Art therapy masks reflect emotional changes in military personnel with PTSS

Among disabling post-traumatic stress symptoms (PTSS) are irritability, aggressive behavior, distressing memories and general impaired cognition and negative mood. Art therapy interventions, including mask-making, can potentially alleviate these symptoms. We tested the hypothesis that art conveys emotions and predicted that blinded viewers would be able to perceive changes in theoretically derived emotional profiles expressed in art made by military personnel with PTSS from the onset to the end of therapy. Five service members and veterans exhibiting PTSS were enrolled in an 8-session art therapy protocol, during which they artistically transformed papier-mâché masks at the beginning and end of the protocol. We found that blinded viewers without knowledge of the masks' creation stage (onset or end of therapy) read initial masks as conveying more negative emotions (e.g., angry, upset, and challenged) and later masks as conveying more positive emotions (calm and pleasure). Based on the assessments from the blinded evaluators, we infer the emotional transition experienced by the participants was expressed in the masks. In an exploratory arm of the study, we also found that viewers were better able to empathize with the negative emotions experienced by participants with PTSS when asked to explicitly take their perspective.

Association of whole mtDNA, an NADPH G11914A variant, and haplogroups with high physical performance in an elite military troop

Physical performance is a multifactorial and complex trait influenced by environmental and hereditary factors. Environmental factors alone have been insufficient to characterize all outstanding phenotypes. Recent advances in genomic technologies have enabled the investigation of whole nuclear and mitochondrial genome sequences, increasing our ability to understand interindividual variability in physical performance. Our objective was to evaluate the association of mitochondrial polymorphic loci with physical performance in Brazilian elite military personnel. Eighty-eight male military personnel who participated in the Command Actions Course of the Army were selected. Total DNA was obtained from blood samples and a complete mitochondrial genome (mtDNA) was sequenced using Illumina MiSeq platform. Twenty-nine subjects completed the training program (FINISHED, 'F'), and fifty-nine failed to complete (NOT_FINISHED, 'NF'). The mtDNA from NF was slightly more similar to genomes from African countries frequently related to endurance level. Twenty-two distinct mtDNA haplogroups were identified corroborating the intense genetic admixture of the Brazilian population, but their distribution was similar between the two groups (FST=0.0009). Of 745 polymorphisms detected in the mtDNA, the position G11914A within the NADPH gene component of the electron transport chain, was statistically different between F and NF groups (P=0.011; OR: 4.286; 95%CI: 1.198-16.719), with a higher frequency of the G allele in group F individuals). The high performance of military personnel may be mediated by performance-related genomic traits. Thus, mitochondrial genetic markers such as the ND4 gene may play an important role on physical performance variability.

D5S2500 is an ambiguously characterized STR: Identification and description of forensic microsatellites in the genomics age

In the process of establishing short tandem repeat (STR) sequence variant nomenclature guidelines in anticipation of expanded forensic multiplexes for massively parallel sequencing (MPS), it was discovered that the STR D5S2500 has multiple positions and genomic characteristics reported. This ambiguity is because the marker named D5S2500 consists of two different microsatellites forming separate components in the capillary electrophoresis multiplexes of Qiagen's HDplex (Hilden, Germany) and AGCU ScienTech's non-CODIS STR 21plex (Wuxi, Jiangsu, China). This study outlines the genomic details used to identify each microsatellite and reveals the D5S2500 marker in HDplex has the correctly assigned STR name, while the D5S2500 marker in the AGCU 21plex, closely positioned a further 1643 nucleotides in the human reference sequence, is an unnamed microsatellite. The fact that the D5S2500 marker has existed as two distinct STR loci undetected for almost ten years, even with reported discordant genotypes for the standard control DNA, underlines the need for careful scrutiny of the genomic properties of forensic STRs, as they become adapted for sequence analysis with MPS systems. We make the recommendation that precise chromosome location data must be reported for any forensic marker under development but not in common use, so that the genomic characteristics of the locus are validated to the same level of accuracy as its allelic variation and forensic performance. To clearly differentiate each microsatellite, we propose the name D5S2800 be used to identify the Chromosome-5 STR in the AGCU 21plex.

Poor health among smokers obtaining colonoscopy screening: making the case for cessation intervention

OBJECTIVES

Assess differences in perceived health status among individuals receiving colonoscopy screening based on smoking status.

STUDY DESIGN

Cross-sectional data were collected as part of a larger study investigating whether verbal and non-verbal communication and behaviors of gastroenterologists and nurses.

METHOD

Data for this study were collected between 2011 and 2013 among receiving colonoscopy screenings. Data were collected as part of a study assessing patients (n = 1785) undergoing colonoscopy screenings about their expectations, concerns, understanding of the procedure, and perceived health status. Differences between current, former and never smokers were analyzed using a one-way between subjects ANOVA, with a Scheffe post hoc.

RESULTS

Post hoc analyses revealed that current smokers were significantly different from former or never smokers on the following variables: days their physical health was not good, days their mental health was not good, days health influenced their activities, days pain influenced their ability to perform activities, perceived general health, and current anxiety.

CONCLUSION

This study looked at perceived health among individuals receiving colonoscopy screening by on smoking status, a relevant population based on the recent Surgeon Generals link. Former smokers reported similar health status across all variables as never smokers, suggesting the effect of quitting smoking on self-perceived health. With this link, tailored smoking cessation messages to smokers receiving colonoscopy screenings may be an excellent vantage point for a smoking cessation intervention.

Prenatal diagnosis of trisomy 20 by chorionic villus sampling (CVS): a case report with long-term outcome

A case of prenatally diagnosed non-mosaic trisomy 20 in cells cultured from a chorionic villus sample (CVS)is presented. The term placental karyotype was also non-mosaic trisomy 20. The karyotype of the newborn was 46,XY/47,XY,+20 in foreskin cultures and in a second skin culture; blood lymphocyte culture was 46,XY. Aside from diffuse, hypopigmentary swirls along the lines of Blaschko observed on his extremities and trunk, referred to as hypomelanosis of Ito, the patient is clinically normal at 8 3/4 years of age. In addition, he is one of the oldest reported cases of mosaic trisomy 20 confirmed after birth for which the clinical outcome has been monitored. This case demonstrates that these trisomy 20 findings are compatible with normal psychomotor development and phenotype.

Antenatal corticosteroids and newborn screening for congenital adrenal hyperplasia

OBJECTIVE

To assess the effect of reported corticosteroid exposure on neonatal levels of 17-hydroxyprogesterone (17-OHP), the cortisol precursor used in newborn screening for congenital adrenal hyperplasia, in newborns weighing less than 2500 g at birth.

DESIGN

A retrospective study of newborns weighing less than 2500 g at birth and exposed to corticosteroids as reported on their newborn screening card compared with newborns weighing less than 2500 g at birth and reported as not exposed to corticosteroids.

METHODS

Birth weight, gestational age, age at screening, special care information, and name of screening hospital were obtained from newborn screening cards for 16 115 newborns screened in Michigan during the first 3 months of 2000. Levels of 17-OHP, measured by fluoroimmunoassay, were obtained from Michigan's Newborn Screening Program database.

RESULTS

The mean 17-OHP level for the 69 low-birth-weight newborns in the corticosteroid-exposed group was 52 ng/mL, which was higher than that for the 771 low-birth-weight newborns in the unexposed group (35 ng/mL) (P<.001). Reported corticosteroid use did not decrease the number of expected borderline positive screening results for congenital adrenal hyperplasia (P>.05). Levels of 17-OHP varied by birth weight in corticosteroid-exposed and unexposed newborns.

CONCLUSIONS

Corticosteroid exposure may not suppress screening 17-OHP levels. Therefore, newborn screening should not be delayed in premature newborns because of antenatal exposure to corticosteroids.

A constrained formulation for the receiver operating characteristic (ROC) curve based on probability summation

We propose a principled formulation of the ROC curve that is constrained in a realistic way by the mechanism of probability summation. The constrained and conventional ROC formulations were fitted to 150 separate sets of rating data taken from previous observer studies of 250 or 529 chest radiographs. A total of 20 different readers had used either discrete or continuous rating scales to evaluate those chest cases for likelihood of separate specified abnormalities: interstitial disease, pulmonary nodule, pneumothorax, alveolar infiltrate, or rib fracture. Both ROC formulations were fitted separately to every set of rating data using maximum-likelihood statistical procedures that specified each ROC curve by normally distributed latent variables with two scaling parameters, and estimated the area below the ROC curve (Az) with its standard error. The conventional and constrained binormal formulations usually fitted ROC curves that were nearly indistinguishable in form and in Az. But when fitted to asymmetric rating data that contained few false-positive cases, the conventional ROC curves often rose steeply, then flattened and extrapolated into an unrealistic upward "hook" at the higher false-positive rates. For those sets of rating data, the constrained ROC curves (without hooks) estimated larger values for Az with smaller standard errors. The constrained ROC formulation describes observers' ratings of cases at least as well as the conventional ROC, and always guarantees a realistic fitted curve for observer performance. Its estimated parameters are easy to interpret, and may also be used to predict observer accuracy in localizing the image abnormalities.

Estrogen-induced suppression of intake is not mediated by taste aversion in female rats

Estrogen treatment can suppress the intake of a previously presented gustatory conditioned stimulus (CS). This finding has been interpreted as an estrogen-induced conditioned taste aversion. However, a distinction must be made between taste aversion and taste avoidance. In particular, tastes are only considered aversive if they elicit a stereotypic behavioral response, otherwise the reduction in intake is classified as an avoidance. Although aversive orofacial responses have been reported in male rats after taste-estrogen pairings, they have not been examined in ovariectomized female rats. The goal of the present investigation, then, was to use similar procedures to determine whether conditioned aversion also mediates the estrogen-induced reduction of intake in female rats. Animals were introduced to a novel 0.1% saccharin solution and immediately thereafter were given a subcutaneous injection of vehicle or estradiol benzoate (10 microg). Responses were assessed using a two-bottle preference test, a one-bottle acceptance test, and a taste reactivity (TR) test. The results confirmed previous reports of a reduced preference for saccharin after saccharin-estradiol pairing using the two-bottle test. The reduction in intake during the one-bottle test, however, was not accompanied by stereotypic aversive responses, such as gaping. Surprisingly, a similar reduction in intake also occurred when using a backward conditioning procedure in which estrogen was injected before, rather than after, CS access. Thus, the present results show that the suppressive effects of estrogen reflect an avoidance, rather than aversion and, moreover, that the reduced intake may be due to an unconditioned, rather than a conditioned, response.

Observer variation and the performance accuracy gained by averaging ratings of abnormality

Six radiologists used continuous scales to rate 529 chest-film cases for likelihood of five different types of abnormalities (interstitial disease, nodule, pneumothorax, alveolar infiltrate, and rib fracture) in each of six replicated readings, yielding 36 separate ratings of each case for the five abnormalities. Separate data analyses of all cases and subsets of the difficult/subtle cases for each abnormality estimated the relative gains in accuracy (linear-scaled area below the ROC curve) obtained by averaging the case-ratings across (a) six independent replications by each reader (25% gain), (b) six different readers within each replication (34% gain), or (c) all 36 readings (48% gain). Although accuracy differed among both readers and abnormalities, ROC curves for the median ratings showed similar relative gains in accuracy, somewhat greater than those predicted from the measured rating correlations. A model for variance components in the observer's latent decision variable could predict these gains from measured correlations in the single ratings of cases. Depending on whether the model's estimates were based on realized accuracy gains or on rating correlations, about 48% or 39% of each reader's total decision variance (summed variance for positive and negative cases) consisted of random (within-reader) error that was uncorrelated between replications, another 10% or 14% came from idiosyncratic responses to individual cases, and about 43% or 47% was systematic variation that all readers found in the sampled cases.

Empiric assessment of parameters that affect the design of multireader receiver operating characteristic studies

RATIONALE AND OBJECTIVES

The authors attempted to assess experimentally the magnitude of reader variability and the correlations and interactions among cases, readers, and modalities during observer performance studies and their possible effects on study design and sample size.

MATERIALS AND METHODS

Published data from 32 selected receiver operating characteristic (ROC) studies were reviewed to compare the magnitude of the variance component from readers with the variance component from modality. Estimates of correlation and interactions among cases, readers, and modalities were also computed directly from ROC data ascertained during two large studies performed in our laboratory. Each of these two studies included 529 cases and six readers, but one study used eight modalities and the other nine.

RESULTS

Published results indicate that reader variability is task dependent and larger (P < .05) than modality variability in detection of interstitial disease. Measured correlations between modalities for the same reader were task dependent and ranged from 0.35 to 0.59. Modality-by-reader and modality-by-case interactions often are not important factors. The random error term was greater than the modality-by-reader interaction in 11 of 20 comparisons and greater than the modality-by-case interaction in eight of 20 comparisons.

CONCLUSION

Use of the same cases interpreted with different modes is justifiable in many situations because of the high variability from readers. This comprehensive review of existing ROC studies resulted in parameter assessments that can be used to better estimate sample-size requirements in multireader ROC studies.

Computer-assisted diagnosis of breast cancer using a data-driven Bayesian belief network

This study investigates a simple Bayesian belief network for the diagnosis of breast cancer, and specifically addresses the question of whether integrating image and non-image based features into a single network can yield better performance than hybrid combinations of independent networks. From a dataset of 419 cases, including 92 malignancies, 13 features relating to mammographic findings, physical examinations and patients' clinical histories, were extracted to build three Bayesian belief networks. The scenarios tested included a network incorporating all features and two hybrids which combined the outputs of sub-networks corresponding to the image or non-image features. Average areas (Az) under the corresponding ROC curves were used as measures of performance. The network incorporating only image based features performed better (Az =0.81) than that using nonimage features (Az = 0.71). Both hybrid classifiers yielded better performance (Az =0.85 for averaging and Az = 0.87 for logistic regression), but neither hybrid was as accurate as the network incorporating all features (Az = 0.89). This preliminary study suggests that, like human observers who concurrently consider different types of information, a single classifier that simultaneously evaluates both image and non-image information can achieve better diagnostic performance than the hybrid combinations considered here.

File management in a radiology department

OBJECTIVE

The objective of this study was to assess the effectiveness of film management in a large urban teaching hospital.

SUBJECTS AND METHODS

For 5 days in March 1998, individuals seeking access to imaging studies performed in the radiology department of a large urban hospital were questioned about their activities and were physically followed in an effort to characterize the efficiency and effectiveness of the department in servicing individuals not employed by the department. Activities in the department were recorded, and the times to visit completion and the failure rates were assessed.

RESULTS

Of the 381 visitors to the department who were followed, 321 were hospital employees and 186 were physicians. The average total time spent in the department was 4 min, during which 2 min were spent viewing images or obtaining consultation. Physicians were in the department an average of only 7 min with 3 min for consultation and image viewing. During the 381 visits, we monitored 753 separate transactions, 693 of which were completed successfully. We found no instances in which a physician indicated that a patient's treatment would be delayed or altered because of film mismanagement and only one instance in which it was suggested that a study may have to be repeated.

CONCLUSION

This study found a high level of efficiency and effectiveness in file room operations.

Mineralocorticoids and glucocorticoids cooperatively increase salt intake and angiotensin II receptor binding in rat brain

Mineralocorticoids, such as deoxycorticosterone acetate (DOCA), and angiotensin II (AngII) act synergistically in the brain to elicit salt appetite. Glucocorticoids, such as dexamethasone (DEX), also may enhance the behavioral effects of DOCA and AngII. However, the brain regions involved in these behavioral interactions have not been elucidated. This study tested the hypothesis that DEX potentiates the effects of DOCA on AngII binding, especially at the AT1 receptor. We confirmed that DEX potentiated the effects of DOCA on salt appetite. Concomitantly, steroid-specific and region-specific changes in AT1 binding were noted. Specifically, in the hypothalamic paraventricular nucleus, treatment with DEX or DOCA + DEX increased AT1 binding. In the subfornical organ (SFO) and area postrema, there was an increase in AT1 binding when both steroids were combined, but not when given individually. However, there was no change in AT2 binding in any brain region studied and no change in AT1 or AT2 binding to either receptor subtype in the pituitary. The results indicate that DOCA and DEX may increase the sensitivity of the brain to the behavioral and physiological actions of AngII by upregulating AT1 receptors in the SFO and area postrema.

Cryptic species in a "living fossil" lineage: taxonomic and phylogenetic relationships within the genus Lepidurus (Crustacea: Notostraca) in North America

Lineages which exhibit little morphological change over geologic time are evolutionarily and ecologically interesting, but often taxonomically difficult. For some morphologically conservative groups, not only is it almost impossible to identify significant changes in fossil forms over time, but the relationships among extant populations are often poorly understood due to lack of known characters which clearly delimit species. Notostracan crustaceans are a classic example of such "living fossils." The paradoxical characteristics of long-term stasis in gross morphology and hypervariability of many individual morphological characters make notostracans an especially taxonomically challenging group. We used molecular and biochemical techniques to investigate the taxonomic and phylogenetic relationships of four nominal species within the genus Lepidurus in North America, three of which had been alternately abandoned, resurrected, or synonymized under a single, globally distributed morphospecies since their original descriptions in the 1800s. Data from a 330-bp sequence of the mitochondrial 12S rDNA gene and from nine allozyme loci consistently indicate five highly genetically divergent clades among the populations we used to represent the four nominal species. Diagnostic molecular characters, magnitudes of genetic divergence among clades, and the fact that these genetically distinct clades have broadly overlapping geographical ranges strongly suggest that the five clades are reproductively isolated species. One of the nominal species (L. couesii) is not monophyletic, but rather consists of two species which are not sister taxa. The other three nominal species (L. lemmoni, L. packardi, and L. bilobatus) are supported as valid phylogenetic species. The best current hypothesis for phylogenetic relationships among the five species is provided by a simultaneous analysis of both 12S rDNA and allozyme data, which places L. bilobatus and L. "couesii"-1 as sister taxa and L. "couesii"-2 as the most basal of all the Lepidurus species included in this study. These results point to the existence of cryptic species within the current classification scheme for Lepidurus, the need for further taxonomic work within the Notostraca in general, and the role that genetic techniques can play in clarifying the systematics of morphologically conservative groups.

Computed radiography versus screen-film mammography in detection of simulated microcalcifications: a receiver operating characteristic study based on phantom images

RATIONALE AND OBJECTIVES

The authors compare a 43-micron computed radiographic system with a mammographic screen-film system for detection of simulated microcalcifications in an observer-performance study.

MATERIALS AND METHODS

The task of detecting microcalcifications was simulated by imaging aluminum wire segments (200-500 microns in length; 100, 125, or 150 microns in diameter) that overlapped with tissue background structures produced by beef brisket. A total of 288 such simulations were generated and examined with both computed radiography and conventional screen-film mammography techniques. Computed radiography was performed with high-resolution plates, a 43-micron image reader, and a 43-micron laser film printer. Computed radiographic images were printed with simple contrast enhancement and compared with screen-film images in a receiver operating characteristic study in which experienced readers detected and scored the simulated microcalcifications. Observer performance was quantitated and compared by computing the area under the receiver operating characteristic curve.

RESULTS

Although the resolution of the computed radiography system was better than that of commercial systems, it fell short of that of screen-film systems. For the 100-micron microcalcifications, the difference in the average area under the curve was not statistically significant, but it was significant for the larger simulated microcalcifications: the average area under the curve was 0.58 for computed radiography versus 0.76 for screen-film imaging for the 125-micron microcalcifications and 0.83 versus 1.00, respectively, for the 150-micron microcalcifications.

CONCLUSION

Observer performance in the detection of small simulated microcalcifications (100-150 microns in diameter) is better with screen-film images than with high-resolution computed radiographic images.

Analysis of angiotensin type 2 receptors in vasopressinergic neurons and pituitary in the rat

Previous functional studies indicated that an angiotensin type 2 (AT2) receptor subtype may participate in the regulation of vasopressin release by angiotensin II (AngII). In the present study, AT2 receptor-directed antiserum immunohistochemically detected AT2 receptors within the hypothalamic paraventricular (PVN) and the supraoptic nuclei (SON) of the rat brain, more specifically, in identified vasopressinergic neurons. Considering the lack of AT2 binding in the PVN and the SON using receptor autoradiography, we tested the hypothesis that these AT2 receptors are transported to the posterior pituitary. Western blot analysis detected AT2 immunoreactivity in the posterior pituitary. However, no AT2 binding was detected in posterior pituitary membranes, and no AT2 binding was detected with quantitative receptor autoradiography in the neurohypophysis. Thus, if AT2 receptors are transported from the magnocellular vasopressin neurons to the posterior pituitary, their role in AngII regulation of vasopressin release at the neurohypophyseal terminals remains to be clarified.

Selection of subtle cases for observer-performance studies: the importance of knowing the true diagnosis

RATIONALE AND OBJECTIVES

To assess the usefulness of classifying degree of difficulty in abnormality detection and to determine the effect of knowing the true diagnosis when selecting subtle images for observer-performance studies.

MATERIALS AND METHODS

A total of 529 posteroanterior chest images that had been used in a multiabnormality, multireader observer-performance study were rated by three observers as to the difficulty of determining the presence or absence of each abnormality when the true diagnosis was known and when it was not known. Changes in image subtlety ratings were evaluated, and actual observer-performance results for the different groups of images grouped according to raters' classifications with and without availability of the true diagnosis were compared.

RESULTS

The majority of negative cases (9,168 of 12,258, 74.8%) were rated as "easy" to determine. Substantial changes were made during the selection of the "subtle" case category when the truth was known compared with when the truth was not provided. These changes caused differences between typical and subtle cases in terms of observer performance. Combined ratings of case subtlety by agreement of multiple classifiers resulted in a well-ordered selection with decreasing observer performance as a function of subtlety ratings.

CONCLUSION

Cases for observer-performance studies that stress the diagnostic system can be successfully selected in the multiple-disease setting by experienced readers and should be selected with the truth known to the raters. The degree of agreement by multiple raters can be used to refine subtlety ratings.

Lactate production from glucose and response to insulin in perifused adipocytes from mesenteric and epididymal regions of lean and obese rats

Lactate, an important metabolic substrate for peripheral tissues and the liver, is released in significant amounts from adipose tissue. Using a perifusion system, we measured lactate production from glucose and response to insulin in isolated mesenteric and epididymal adipocytes removed from fed or fasted male Wistar rats at two stages of growth and development: (a) lean rats (7 weeks to 9 weeks old, weighing approximately 250 g), and (b) fatter rats (6 months to 8 months old, weighing approximately 550 g). The results show that lactate production in perifused adipocytes is regulated by the prior nutritional state of the animals, by the adipose tissue region, and by the presence of insulin in the perifusate. In fat cells from lean rats, basal lactate production was significantly higher (p<0.05) in mesenteric cells when compared with epididymal cells, both in the fed state (7.8 nmo/10(7) fat cells per minute vs. 2.9 nmol/10(7) fat cells per minute) and after 2 days of fasting (13.6 nmol vs. 3.5 nmol). When the response to 1 mU/mL insulin was studied, however, the relative increase in lactate production produced by insulin was greater in the epididymal cells than in the mesenteric cells, in both the fed (194% vs. 91% over basal, respectively) and fasted (360% vs. 55% over basal, p<0.05) state. When larger epididymal adipocytes from fatter rats were compared with an equal number of smaller epididymal cells from leaner rats, the larger cells produced 4.99 nmol of lactate/10(7) fat cells per minute, whereas the smaller cells produced 2.93 nmol (p=0.08). Large fat cells showed a small and nonsignificant response to insulin in either type of cell (epididymal vs. mesenteric) or nutritional state (fed vs. fasted). This study indicates that distinct regional differences exist in lactate production and response to insulin. Mesenteric adipose tissue, which drains directly into the portal vein and provides substrates to the liver, may be an important source of lactate for the hepatic processes of gluconeogenesis and glycogenesis.

Forced choice and ordinal discrete rating assessment of image quality: a comparison

This study compared a five-category ordinal scale and a two-alternative forced-choice subjective rating of image quality preferences in a multiabnormality environment. 140 pairs of laser-printed posteroanterior (PA) chest images were evaluated twice by three radiologists who were asked to select during a side-by-side review which image in each pair was the "better" one for the determination of the presence or absence of specific abnormalities. Each pair included one image (the digitized film at 100 microns pixel resolution and laser printed onto film) and a highly compressed (approximately 60:1) and decompressed version of the digitized film that was laser printed onto film. Ratings were performed once with a five-category ordinal scale and once with a two-alternative forced-choice scale. The selection process was significantly affected by the rating scale used. The "comparable" or "equivalent for diagnosis "category was used in 88.5% of the ratings with the ordinal scale. When using the two-alternative forced-choice approach, noncompressed images were selected 66.8% of the time as being the "better" images. This resulted in a significantly lower ability to detect small differences in perceived image quality between the noncompressed and compressed images when the ordinal rating scale is used. Observer behavior can be affected by the type of question asked and the rating scale used. Observers are highly sensitive to small differences in image presentation during a side-by-side review.

Immunological effects of an arginine side chain contaminating synthetically prepared peptides

The side chain, 4-methoxy-2,3,6-trimethylbenzenesulphonyl (Mtr), is a protective group coupled to arginine to mask the omega-nitrogen, in order to protect the guanidino function during peptide synthesis by the 9-fluorenylmethoxycarbonyl (Fmoc) procedure (Walker, 1994). This group is removed at the completion of peptide synthesis; however, the cleavage process can be incomplete. We have found that animals injected with a mixed population of pure, i.e. unmodified, and Mtr-containing MBP peptides have an immunodominant humoral response to the Mtr-bearing peptide. This response is dependent on the characteristics of the MBP peptide involved. For two MBP peptides, the Mtr-containing peptide had increased binding to antibody over pure peptide. For two other peptides, only the Mtr-containing peptide bound antibody while the unmodified peptide did not. In a separate system involving a polyclonal response to an unrelated peptide from beta2-microglobulin (beta2 m), the dominance of the Mtr group was also evident. These results provide further evidence that a small side chain on a single amino acid in a peptide can markedly alter the immunogenicity and antigenicity of that peptide for antibody reactivity. This evidence emphasizes the need for a critical awareness of each component of peptide synthesis and its potential to alter the immunoreactivity of the final product.

The incidence of scintigraphically viable and nonviable tissue by rubidium-82 and fluorine-18-fluorodeoxyglucose positron emission tomographic imaging in patients with prior infarction and left ventricular dysfunction

BACKGROUND

Although reversible perfusion defects, perfusion-metabolism mismatch and match patterns are important for differentiating viable from nonviable myocardium, the frequency of these scintigraphic patterns has not been reported. The study objective was to establish the incidence of these scintigraphic patterns to estimate the clinical need for metabolic positron emission tomography for evaluating tissue viability in patients with prior myocardial infarction (MI).

METHODS AND RESULTS

82Rb perfusion images were interpreted to identify reversible or irreversible defects, followed by determination of their 18F-fluorodeoxyglucose (18F-FDG) uptake pattern. In 155 patients with prior MI, analysis of 613 abnormal segments showed reversible perfusion defects in 13%. The 87% irreversible defects, 18% showed perfusion-metabolism mismatch, whereas 69% showed the match pattern. Reversible perfusion defects and perfusion-metabolism mismatches were noted in 20% (31/155) and 29% (45/155) of patients, respectively, whereas the match pattern was noted in 51% (79/155) of patients.

CONCLUSION

Irreversible perfusion defects were common in our patients with prior MI, and distinction between viable and nonviable tissue was not possible by perfusion imaging alone. The identification of hibernating myocardium was possible only with the additional 18F-FDG imaging in about one third of patients. This indicates a significant clinical demand for 18F-FDG imaging that identifies patients who will benefit from revascularization.

Imaging systems evaluation: effect of subtle cases on the design and analysis of receiver operating characteristic studies

OBJECTIVE

Large-scale receiver operating characteristic (ROC) studies are expensive and time-consuming. If most of the difference in diagnostic accuracy occurs in a subset of subtle cases, considerable effort could be saved by restricting comparisons to this subset. We investigate the effect of subtle cases on diagnostic accuracy, the magnitude of error that can occur because of an imbalance of subtle cases in two groups, and the potential for sample size reductions if only subtle cases are used.

METHODS

Data from a previous study of posteroanterior chest radiographs were reanalyzed separately for subsets of typical cases and subsets of subtle cases. Actually positive and actually negative cases were classified as subtle or typical and as difficult or easy for diagnosis of the specific abnormality. The area under the ROC curve (Az) was used as the measure of diagnostic accuracy. Pairwise comparisons were done among three techniques and for the detection of nodules and interstitial disease.

RESULTS

The performance index (Az) was significantly (> or = 25%) lower for the subset of subtle cases as compared with the subset of typical cases. The difference in observer performance between two techniques was more often greater in the subset of subtle cases than in the subset of typical cases.

CONCLUSION

The difference in diagnostic accuracy between the subset of typical cases and the subset of subtle cases is large enough that a difference in the proportion of subtle cases in two samples could result in clinically significant false differences in observer performance. Furthermore, the generally larger difference observed in the group of subtle cases suggests that sample sizes for some experiments could be reduced by 45-90% if the experiment were restricted to subtle cases.

On the generalization of the receiver operating characteristic analysis to the population of readers and cases with the jackknife method: an assessment

RATIONALE AND OBJECTIVES

A new methodology that analyzes receiver operating characteristic (ROC) data sets based on jackknifing and that considers both case and reader variability has been proposed. The purpose of this investigation was to compare results using this method to those using commonly reported methodology.

METHODS

ROC data sets using discrete and continuous rating scales were analyzed using the proposed jackknifing method, and results were compared to analysis of the same data sets using the paired t test.

RESULTS

The two methodologies did not result in the same significance levels, and in some cases, the difference was sufficient to affect conclusions regarding comparisons of diagnostic modalities. The probability value for the jackknifing procedure is based on large sample distribution theory, and its appropriateness is unknown for sample sizes used in practice. Also, the jackknifing technique was found to be sensitive to outliers resulting when data from the computer programs used to estimate area under the ROC curve failed to converge.

CONCLUSION

Although the proposed methodology yields reasonable results, several fundamental and practical issues must be addressed before it can be used widely as the analytic method of choice in ROC studies comparing different imaging techniques or reading environments.

Diagnostic reading session: temporal patterns and case-order effects

The authors analyzed receiver-operating-characteristic studies to determine temporal patterns and performance as a function of the elapsed time in a reading session. Nineteen radiologists each read as many as 300 chest images with use of seven different display modalities, including conventional and laser-printed film and high-resolution soft display. With a computerized reporting system, the ratio of observers' interpretation rates (time to diagnosis) were recorded for the last five and 10 compared with the first five and 10 of 30-40 cases seen in sessions lasting 45-110 minutes. Observers tended to accelerate their interpretation as the sessions progressed by an average of 15% (P < .001). The acceleration was consistent for all readers (both fast and slow) with a variety of display modes under the nonrestricted time environment.

Clinical outcome of cardiac patients with negative thallium-201 SPECT and positive rubidium-82 PET myocardial perfusion imaging

In a previous comparison of 202 consecutive patients who underwent myocardial perfusion imaging with both 201Tl SPECT and 82Rb PET, 27 patients were identified as having true-positive 82Rb images, but false-negative 201Tl images. The purpose of this report is to determine the effect of correct image interpretation of coronary artery disease on the final management of those patients and compare it to the previous management scheme wherein a negative image was usually accepted as the end point unless clinical symptoms dictated otherwise. A follow-up study of the clinical course and outcome of these studies showed that 63% (17/27) of the patients with a true-positive 82Rb PET image were recommended for revascularization procedures. It is doubtful that this majority of patients would have received either surgical or interventional management based on the false-negative 201Tl SPECT procedure alone.

Practical issues of experimental ROC analysis. Selection of controls

Receiver operating characteristics (ROC) analysis has been used in many medical imaging applications during the past decade. With the recent expansion of the ROC methodology to multi-disease studies, several reports have begun to address both the theoretical and experimental design issues associated with such studies. While the appropriate selection, classification, and verification of actually positive cases is carefully addressed in the literature, similar considerations are rarely given to the selection of actually negative controls for these studies. In this paper, theoretical considerations and experimental data are provided to demonstrate the significance of this very issue.

A 3' splice site-binding sequence in the catalytic core of a group I intron

Ribozymes use specific RNA-RNA interactions for substrate binding and active-site formation. Self-splicing group I introns have approximately 70 nucleotides constituting the core, a region containing sequences and structures indispensable for catalytic function. The catalytic core must interact with the substrates used for the two steps of the self-splicing reaction, that is, guanosine, the 5'-splice-site helix (P1) and the 3' splice site. Mutational evidence suggests that core sequences near segment J6/7 that joins the base-paired stems P6 and P7, and the bulged base of P7(5'), participate in binding guanosine substrate, but nothing is known about the interactions between the core, the 5'-splice-site helix and the 3' splice site. On the basis of comparative sequence data, it has been suggested that two specific bases in the catalytic core of group I introns might form a binding sequence for the 3' splice site. Here we present genetic evidence that such a binding site exists in the core of the Tetrahymena large subunit ribosomal RNA intron. We demonstrate that this pairing, termed P9.0, is functionally important in the exon ligation step of self-splicing, but is not itself responsible for 3'-splice-site selection.

Effect of two rating formats in multi-disease ROC study of chest images

ROC methodology has been expanded in recent years to include multi-disease experiments. To accommodate these changes, different rating formats, general or disease specific, can be used. No experimental data are available concerning the possible effects of the rating format on the results of these studies. We performed a multi-observer, multi-disease study in which 196 chest images were rated using a format where each disease was evaluated individually and one in which the cases were evaluated without scoring a specific disease. The results indicate that for our data set, the overall assessment of accuracy was not significantly affected by the study format used. Thus, in spite of the difficulties in selecting appropriate controls and the necessity of reassessing sample size considerations, the disease-specific format appears to produce an assessment of accuracy equivalent to that produced by the general format. This equivalence permits the use of the disease-specific approach since it more closely simulates the readers' true environment and is more appropriate for comparing imaging systems that may have a relative accuracy that is disease specific.

Distribution of two basement membrane proteoglycans through hair follicle development and the hair growth cycle in the rat

The distribution of two distinct populations of basement membrane proteoglycans has been monitored through hair growth development in the rat embryo and subsequent hair growth cycle. An antiserum against a small heparan sulfate proteoglycan uniformly stained the dermal-epidermal junction of embryonic rats throughout the period of hair follicle formation. On the other hand, monoclonal antibodies recognizing a basement membrane-specific chondroitin sulfate proteoglycan only weakly stained 16-d embryo dermal-epidermal junction, but strong staining was associated with hair follicle buds as they developed. Through the hair growth cycle, it was found that the heparan sulfate proteoglycan persisted around the follicles, while the chondroitin sulfate proteoglycan decreased in amount through catagen until it was undetectable at the base and dermal papilla of the telogen follicle. As anagen commenced, expression of the chondroitin sulfate proteoglycan was again demonstrated. It therefore appears that a basement membrane-specific proteoglycan shows variation in its distribution in rat skin, expression correlating with morphogenetic activity in hair follicles. It is possible that this newly described basement membrane component is involved in the complex processes of dermal-epidermal interaction that lead to skin appendage formation and growth.

Use of the 82Sr/82Rb generator in clinical PET studies

The use of the 82Sr/82Rb generator in clinical positron emission tomography (PET) studies of myocardial perfusion has been described. An infusion pump is used to deliver the short-lived 82Rb from the generator to the patient. Various characteristics of the generator and the infusion system are described. The 82Rb yield was 69.8 +/- 13.3% and the 82Sr breakthrough was always less than the limit of 0.02 microCi/mCi 82Rb. The yield of 82Rb increased with the flow rate and the potency of the generator. Patients with coronary artery disease were studied for myocardial perfusion abnormalities by the 82Rb PET technique and images of excellent diagnostic quality were obtained.

Evolutionary nucleotide replacements in DNA

With the increasing availability of analytical information on mRNA molecules, it is now possible to compare homologous nucleotide sequences from different organisms and to draw conclusions about their evolution. Such comparisons have shown that silent changes in codons occur more frequently than nucleotide replacements that produce changes in amino acid sequences (code-altering changes). Furthermore, there is an important difference between amino acid sequence comparisons and nucleotide sequence comparisons. The former show only differences in amino acid residues, but the latter show several types of differences when corresponding codons are compared. Single-base replacements may be degenerate (silent) or expressed as amino acid replacements. Two-base codon changes may be degenerate, single-base changes, or be visible as such. Three-base codon changes may be degenerate (involving serine), simulate either single-base or two-base changes or be visible as such. All nine types of change are found in comparisons of genes from the viruses phi X174 and G4. The relative numbers of these nine types as based on all possible interchanges between all 61 amino acid codons were listed by Holmquist et al. and are shown in Table 1. We discuss these results in the light of the significance of nucleotide changes in molecular evolution.

Fixation of a deleterious allele at one of two "duplicate" loci by mutation pressure and random drift

We consider a diploid population and assume two gene loci with two alleles each, A and a at one locus and B and b at the second locus. Mutation from wild-type alleles A and B to deleterious alleles a and b occurs with mutation rates va and vb, respectively. We assume that alleles are completely recessive and that only the double recessive genotype aabb shows a deleterious effect with relative fitness 1-epsilon. Then, it can be shown that if va greater than vb mutant a becomes fixed in the population by mutation pressure and a mutation-selection balance is ultimately attained with respect to the B/b locus alone. The main aim of this paper is to investigate the situation in which va = vb exactly. In this case a neutral equilibrium is attained and either locus can drift to fixation for the mutant allele. Diffusion models are developed to treat the stochastic process involved whereby the deleterious mutant eventually becomes fixed in one of the two duplicated loci by random sampling drift in finite populations. In particular, the equation for the average time until fixation of mutant a or b is derived, and this is solved numerically for some combinations of parameters 4Nev and 4Ne epsilon, where v is the mutation rate (va = vb = v) and Ne is the effective size of the population. Monte Carlo experiments have been performed (using a device termed "pseudo sampling variable") to supplement the numerical analysis.

Unimodality, symmetry and the step-state hypothesis of electrophoretic variation in natural populations

The population frequency distributions of electromorphs of polymorphic loci, when ordered by electrophoretic mobility, tend strongly and significantly to be both unimodal and symmetrical. Such distributions are predicted by all step-change models and their generality in published data can be construed as supportive of the step-change hypothesis. On the other hand, unimodality and symmetry might also be due to artifactual "unit perception" biases that affect the interpretation and reporting of electrophoretic data. In any case, it appears that perceived electromorphs are highly heterogeneous.

Polyallelic mutational equilibria

A new deterministic formulation is derived of the equilibrium between mutation and natural selection, which takes into account(a) the possibility of many allelic mutation states, (b) selection coefficients of the order of magnitude of the mutation rate and (c) the possibility of further mutation of already mutant alleles. The frequencies of classes of alleles 0, 1, 2, n mutant steps removed from the type allele are shown to form a Poisson distribution, with a mean and variance of the mutation rate divided by the coefficient of selection against each incremental mutational step.--This formulation is interpreted in terms of the expected frequencies of electromorphs, defined as classes of alleles characterized by common electrophoretic mobilities of their protein products. Electromorph frequencies are predicted to form stable unimodal distributions of relatively few phenotypic classes. Common electromorph frequencies found throughout the ranges of species with large population sizes are interpreted as being a uniquely electrophoretic phenomenon; band patterns on starch and acrylamide gels are phenotypes, not genotypes. It is predicted that individual electromorphs are highly heterogenous with regard to amino acid sequence.