteurianum, DeltaV degrees = -27 mL/mol, DeltaS degrees = -36 cal K-1 mol-1, and DeltaH degrees = -10 kcal/mol, and for P. furiosus, DeltaV degrees = -31 mL/mol, DeltaS degrees = -41 cal K-1 mol-1, and DeltaH degrees = -13 kcal/mol) from its pressure- and temperature-reduction potential profiles. The thermodynamic parameters for electron transfer (DeltaV degrees, DeltaS degrees, and DeltaH degrees ) for both proteins were very similar, which is not surprising considering their structural similarities and sequence homology. Despite the fact that these two proteins exhibit dramatic differences in thermostability, it appears that structural changes that confer dramatic differences in thermostability do not significantly alter electron transfer reactivity. The experimental changes in reduction potential as a function of pressure and temperature were simulated using a continuum dielectric electrostatic model (DELPHI). A reasonable estimate of the protein dielectric constant (epsilonprotein) of 6 for both rubredoxins was determined from these simulations. A discussion is presented regarding the analysis of electrostatic interaction energies of biomolecules through pressure- and temperature-controlled electrochemical studies.

The value of MR imaging in differentiating between hard and soft cervical disc disease: a comparison with intraoperative findings

The aim of this study is to assess the accuracy of MRI alone in the differentiation of soft cervical disc protrusion from osteophytic compression in cervical disc disease. In a retrospective study, the MRI scans of 41 patients with cervical disc disease, who had previously undergone surgery, were presented to three independent observers, randomly on two different occasions, to identify the accuracy of the diagnosis of the presence of hard or soft disc or both as a cause of compression. The observers (two neurosurgeons and one neuroradiologist) were not involved with the treatment of the cases at any stage and were unaware of the surgical findings. Their observations were compared with those of the surgeon recorded at operation. The intra-observer agreement was poor for diagnosis into three categories as hard or soft disc or both. In distinguishing between the presence or absence of hard disc, there was moderate to good (Kappa = 0.6) intra observer and fair to moderate (Kappa = 0.4) interobserver agreement. The sensitivity of diagnosis of a hard disc was high (87%) but specificity was low (44%), due to the overestimation of the presence of hard disc. There was a significantly higher incidence of hard disc in the elderly age group (76% over the fifth decade, P = 0.0073). It is concluded that MRI alone is not a very efficient diagnostic tool in distinguishing between hard and soft disc in the cervical disc disease.

Direct electrochemistry of the flavin domain of assimilatory nitrate reductase: effects of NAD+ and NAD+ analogs

Direct electrochemical studies, utilizing two voltammetric methods-square-wave voltammetry (SWV) and cyclic voltammetry (CV)-have been performed on recombinant forms of the flavin domain of spinach assimilatory nitrate reductase in the presence of NAD+ analogs. The reduction potentials (E degrees ') of the flavin domains have been determined at an edge pyrolytic graphite electrode utilizing MgCl2 as a redox-inactive promoter. Under identical experimental conditions (pH 7.0, 25 degrees C), the two-electron reduction potential for the FAD/FADH2 couple has been determined to be -274 and -257 mV by SWV and CV, respectively. In contrast, the reduction potentials of free FAD have been determined to be -234 and -227 mV by SWV and CV, respectively. The reduction potentials of the complex formed between the FAD prosthetic group in the recombinant flavin domain and various NAD+ analogs have been determined to be as follows: NAD+ (E degrees ' = -192 mV), 5'-ADP ribose (E degrees ' = -199 mV), ADP (E degrees ' = -154 mV), AMP (E degrees ' = -196 mV), adenosine (E degrees ' = -192 mV), adenine (E degrees ' = -220 mV), and NMN (E degrees ' = -208 mV). In contrast to these positive shifts in reduction potential, nicotinamide (E degrees ' = -268 mV) had very little effect on the reduction potential of this flavin complex. Moreover, addition of NAD+ to the FAD prosthetic group in a variety of mutant forms of the recombinant flavin domain resulted in positive shifts in the reduction potential of the complex, although the magnitude of the shifts varied from a minimum of 6 mV obtained for the C240A mutant to a maximum of 79 mV obtained for the C62S mutant. These results represent the first extensive application of direct electrochemistry to examine the redox properties of assimilatory nitrate reductase and indicate that complex formation with NAD+, or various NAD+ analogs, results in a positive shift in the flavin reduction potential, with the magnitude of the shift correlating well with the efficiency of the inhibitor.

Sudden cardiac death associated with hypoplasia of the coronary arteries and conduction system alteration

We present a case of sudden cardiac death in a 24-year-old woman with evidence of hypoplasia of the left anterior descending (LAD) and posterior descending (PDA) coronary arteries. These vessels averaged 0.7 mm in internal diameter combined, in contrast to an average of 2.4 mm in control coronary arteries (p < 0.001). The myocardium exhibited areas of acute and chronic ischemic change. Also, the cardiac conduction system (CCS) had diffuse cellular enlargement, believed to be secondary to ischemia. The cells of the sinoatrial node (SAN) and the Purkinje cells of the proximal right bundle branch (RBB) averaged 28.5 and 25.6 microns, respectively. These were significantly larger than the SAN cells (21.6 microns, p = 0.002) and larger than the Purkinje cells (15.9 microns, p = 0.012) of control cases. We report that hypoplastic coronary artery disease is a cause of sudden death, is associated with varying degrees of ischemic change in the heart, and can be associated with condition system alteration.

Physical characterization of a totally synthetic rubredoxin

The entire polypeptide of hyperthermophilic Pyrococcus furiosus rubredoxin was synthesized in order to specifically probe structural determinants of protein thermostability. The uv-visible, circular dichroic, electron paramagnetic, and nuclear magnetic resonance spectra, and electrochemical properties, of the native and synthetic proteins were essentially identical. The synthetic protein had a half-life for denaturation of 24 hr at 80 degrees C. The synthetic protein is considerably more thermostable than nonhyperthermophilic rubredoxins, but not as stable as the native protein. Based on the spectroscopic evidence, it appears that the synthetic protein is incorporating iron properly to form holoprotein, but the peptide still may not be folded correctly.

Thiol modification and site directed mutagenesis of the flavin domain of spinach NADH:nitrate reductase

Incubation of either Chlorella nitrate reductase or the recombinant flavin domain of spinach nitrate reductase with reagents specific for modification of cysteine residues, such as N-ethylmaleimide, resulted in a time-dependent inactivation of NADH:ferricyanide reductase activity which could be prevented by incubation in the presence of NADH. At 25 degrees C and employing a fixed enzyme:modifier ratio, the rate of inactivation for both the Chlorella and spinach enzymes followed the order p-chloromercuribenzoate > methyl methanethiosulfonate > 2-(4'-maleimidylanilino)naphthalene-6-sulfonic acid > N-ethylmaleimide. For the spinach flavin domain, inactivation by methyl methanethiosulfonate or p-chloromercuribenzoate was found to be concentration independent suggesting the absence of nonspecific modifications. Initial rate studies of the methyl methanethiosulfonate-modified flavin domain indicated a reduction in NADH:ferricyanide activity (Vmax) from 85 to 44 micromol NADH consumed/min/nmol FAD and an increase in the Km for NADH from 12 to 35 microM when compared to the native enzyme, confirming a role for cysteine residue(s) in maintaining diaphorase activity. Site-directed mutagenesis of the four individual cysteines (residues 17, 54, 62, and 240) in the recombinant spinach flavin domain resulted in mutant proteins with visible and CD spectra very similar to those of the wild-type domain. Initial rate studies indicated that only substitutions of serine for cysteine 240 decreased diaphorase activity with maximal NADH:ferricyanide activity for the C240S mutant corresponding to 51 micromol NADH consumed/min/nmol FAD with a Km for NADH of 14 microM. Mutation of C240 to Ala or Gly resulted in greater loss of activity. The thermal stability of the four serine mutants was slightly decreased compared to the wild-type domain with the C62S mutant exhibiting the greatest instability. In contrast to the effects on diaphorase activity, square wave voltammetric studies indicated changes in the oxidation-reduction midpoint potential for the FAD/FADH2 couple in the C54S (E0'= -197 mV), C62S (E0' = -226 mV), and C240S (E0' = -219 mV) mutants compared to the wild-type domain (E0' = -268 mV). These results indicate that of the four cysteine residues in the spinach nitrate reductase flavin domain, only C240 plays a role in maintaining diaphorase activity, while C54 has the greatest influence on flavin redox potential and that no correlation between changes in catalytic activity and flavin redox potential was observed.

Variability in measurement of extracranial internal carotid artery stenosis as displayed by both digital subtraction and magnetic resonance angiography: an assessment of three caliper techniques and visual impression of stenosis

BACKGROUND AND PURPOSE

The degree of stenosis in the extracranial internal carotid artery helps predict the risk of an individual suffering subsequent cerebrovascular ischemic events. Different techniques have evolved to measure stenosis from angiograms, leading to some confusion and a call for the adoption of a single technique. To help choose the most reliable technique, this study assessed observer variability in reporting carotid stenosis for four different techniques, from both digital subtraction (DSA) and MR angiograms (MRA). Three of the techniques used caliper measurements; the fourth was the visual impression of stenosis.

METHODS

From a total of 137 angiograms, caliper measurements were possible on 105 DSAs and 74 MRAs. Measurements from these angiograms were made by two independent observers on two separate occasions to assess interobserver and intraobserver variation in reporting.

RESULTS

For DSA, the variability in reporting and the number of clinically significant differences arising as a result were similar for each of the four techniques. While the typical measurement errors for each of the techniques studied were on the order of +/- 5%, each technique produced some sizable individual differences for the same angiogram, with resultant wide 95% limits of agreement. Observer variability for reporting MRA was generally a little greater than for DSA. Compared with the caliper techniques, the visual impression of stenosis technique performed well, particularly for MRA.

CONCLUSIONS

Although observer variability in reporting can be considerable, no important differences were found among the different techniques widely used for measuring carotid stenosis.

Observer variation in the interpretation of intra-arterial angiograms and the risk of inappropriate decisions about carotid endarterectomy

OBJECTIVE

To determine how often observer variation in the interpretation of intra-arterial angiograms might alter the decision whether or not to refer patients for carotid surgery.

METHODS

A prospective study was carried out in a consecutive series of 99 patients with transient ischaemic attacks and minor strokes. Interpretable angiographic films were available for 179 carotid artery bifurcations. Stenosis of the internal carotid artery was measured using mm scales, independently by three different radiologists (A, B, and C), using the European Carotid Surgery Trial method.

RESULTS

An analysis of the grouped data showed good to moderate agreement by kappa statistics for radiologists A v B, B v C, and A v C of 0.68, 0.60, and 0.70 respectively. The mean absolute difference in the estimate of stenosis by each of the different radiologists (interobserver variation) was 9.5% and for each radiologist on two separate occasions (intraobserver variation) 8.4%. The degree of observer error was smallest among severely stenosed arteries. Although the absolute differences were small, "clinically important" differences which could change the treatment recommended from surgery to no surgery (or vice versa) occurred between radiologists A and B, B and C, and A and C in: seven (3.9%), six (3.4%), and 11 (6.1%) vessels respectively.

CONCLUSIONS

Because observer variation affects all of the imaging methods (Doppler, duplex, contrast arteriography, and MR angiography) used to select patients with transient ischaemic attack and stroke, these findings are likely to be widely relevant. Any centre assessing patients with cerebrovascular disease will need to implement strict quality control measures in the interpretation of angiograms (and other vascular imaging procedures) to minimise observer error and thereby reduce the number of inappropriate decisions made to refer for carotid artery surgery or not.

A variable-temperature direct electrochemical study of metalloproteins from hyperthermophilic microorganisms involved in hydrogen production from pyruvate

The hyperthermophilic bacterium Thermotoga maritima and the hyperthermophilic archaeon Pyrococcus furiosus grow optimally at 80 and 100 degrees C, respectively, by the fermentation of carbohydrates to organic acids, CO2, and H2. Pyruvate is a major source of reductant for H2 production during fermentation, and pyruvate ferredoxin oxidoreductase (POR), a 4Fe-type ferredoxin, and hydrogenase have been previously purified from both species. P. furiosus utilizes a copper-iron-containing POR and a nickel-iron-containing hydrogenase, whereas the POR of T. maritima lacks copper and its hydrogenase lacks nickel. For all four enzymes and for the two ferredoxins, we have determined their reduction potentials (E degrees') and, where possible, thermodynamic parameters associated with electron transfer (delta S degrees and delta H degrees), using differential pulse voltammetry at temperatures ranging from 25 to 95 degrees C. At ambient temperature, the E degrees' values for all six proteins were comparable and spanned less than 50 mV, but their temperature dependence varied dramatically, even between analogous proteins, such that in the physiological-relevant temperature range the E degrees' values became widely separated. In most cases, transition points were observed in E degrees'/temperature profiles, and these generally corresponded with significant increases in catalytic activity, but occurred at lower temperatures in T. maritima than in P. furiosus. The two ferredoxins (and also P. furiosus rubredoxin) had much more negative entropy terms than were calculated for POR and hydrogenase, and these values were also more negative than those previously reported for mesophilic redox proteins. The reduction potentials measured at high temperatures and likely efficiencies of electron transfer between the various proteins were consistent with in vitro activity measurements.(ABSTRACT TRUNCATED AT 250 WORDS)

A pressure- and temperature-controlled electrochemical cell for investigating biological electron transfer reactions

The construction and operation of a cell for pressure- and temperature-controlled direct electrochemical studies of oxygen-sensitive biological materials is described. The stainless steel electrochemical cell, which contains a pyrolytic graphite working electrode, and Ag/AgCl counter and reference electrodes in an isolated compartment, easily maintains pressures between 1 and 2000 atm, and temperatures between 4 degrees C and at least 100 degrees C. The utility of the cell was demonstrated by determining the reduction potential of a redox dye, phenol red, by square wave voltammetry as a function of pressure and temperature. Thermodynamic parameters associated with electron transfer (delta V degree, delta beta, delta S degree, and delta H degree) were determined from the pressure and temperature/reduction potential profiles. Both pressure- and temperature-dependent reduction potentials of phenol red were attributed to differences in solvent interactions between its oxidation states. A discussion regarding the analysis of electrostatic interaction energies of biomolecules through pressure- and temperature-controlled electrochemical studies is presented.

Comparison of magnetic resonance angiography, duplex ultrasound, and digital subtraction angiography in assessment of extracranial internal carotid artery stenosis

The results of a prospective study comparing ultrasound, intra-arterial digital subtraction angiography, and magnetic resonance angiography in the assessment of the degree of extracranial internal carotid artery stenosis are reported in patients with symptoms of recent carotid territory ischaemia. A total of 70 patients and 137 vessels were examined by all three techniques. The results obtained by each technique were reported blind. The mean difference (SD) for the comparison of magnetic resonance angiography and digital subtraction angiography was -0.7 (14)%, for ultrasound and digital subtraction angiography 3.1 (15)%, and for magnetic resonance angiography and ultrasound -3.8 (15)%. The level of agreement was greater for the more tightly stenosed vessels. With the assumption that the results of the digital subtraction angiogram reflect the true situation, the sensitivity and specificity in the detection of > or = 30% stenoses were 93% and 82% with ultrasound and 89% and 82% with magnetic resonance angiography; for stenoses > or = 70% 93% and 92% with ultrasound and 90% and 95% with magnetic resonance angiography; and for stenoses of 70-99% 89% and 93% with ultrasound and 86% and 93% with magnetic resonance angiography. For occlusion the values were 93% and 99% with ultrasound and 80% and 99% with magnetic resonance angiography. Increased sensitivity and specificity were obtained when analysis was confined to those vessels in which ultrasound and magnetic resonance angiography were in agreement over classification. It is thus possible to accurately categorize the degree of stenosis of the extracranial internal carotid artery from a combination of ultrasound and magnetic resonance angiography. The adoption of this combination for the investigation of patients before carotid endarterectomy removes the risk associated with conventional angiography and represents an important advance in the management of carotid stenosis.

Cloning, expression, and molecular characterization of the gene encoding an extremely thermostable [4Fe-4S] ferredoxin from the hyperthermophilic archaeon Pyrococcus furiosus

The gene for ferredoxin from the hyperthermophilic archaeon Pyrococcus furiosus was cloned, sequenced, and expressed in Escherichia coli. The coding region confirmed the determined amino acid sequence. Putative archaeon-type transcriptional regulatory elements were identified. The fdxA gene appears to be an independent transcriptional unit. Recombinant ferredoxin was indistinguishable from the protein purified from P. furiosus in its thermal stability and in the potentiometric and spectroscopic properties of its [4Fe-4S] cluster.

Solution 1H NMR determination of secondary structure for the three-iron form of ferredoxin from the hyperthermophilic archaeon Pyrococcus furiosus

Two-dimensional 1H NMR data have been used to make sequence-specific assignments and define the secondary structure of the three-iron form of the oxidized ferredoxin, Fd, from the hyperthermophilic archaeon Pyrococcus furiosus, Pf. Signals for at least some protons were located for 65 of the 66 amino acids in the sequence, in spite of the paramagnetic (S = 1/2) ground state, but not all could be assigned. Unassigned and missing signals could be qualitatively correlated with the expected proximity of the protons to the paramagnetic cluster. The secondary structure was deduced from qualitative analysis of the 2D nuclear Overhauser effect, which identified two antiparallel beta-sheets, one triple-stranded including Ala1-Ser5, Val39-Glu41, and Thr62-Ala66, and one double-stranded consisting of Glu26-Asn28 and Lys32-Glu34, as well as an alpha-helix involving Glu43-Glu54. Three tight type I turns are located at residues Asp7-Thr10, Pro22-Phe25, and Asp29-Gly31. Comparison with the crystal structure of Desulfovibrio gigas, Dg, Fd (Kissinger et al., 1991) reveals a very similar folding topology, although several secondary structural elements are extended in Pf relative to Dg Fd. Thus the beta-sheet involving the two termini is expanded to include the two terminal residues and incorporates a third strand from the internal loop that is lengthened by several insertions in Pf relative to Dg Fd. The double-stranded beta-sheet in the interior of Pf Fd is lengthened slightly due to a much tighter type I turn between the two strands. The helix near the C-terminus is three residues longer in Pf than in Dg Fd, as well as being shifted toward the N-terminus. The disulfide link between the two nonligating Cys residues (Cys21 and Cys48) is conserved in Pf Fd, but the link near the C-terminus is in the middle of the long alpha-helix in Pf Fd, instead of at the N-terminus of the helix as in Dg Fd. The extensions of the beta-sheets and alpha-helix increase the number of main-chain hydrogen bonds in Pf Fd by approximately 8 relative to those in Dg Fd and likely contribute to its remarkable thermostability (it is unaffected by anaerobic incubation at 95 degrees C for 24 h).(ABSTRACT TRUNCATED AT 400 WORDS)

Identification of an unusual paramagnetic species and of three [2Fe-2S] clusters in the iron-only hydrogenase from the hyperthermophilic bacterium Thermotoga maritima

Thermotoga maritima is a H2-producing, fermentative anaerobe and is one of the most thermophilic bacteria known. Its iron-only (Fe-)hydrogenase was previously shown to be a homotetramer and to contain two [4Fe-4S] and two [2Fe-2S] clusters per monomer, but the enzyme lacked the characteristic EPR signal of the oxidized H cluster, the proposed site of H2 catalysis in mesophilic Fe-hydrogenases (Juszczak, A., Aono, S. and Adams, M.W.W. (1991) J. Biol. Chem. 266, 13834-13841). The two types of cluster were shown by spectroelectrochemistry to have reduction potentials (Em) of -390 and -440 mV, respectively. We have now identified two additional redox centers in the enzyme, a [2Fe-2S] center with a higher reduction potential (Em = -365 mV) and an unusual paramagnetic species (Em > -200 mV). The higher potential [2Fe-2S] center can be reduced by sodium dithionite at pH 6.0 and exhibits an axial-type EPR signal with gz = 2.026 and gy = gx = 1.940. The two lower potential [2Fe-2S] centers are fully reduced by sodium dithionite only at pH 10.0. Both of these clusters in their reduced states exhibit rhombic-type EPR signals with gz = 2.005, gy = 1.955, and gx = 1.921. This hydrogenase is therefore thought to contain three [2Fe-2S] clusters, as well as two [4Fe-4S] clusters. In addition, a nearly isotropic EPR signal (g = 2.01) was observed when the enzyme was anaerobically oxidized by organic dyes such as thionine (E alpha = 64 mV) or 2,6-dichlorophenolindophenol (E alpha = 217 mV). This resonance was not observed at 20 K due to relaxation broadening and therefore did not arise from a conventional organic radical. The oxidized enzyme was fully active in an H2 production assay, and also reacted directly with H2. In contrast, the air-oxidized enzyme was inactive and did not exhibit the g = 2.01 EPR signal. This resonance was assigned to a novel paramagnetic species with an approximate Em value of -70 mV. It is thought to be associated with the H2 activating site of this atypical Fe-hydrogenase.

Pyruvate ferredoxin oxidoreductases of the hyperthermophilic archaeon, Pyrococcus furiosus, and the hyperthermophilic bacterium, Thermotoga maritima, have different catalytic mechanisms

Pyruvate ferredoxin oxidoreductase (POR) has been previously purified from two hyperthermophiles, the archaeon Pyrococcus furiosus (Pf, Topt = 100 degrees C) and the bacterium Thermotoga maritima (Tm, Topt = 80 degrees C). Each catalyzes the oxidative decarboxylation of pyruvate to acetyl-CoA and CO2 near the optimal growth temperature of the organism and are virtually inactive at 25 degrees C. Both PORs contain a thiamine pyrophosphate (TPP) cofactor and at least two [4Fe-4S] ferredoxin-type clusters. We have now shown, using EPR spectroscopy and metal analyses, that PfPOR also contains an unusual copper center that is not present in Tm POR. In addition, distinct catalytic intermediates were generated in both enzymes by the addition, separately and in combination, of the substrates pyruvate and CoASH, and these were examined by EPR spectroscopy. The addition of pyruvate to oxidized Pf POR produced an isotropic signal centered at g = 2.01, which was measurably broader in the presence of pyruvate-2(13)C. This signal, which was assigned to a (hydroxyethyl)thiamine pyrophosphate radical intermediate, was not observed in Tm POR under the same experimental conditions. Incubation of the oxidized enzymes with CoASH resulted in the partial reduction of the copper site in Pf POR and the partial reduction of a novel iron-sulfur center in Tm POR, which was not seen in the dithionite-reduced enzyme. The addition of both pyruvate and CoASH to the PORs in their oxidized states resulted in the reduction of the same iron-sulfur centers that are reduced by sodium dithionite.(ABSTRACT TRUNCATED AT 250 WORDS)

Medium-chain acylcoenzyme-A dehydrogenase deficiency. Not just another Reye syndrome

The medium-chain acylcoenzyme-A dehydrogenase enzyme (MCAD) is involved in the initial stages of breakdown of medium-chain-length fatty acids in mitochondria. A deficiency of this enzyme can become symptomatic during a catabolic state and may resemble Reye syndrome. We report the case of a 17-month-old white girl whose 1-day history of vomiting and agitation followed by generalized unresponsiveness caused her to be brought to a local emergency department. She died after resuscitative efforts failed, and an autopsy revealed severe cerebral edema, marked hepatic steatosis, and steatosis of the renal tubule epithelia. Electron microscopy of the liver showed cytoplasmic lipid spherules and mitochondria with dense matrices, changes similar to Reye syndrome; however, postmortem examination of the decedent's blood revealed elevated medium-chain-length acylcarnitines diagnostic of an MCAD deficiency. Although uncommon, a deficiency of this enzyme should be considered in apparent Reye syndrome victims.

Proton NMR investigation of the oxidized three-iron clusters in the ferredoxins from the hyperthermophilic archae Pyrococcus furiosus and Thermococcus litoralis

The 3Fe forms of ferredoxins (Fd) from the hyperthermophilic archaebacteria Pyrococcus furiosus (Pf) and Thermococcus litoralis (Tl) have been investigated by 1H NMR. A combination of one-dimensional nuclear Overhauser and two-dimensional NOESY and bond correlation spectroscopy provides the assignment of the aromatic residues, one conserved valine, and the location of the signals for each of the three cysteines coordinated to the clusters. Dipolar contacts between the Trp 2 and Tyr 46 in Pf Fd and from an invariant phenylalanine to an invariant valine and a cluster cysteine in both Fd confirm a folding pattern for these proteins that is very similar to that of the crystallographically characterized ferredoxin from the mesophile Desulfovibro gigas. The sequence-specific assignment of the buried cysteine near the invariant phenylalanine has been made. The temperature dependence of the contact-shifted cysteinyl residues reveals a distinct 2:1 asymmetry in the magnetic coupling among the three high-spin ferric ions, in that one cysteine exhibits Curie behavior, while the other two cysteines display anti-Curie behavior. These magnetic properties are rationalized qualitatively on the basis of a magnetic coupling scheme where two iron couple to yield an intermediate spin of 2 which couples to the remaining S = 5/2 iron to yield the total cluster spin 1/2. This magnetic asymmetry appears to be a characteristic feature of oxidized 3 Fe clusters. Pf Fd also undergoes a dynamic equilibrium between two alternate forms that differ slightly in the environment of two of the coordinated cysteines. Analysis of the pattern of the contact shifts for the three cysteines in the two ferredoxins suggests that the cysteine coordinated to the unique iron does not have the same sequence origin.

A temperature-controlled, anaerobic cell for direct electrochemical studies

The construction and operation of a cell for temperature-controlled, direct electrochemical studies of oxygen-sensitive materials are described. The borosilicate cell contains a pyrolytic graphite working electrode, a Ag/AgCl reference electrode, and a platinum counter electrode, all of which can be readily interchanged with other types of electrodes. It is surrounded by a water jacket constructed of steel and Lexan, which can easily maintain temperatures between 4 degrees C and at least 90 degrees C. The entire cell was designed to minimize the number, complexity, and expense of components, as well as minimize required sample volume (250 microliters) and sources of oxygen leakage. As examples of the cell's utility, the redox properties of two common organic redox dyes, methyl viologen and thionin, were determined by differential pulse voltammetry at temperatures from 30 to 90 degrees C.

Direct electrochemical studies of hydrogenase and CO dehydrogenase

The reduction potentials of two relatively high-molecular-mass enzymes were determined directly at an edge pyrolytic graphite electrode by using square-wave voltammetry. The equilibrium reduction potential versus standard hydrogen electrode was determined for Clostridium pasteurianum hydrogenase I (E'0 = -377 +/- 10 mV; molecular mass 60 kDa) and Rhodospirillum rubrum carbon monoxide dehydrogenase (E'0 = -418 +/- 7 mV; molecular mass 62 kDa). The reduction potential of each enzyme was pH-independent, and one electron was transferred per redox centre. The reduction potential was determined to be identical for the CO dehydrogenase, semi-apo-(CO dehydrogenase), and CO dehydrogenase with carbonyl sulphide (COS) or cyanide bound. The electron-transferring efficiency of CO dehydrogenase was affected by two inhibitors, COS and cyanide, as indicated by a diminished analytic current.

A totally synthetic histidine-2 ferredoxin: thermal stability and redox properties

The entire polypeptide of Clostridium pasteurianum ferredoxin (Fd) with a site-substituted tyrosine-2----histidine-2 was synthesized using standard t-Boc procedures, reconstituted to the 2[4Fe-4S] holoprotein, and compared to synthetic C. pasteurianum and native Fds. Although histidine-2 is commonly found in thermostable clostridial Fds, the histidine-2 substitution into synthetic C. pasteurianum Fd did not significantly increase its thermostability. The reduction potential of synthetic histidine-2 Fd was -343 and -394 mV at pH 6.4 and 8.7, respectively, versus standard hydrogen electrode. Similarly, Clostridium thermosaccharolyticum Fd which naturally contains histidine-2 was previously determined to have a pH-dependent reduction potential [Smith, E.T., & Feinberg, B.A. (1990) J. Biol. Chem. 265, 14371-14376]. An electrostatic model was used to calculate the observed change in reduction potential with pH for a homologous ferredoxin with a known X-ray crystal structure containing a hypothetical histidine-2. In contrast, the reduction potential of both native C. pasteurianum Fd and synthetic Fd with the C. pasteurianum sequence was -400 mV versus standard hydrogen electrode and was pH-independent [Smith, E.T., Feinberg, B.A., Richards, J.H., & Tomich, J.M. (1991) J. Am. Chem. Soc. 113, 688-689]. On the basis of the above results, we conclude that the observed pH-dependent reduction potential for both synthetic and native ferredoxins that contain histidine-2 is attributable to the electrostatic interaction between histidine-2 and iron-sulfur cluster II which is approximately 6 A away.

Cerebral CT lesions in multiple sclerosis mimicking multiple metastases

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Redox properties of several bacterial ferredoxins using square wave voltammetry

The equilibrium reduction potential of the 2[4Fe-4S] ferredoxin (Fd) isolated from four different bacterial strains was determined at a methyl viologen-modified gold electrode using square wave voltammetry. The observed reduction potential at pH 8 for Clostridium thermoaceticum Fd was -385 mV; Clostridium pasteurianum, -393 mV; Clostridium thermosaccharolyticum, -408 mV; and Chromatium vinosum, -460 mV versus normal hydrogen electrode at 25 degrees C. The reduction potential of the C. pasteurianum Fd was found to be pH independent from pH 6.4 to 8.7, indicating that the electron transfer mechanism does not involve proton exchange. In contrast, the reduction potential of the C. thermosaccharolyticum Fd was found to be pH dependent from pH 6.4 to 8.7, with pKox approximately 7 and pKred approximately 7.5. The +30 mV change in reduction potential from pH 8.7 to 6.4 was attributed to an electrostatic interaction between the iron-sulfur cluster II and the protonated histidine 2 residue located about 6 A away. The Ch. vinosum Fd interacted reversibly at the methyl viologen-modified gold electrode, and its reduction potential was verified using visible spectroelectrochemistry. The reduction potential of Ch. vinosum Fd was found to be 30 mV more positive than previously reported. The similarities of the bacterial Fd reduction potentials are discussed in terms of the homology of their primary structure as reflected by the similarities in the visible and circular dichroic spectra.

A method for identification of vertebral level

A method of spinal level marking applicable particularly for use in thoracolumbar posterior spinal operations is described. The use of patent blue V dye in this procedure is discussed in a consecutive series of over 100 cases. No serious adverse effects were observed. The technique ensures accurate identification of spinal marking and helps to minimize anaesthetic time.

A technique for closure of the lesser curvature of the stomach used in the von Eiselberg-Hofmeister reconstruction after subtotal gastrectomy

A technique for closing the lesser curvature of the stomach after subtotal gastrectomy has been used in 847 subtotal gastrectomies. In this group, one patient had transient postoperative bleeding and none had anastomotic leakage. The technique is recommended as a simple method of obtaining a secure and hemostatic closure which can be accomplished rapidly and which does not require the use of special instruments or material.

The lethal hit stage of mouse T and non-T cell-mediated cytolysis: differences in cation requirements and characterization of an analytical "cation pulse" method

We investigated in detail the cation requirements of two different systems of mouse cell-mediated cytolysis in vitro, at their recognition, post-recognition hit and target cell disintegration stages. In T cell-mediated cytolysis, respectively Mg++ or Ca++, Ca++, and no cations, were required. In non-T cell-mediated hemolysis, respectively no cations, Mg++, and no cations, were required. Two main conclusions can be drawn. First, the cation requirements are different from one system to the other especially at the post-recognition hit stage, which strongly suggests the existence of differences between both systems as to the actual mechanism of lysis. Second, the cation requirements are different within each system from one step to another. This formed the basis of a step-by-step analysis of the lytic process, leading to the characterization of a cation pulse method for the experimental isolation and further study of the post-recognition hit stage of cell-mediated cytolysis.

A Case of Lymphangioma of the Orbit

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A Case of Epibulbar Polymorphous Sarcoma

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