The impact of diet and ethnicity on gut microbiota variation in irritable bowel syndrome: A multi-center study

BACKGROUND AND AIM

The gut microbiota in irritable bowel syndrome (IBS) is known to vary with diet. We aim to (i) analyze the gut microbiota composition of IBS patients from a multi-ethnic population and (ii) explore the impact of a low FODMAP diet on gastrointestinal symptoms and gut microbiota composition among IBS patients.

METHODS

A multi-center study of multi-ethnic Asian patients with IBS was conducted in two phases: (i) an initial cross-sectional gut microbiota composition study of IBS patients and healthy controls, followed by (ii) a single-arm 6-week dietary interventional study of the IBS patients alone, exploring clinical and gut microbiota changes.

RESULTS

A total of 34 adult IBS patients (IBS sub-types of IBS-D 44.1%, IBS-C 32.4%, and IBS-M 23.5%) and 15 healthy controls were recruited. A greater abundance of Parabacteroides species with lower levels of bacterial fermenters and short-chain fatty acids producers were found among IBS patients compared with healthy controls. Age and ethnicity were found to be associated with gut microbiota composition. Following a low FODMAP dietary intervention, symptom and quality of life improvement were observed in 24 (70.6%) IBS patients. Symptom improvement was associated with adherence to the low FODMAP diet (46.7% poor adherence vs 92.9% good adherence, P = 0.014), and gut microbiota patterns, particularly with a greater abundance of Bifidobacterium longum, Anaerotignum propionicum, and Blautia species post-intervention.

CONCLUSION

Gut microbiota variation in multi-ethnic IBS patients may be related to dietary intake and may be helpful to identify patients who are likely to respond to a low FODMAP diet.

The Association between Hope and Quality of Life among Adolescents with Chronic Diseases: A Systematic Review

Purpose

Hope has been identified as a protective factor that contributes to achieving a better quality to life, especially in patients with chronic disease. The purpose of this review was to synthesize current knowledge about the relationship between hope and quality of life among adolescents living with chronic illnesses.

Methods

We searched major English-language databases (PsycINFO, PubMed, and CINAHL) for studies from January 1, 2002 to July 12, 2019. Studies were included if they provided data on hope and its relationship with quality of life among adolescents with chronic diseases.

Results

In total, five articles were selected from the 336 studies that were retrieved. All five studies reported a positive correlation between hope and quality of life, such that people with a higher level of hope had a better quality of life. Hope was found to have direct and indirect effects on quality of life in adolescents with chronic diseases.

Conclusion

Healthcare professionals should make more efforts to enhance hope in adolescents with chronic diseases in order to improve their quality of life. Future studies exploring how hope develops in adolescents with chronic diseases and the long-term impact of hope on quality of life are necessary.

Potential effects of Psidium sp., Mangifera sp., Mentha sp. and its mixture (PEM) in reducing bacterial populations in biofilms, adherence and acid production of S. sanguinis and S. mutans

OBJECTIVE

Psidium sp., Mangifera sp. and Mentha sp. and its mixture (PEM) are known to have antimicrobial and anti-adherence effects.

DESIGN

Here, we have investigated these individual plant extracts and its synergistic mixture (PEM) for its anti-cariogenic effect to reduce populations of single and mixed-species of Streptococcus sanguinis and Streptococcus mutans in a planktonic or/and biofilm and their others reduced virulence. Bacterial populations in the biofilm after 24 h, hydrophobic cell surface activity to n-hexadecane and pH changes at 5 min' intervals until 90 min of incubation were recorded. Total phenolic content and bioactive compounds in the crude aqueous plant extracts were analysed. Regulatory gene expressions of S. mutans adhesins genes (gtfB, gtfC, gbpB and spaP) upon treatment with PEM were investigated in planktonic and biofilm conditions.

RESULTS

All plant extracts strongly reduced S. mutans in the biofilm compared to S. sanguinis in single and mixed-species. PEM reduced S. mutans by 84% with S. sanguinis 87% in the mixed population. Psidium sp. and PEM highly reduced cell-surface hydrophobicity of the two bacteria thus reducing adherence and biofilm formation. PEM and Mangifera sp. lowered initial pH change in the mixed populations of S. sanguinis and S. mutans. PEM downregulated the S. mutans gtfB gene expression in the single species planktonic and mixed-species biofilms.

CONCLUSIONS

The effectiveness of PEM in reducing S. mutans within the biofilm, cell-surface hydrophobicity, acid production and adhesin gene (gtfB) expression in mixed-species with S. sanguinis indicates its potential as an antibacterial agent against dental caries. This is attributed to the phenolic content in the PEM.

Characterization, yield optimization, scale up and biopreservative potential of fermencin SA715, a novel bacteriocin from Lactobacillus fermentum GA715 of goat milk origin

BACKGROUND

Emergence of antibiotic resistance and growing consumer trend towards foods containing biopreservatives stimulated the search for alternative antimicrobials. This research is aimed at characterizing, investigating the mechanism of action, scale up optimization and evaluating the biopreservative potential of a bacteriocin from Lactobacillus fermentum.

RESULTS

Fermencin SA715 is a novel, broad-spectrum, non-pore-forming and cell wall-associated bacteriocin isolated from L. fermentum GA715 of goat milk origin. A combination of hydrophobic interaction chromatography, solid-phase extraction and reversed-phase HPLC was necessary for purification of the bacteriocin to homogeneity. It has a molecular weight of 1792.537 Da as revealed by MALDI-TOF mass spectrometry. Fermencin SA715 is potent at micromolar concentration, possesses high thermal and pH stability and inactivated by proteolytic enzymes thereby revealing its proteinaceous nature. Biomass accumulation and production of fermencin SA715 was optimum in a newly synthesized growth medium. Fermencin SA715 did not occur in the absence of manganese(II) sulphate. Tween 80, ascorbic acid, sodium citrate and magnesium sulphate enhanced the production of fermencin SA715. Sucrose is the preferred carbon source for growth and bacteriocin production. Sodium chloride concentration higher than 1% suppressed growth and production of fermencin SA715. Optimum bacteriocin production occurred at 37 °C and pH 6-7. Scale up of fermencin SA715 production involved batch fermentation in a bioreactor at a constant pH of 6.5 which resulted in enhanced production. Fermencin SA715 doubled the shelf life and improved the microbiological safety of fresh banana. Bacteriocin application followed by refrigeration tripled the shell life of banana.

CONCLUSIONS

This study reveals the huge potential of fermencin SA715 as a future biopreservative for bananas and reveals other interesting characteristics which can be exploited in the preservation of other foods. Furthermore insights on the factors influencing the production of fermencin SA715 have been revealed and optimized condition for its production has been established facilitating future commercial production.

Pentocin MQ1: A Novel, Broad-Spectrum, Pore-Forming Bacteriocin From Lactobacillus pentosus CS2 With Quorum Sensing Regulatory Mechanism and Biopreservative Potential

Micrococcus luteus, Listeria monocytogenes, and Bacillus cereus are major food-borne pathogenic and spoilage bacteria. Emergence of antibiotic resistance and consumer demand for foods containing less of chemical preservatives led to a search for natural antimicrobials. A study aimed at characterizing, investigating the mechanism of action and regulation of biosynthesis and evaluating the biopreservative potential of pentocin from Lactobacillus pentosus CS2 was conducted. Pentocin MQ1 is a novel bacteriocin isolated from L. pentosus CS2 of coconut shake origin. The purification strategy involved adsorption-desorption of bacteriocin followed by RP-HPLC. It has a molecular weight of 2110.672 Da as determined by MALDI-TOF mass spectrometry and a molar extinction value of 298.82 M⁻¹ cm⁻¹. Pentocin MQ1 is not plasmid-borne and its biosynthesis is regulated by a quorum sensing mechanism. It has a broad spectrum of antibacterial activity, exhibited high chemical, thermal and pH stability but proved sensitive to proteolytic enzymes. It is potent against M. luteus, B. cereus, and L. monocytogenes at micromolar concentrations. It is quick-acting and exhibited a bactericidal mode of action against its targets. Target killing was mediated by pore formation. We report for the first time membrane permeabilization as a mechanism of action of the pentocin from the study against Gram-positive bacteria. Pentocin MQ1 is a cell wall-associated bacteriocin. Application of pentocin MQ1 improved the microbiological quality and extended the shelf life of fresh banana. This is the first report on the biopreservation of banana using bacteriocin. These findings place pentocin MQ1 as a potential biopreservative for further evaluation in food and medical applications.

Dentists' Attitudes and perceptions toward protective mouthguards

Objectives (Background)

Risk of dental injury from contact sports can be prevented by the use of mouthguards. Dentists provide excellent information regarding mouthguards. Thus, the aim was to assess the awareness among dentists regarding the same, the level of training in fabricating a mouthguard and whether they regularly recommend one for their athletically active patients.

Materials and Methods

This institutional cross-sectional survey was conducted in the Department of Orthodontics, Government Dental College, Kottayam, and Kerala, India. An online form was sent out to 1500 offices and departments in dental institutions through email with a time period of 1 month given to fill responses and was analyzed using descriptive statistics.

Results

A response from 640 was recorded; most of them had not received or had fabricated a mouthguard during their dental training or private practice, even though one-third recommended one to their athletically active patients with a lack of formal training being the reason for not routinely advocating mouthguard usage. Most were aware of more than one type of mouthguards and recommended customized one for the same, however, more than half were not aware of a different type intended for orthodontic patients.

Conclusion

It is not a routine practice currently, among general dentists and specialists alike, in our country, to prescribe a mouthguard. It is time that the dental fraternity spread awareness for the prevention of injuries. A relook into the academic curriculum while advocating the use of customized mouthguards to patients due to contact sports is required.

Antibacterial and anti-adherence effects of a plant extract mixture (PEM) and its individual constituent extracts (Psidium sp., Mangifera sp., and Mentha sp.) on single- and dual-species biofilms

Background

Plant extracts mixture (PEM) and its individual constituent plant extracts(Psidium sp., Mangifera sp., Mentha sp.) are known to have an anti-adhering effect towards oral bacteria in the single-species biofilm. To date, the adhering ability of the early and late plaque colonisers (Streptococcus sanguinis and Streptococcus mutans) to PEM-treated experimental pellicle have not been investigated in dual-species biofilms.

Methods

Fresh leaves of these plants were used in the preparation of the respective aqueous extract decoctions. The minimum inhibitory concentration (MIC) of the extracts towards S. sanguinis ATCC BAA-1455 and S. mutans ATCC 25175 was determined using a two-fold serial microdilution method. The sum of fractional inhibitory concentration (ΣFIC) index of PEM and its constituent plant extracts was calculated using the MIC values of the plants. The minimum bactericidal concentration (MBC) of the plant extracts was also determined. The anti-adherence effect of the plant extracts (individually and mixed) was carried out by developing simulated S. sanguinis and S. mutans respectively in single- and dual-species of biofilms in the Nordini’s Artificial Mouth (NAM) model system in which the experimental pellicle was pretreated with the plant extract before bacterial inoculation. The bacterial population in the respective biofilms was quantified using ten-fold serial dilutions method and expressed as colony forming unit per ml (CFU/ml). The bacterial population was also viewed using Scanning Electron Microscope (SEM). All experiments were done in triplicate.

Results

The PEM compared with its respective constituent plants showed the lowest MIC towards S. sanguinis (3.81 mg/ml) and S. mutans (1.91 mg/ml) and exhibited a synergistic effect. The Psidium sp. (15.24 mg/ml) and, PEM and Psidium sp. (30.48 mg/ml) showed the lowest MBC towards S. sanguinis and S. mutans respectively. The anti-adherence effect of the PEM and its respective constituent plants (except Psidium sp.) was different for the two bacteria in the single-species biofilm. In the dual-species biofilms, PEM demonstrated similar anti-adherence effect towards S. sanguinis and S. mutans. The proportions of the bacterial population viewed under SEM appeared to be in agreement with the quantified population.

Discussion

The combination of the active constituents of the individual plant extracts in PEM may contribute to its low MIC giving rise to the synergistic effect. The different anti-adherence effect towards S. sanguinis and S. mutans in both single- and dual-species biofilms could be due to the different proportion of the active constituents of the extracts and the interaction between different bacteria. The better adhering ability of S. sanguinis towards the PEM-treated pellicle when present together with S. mutans in the dual-species biofilms may suggest the potential of PEM in controlling the balance between the early and late colonisers in biofilms.

New insights into the mode of action of the lantibiotic salivaricin B

Salivaricin B is a 25 amino acid polycyclic peptide belonging to the type AII lantibiotics and first shown to be produced by Streptococcus salivarius. In this study we describe the bactericidal mode of action of salivaricin B against susceptible Gram-positive bacteria. The killing action of salivaricin B required micro-molar concentrations of lantibiotic whereas the prototype lantibiotic nisin A was shown to be potent at nano-molar levels. Unlike nisin A, salivaricin B did not induce pore formation or dissipate the membrane potential in susceptible cells. This was established by measuring the fluorescence of the tryptophan residue at position 17 when salivaricin B interacted with bacterial membrane vesicles. The absence of a fluorescence blue shift indicates a failure of salivaricin B to penetrate the membranes. On the other hand, salivaricin B interfered with cell wall biosynthesis, as shown by the accumulation of the final soluble cell wall precursor UDP-MurNAc-pentapeptide which is the backbone of the bacterial peptidoglycan. Transmission electron microscopy of salivaricin B-treated cells showed a reduction in cell wall thickness together with signs of aberrant septum formation in the absence of visible changes to cytoplasmic membrane integrity.

Purification and Characterization of Bacteriocin Produced by Weissella confusa A3 of Dairy Origin

A dramatic increase in bacterial resistance towards currently available antibiotics has raised worldwide concerns for public health. Therefore, antimicrobial peptides (AMPs) have emerged as a promisingly new group of therapeutic agents for managing infectious diseases. The present investigation focusses on the isolation and purification of a novel bacteriocin from an indigenous sample of cow milk and it’s mode of action. The bacteriocin was isolated from Weissella confusa A3 that was isolated from the sample and was shown to have inhibitory activity towards pathogenic bacteria namely Bacillus cereus, Escherichia coli, Pseudomonas aeruginosa and Micrococcus luteus. The bacteriocin was shown to be heat stable and functioned well at low pH (2 to 6). Reduction of activity was shown after treatment with proteinase K, trypsin and peptidase that confirmed the proteinaceous nature of the compound. MALDI-TOF analysis of the sample gave a mass approximating 2.7 kDa. The membrane of the bacteria was disrupted by the bacteriocin causing SYTOX^® green dye to enter the cell and bind to the bacterial DNA giving fluorescence signal. Bacterial cell treated with the bacteriocin also showed significant morphological changes under transmission electron microscope. No virulence and disease related genes can be detected from the genome of the strain.

Isolation and mode of action of bacteriocin BacC1 produced by nonpathogenic Enterococcus faecium C1

Lactic acid bacteria are present in fermented food products and help to improve shelf life and enhance the flavor of the food. They also produce metabolites such as bacteriocins to prevent the growth of undesirable or pathogenic bacteria. In this study, Enterococcus faecium C1 isolated from fermented cow milk was able to produce bacteriocin BacC1 and inhibit the growth of selected food-spoilage bacteria. The bacteriocin was purified through 4 steps: ammonium sulfate precipitation, hydrophobic interaction column, a series of centrifugal steps, and finally reversed-phase HPLC. A membrane permeability test using SYTOX green dye (Invitrogen, Grand Island, NY) showed that the bacteriocin caused significant disruptions to the test bacterial membrane, as shown by transmission electron microscopy. The molecular weight of the BacC1 obtained from SDS-PAGE was around 10kDa, and N-terminal sequencing revealed a partial amino acid sequence of BacC1: GPXGPXGP. The bacterial strain was nonhemolytic and not antibiotic resistant. Therefore, it has high potential for application in the food industry as an antimicrobial agent to extend the shelf life of food products.

Elucidating the mechanism of peptide interaction with membranes using the intrinsic fluorescence of tryptophan: perpendicular penetration of cecropin B-like peptides into Pseudomonas aeruginosa

The mechanism of peptide interaction with bacterial membranes can be studied effectively by using the intrinsic fluorescence of tryptophan.

The inter-therapist reliability of the slump test

This study examined the inter-therapist reliability of the slump test. Six pairs of physiotherapists tested a total of 93 patients currently receiving treatment for lumbar and/or lower limb symptoms. Each pair performed two slump tests on patients during a normal clinical visit. The slump test was positive if the patients' symptoms were reproduced, and subsequently decreased with cervical extension. A second definition of positive slump required decreased symptoms and increased knee extension with cervical extension. The results indicated that the slump test has high inter-therapist reliability which is consistent with reliability findings for related clinical tests of pain.

Variable characteristics of bacteriocin-producing Streptococcus salivarius strains isolated from Malaysian subjects

BACKGROUND

Salivaricins are bacteriocins produced by Streptococcus salivarius, some strains of which can have significant probiotic effects. S. salivarius strains were isolated from Malaysian subjects showing variable antimicrobial activity, metabolic profile, antibiotic susceptibility and lantibiotic production.

METHODOLOGY/PRINCIPAL FINDINGS

In this study we report new S. salivarius strains isolated from Malaysian subjects with potential as probiotics. Safety assessment of these strains included their antibiotic susceptibility and metabolic profiles. Genome sequencing using Illumina's MiSeq system was performed for both strains NU10 and YU10 and demonstrating the absence of any known streptococcal virulence determinants indicating that these strains are safe for subsequent use as probiotics. Strain NU10 was found to harbour genes encoding salivaricins A and 9 while strain YU10 was shown to harbour genes encoding salivaricins A3, G32, streptin and slnA1 lantibiotic-like protein. Strain GT2 was shown to harbour genes encoding a large non-lantibiotic bacteriocin (salivaricin-MPS). A new medium for maximum biomass production buffered with 2-(N-morpholino)ethanesulfonic acid (MES) was developed and showed better biomass accumulation compared with other commercial media. Furthermore, we extracted and purified salivaricin 9 (by strain NU10) and salivaricin G32 (by strain YU10) from S. salivarius cells grown aerobically in this medium. In addition to bacteriocin production, S. salivarius strains produced levan-sucrase which was detected by a specific ESI-LC-MS/MS method which indicates additional health benefits from the developed strains.

CONCLUSION

The current study established the bacteriocin, levan-sucrase production and basic safety features of S. salivarius strains isolated from healthy Malaysian subjects demonstrating their potential for use as probiotics. A new bacteriocin-production medium was developed with potential scale up application for pharmaceuticals and probiotics from S. salivarius generating different lantibiotics. This is relevant for the clinical management of oral cavity and upper respiratory tract in the human population.

Synergy of antibacterial and antioxidant activities from crude extracts and peptides of selected plant mixture

BACKGROUND

A plant mixture containing indigenous Australian plants was examined for synergistic antimicrobial activity using selected test microorganisms. This study aims to investigate antibacterial activities, antioxidant potential and the content of phenolic compounds in aqueous, ethanolic and peptide extracts of plant mixture.

METHODS

Well diffusion, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) assays were used to test antibacterial activity against four pathogenic bacteria namely Staphylococcus aureus, Escherichia coli, Bacillus cereus, and Pseudomonas aeruginosa. DPPH (2, 2-diphenyl-1- picrylhydrazyl) and superoxide dismutase (SOD) assays were used to evaluate antioxidant activity. HPLC and gel filtration were used for purification of the peptides. Scanning electron microscope was applied to investigate the mode of attachment of the peptides on target microbial membranes.

RESULTS

Aqueous extraction of the mixture showed no inhibition zones against all the test bacteria. Mean diameter of inhibition zones for ethanol extraction of this mixture attained 8.33 mm, 7.33 mm, and 6.33 mm against S. aureus at corresponding concentrations of 500, 250 and 125 mg/ml while E .coli showed inhibition zones of 9.33 mm, 8.00 mm and 6.66 mm at the same concentrations. B. cereus exhibited inhibition zones of 11.33 mm, 10.33 mm and 10.00 mm at concentrations of 500, 250 and 125 mg/ml respectively. The peptide extract demonstrated antibacterial activity against S. aureus, E. coli and B. cereus. The MIC and MBC values for ethanol extracts were determined at 125 mg/ml concentration against S. aureus and E. coli and B. cereus value was 31.5 mg/ml. MIC and MBC values showed that the peptide extract was significantly effective at low concentration of the Australian plant mixture (APM). Phenolic compounds were detected in hot aqueous and ethanolic extracts of the plant mixture. Hot aqueous, ethanol and peptides extracts also exhibited antioxidant activities.

CONCLUSIONS

It was concluded that APM possessed good antibacterial and antioxidant activities following extraction with different solvents. The results suggest that APM provide a new source with antibacterial agents and antioxidant activity for nutraceutical or medical applications.

Enhanced production, purification, characterization and mechanism of action of salivaricin 9 lantibiotic produced by Streptococcus salivarius NU10

Background

Lantibiotics are small lanthionine-containing bacteriocins produced by lactic acid bacteria. Salivaricin 9 is a newly discovered lantibiotic produced by Streptococcus salivarius. In this study we present the mechanism of action of salivaricin 9 and some of its properties. Also we developed new methods to produce and purify the lantibiotic from strain NU10.

Methodology / Principal Findings

Salivaricin 9 was found to be auto-regulated when an induction assay was applied and this finding was used to develop a successful salivaricin 9 production system in liquid medium. A combination of XAD-16 and cation exchange chromatography was used to purify the secondary metabolite which was shown to have a molecular weight of approximately 3000 Da by SDS-PAGE. MALDI-TOF MS analysis indicated the presence of salivaricin 9, a 2560 Da lantibiotic. Salivaricin 9 is a bactericidal molecule targeting the cytoplasmic membrane of sensitive cells. The membrane permeabilization assay showed that salivaricin 9 penetrated the cytoplasmic membrane and induced pore formation which resulted in cell death. The morphological changes of test bacterial strains incubated with salivaricin 9 were visualized using Scanning Electron Microscopy which confirmed a pore forming mechanism of inhibition. Salivaricin 9 retained biological stability when exposed to high temperature (90-100°C) and stayed bioactive at pH ranging 2 to 10. When treated with proteinase K or peptidase, salivaricin 9 lost all antimicrobial activity, while it remained active when treated with lyticase, catalase and certain detergents.

Conclusion

The mechanism of antimicrobial action of a newly discovered lantibiotic salivaricin 9 was elucidated in this study. Salivaricin 9 penetrated the cytoplasmic membrane of its targeted cells and induced pore formation. This project has given new insights on lantibiotic peptides produced by S. salivarius isolated from the oral cavities of Malaysian subjects.

An evaluation of a Mental Health Act educational resource

The Mental Health (Care and Treatment) (Scotland) Act 2003 was developed with the participation of patients and carers. This Act is fundamentally different from all previous versions of the Mental Health Acts in the UK because it is based on Millan's 10 principles. Its objective is to ensure that people with mental disorder receive effective care and treatment. It is crucial that all staff who deal with persons with mental disorder are familiar with the Act and incorporate it into practice. This depends on the effectiveness of educational resources in supporting staff to develop their practice. The project presented here was commissioned by the National Health Service Education for Scotland (NES) to evaluate the accessibility and use of the educational resources produced for all frontline staff in Scotland. The aim was to evaluate the educational resources produced by NES to prepare the frontline staff in relation to the Mental Health (Care and Treatment) (Scotland) Act 2003. Evaluation was conducted through a questionnaire survey, focus groups and individual interviews. The NES educational resource was effective in assisting professionals in implementing the complex and progressive requirements of the new Mental Health Act. The three formats reached a wide audience, and are an effective model for future initiatives.

Common mental disorders among primary care attenders in Vellore, South India: nature, prevalence and risk factors

OBJECTIVE

The study examined the nature and prevalence of and the factors associated with common mental disorders in primary care in Vellore, South India.

METHOD

Consecutive attenders (N = 327) to a primary health care facility were recruited.

RESULTS

One hundred and eleven (33.9%) subjects satisfied criteria for common mental disorders. Depression was the common presentation (83.8%). Indicators of low socio-economic status (being in debt, inability to buy food, having less than three square meals per day) and illiteracy were significantly associated with caseness.

CONCLUSIONS

Subjects with common mental disorders are commonly seen in primary health care settings. Illiteracy and poverty are associated with caseness. Primary health care research and policy needs to focus on common mental disorders.

The validation of the Tamil version of the 12 item general health questionnaire

The 12 item General Health Questionnaire (GHQ-12), increasingly used to screen for common mental disorders (CMD) in primary care, has been validated in different languages and cultures. However, the validity of the Tamil version has not been established. Consecutive patients, attending a primary health care centre in Vellore, rural Tamil Nadu, India, were screened for CMD using the Tamil version of the GHQ-12. The subjects were also interviewed using the Revised Clinical Interview Schedule (CIS-R). The International Classification of Diseases-10: Primary care version (ICD-10 PHC) criteria were used to diagnose CMD. Various thresholds of the GHQ-12 were compared against the standards of the ICD-10 PHC. A receiver operator characteristic curve was drawn to obtain the best threshold value for screening. Principal Component Analysis was done to identify latent variables. The Cronbach's alpha and the split half reliability were also calculated. One hundred and eleven (33%) subjects of the 327 patients interviewed satisfied ICD-10 PHC criteria for CMD. The optimal threshold for the GHQ-12 was 2/3. This threshold had a sensitivity 87.4% and a specificity of 79.2%. Three factors were extracted with eigen values of 5.0 (depression-anxiety), 1.7 (social performance) and 1.1 (self-esteem) which explained 42.0%, 13.9% and 9.2% of the variance. The Cronbach's alpha was 0.86 while the split half-reliability was 0.83. The sensitivity and specificity of the Tamil version of the GHQ-12 is high. The factor structure is similar to that reported in other populations. The instrument can be employed as a screening instrument in this population.

Young people and mentoring-towards a typology?

This study explores young people's perceptions of mentoring relationships and proposes a typology of mentoring forms. A sample of 150 adolescents was interviewed both in groups (n=12 groups of up to 13 young people) and individually (n=30 individuals recruited from the group interviews). Results suggested that a range of forms of mentoring were perceived as valuable by different groups of young people and from these a typology of mentoring forms is devised.

A method for automatic edge detection and volume computation of the left ventricle from ultrafast computed tomographic images

RATIONALE AND OBJECTIVES

Detection of endocardial and epicardial borders of the left ventricle (LV) using various imaging modalities is time-consuming and prone to interpretive error. An automatic border detection algorithm is presented that is used with ultrafast computed tomographic images of the heart to compute cavity volumes.

METHODS

The basal-level slice is identified, and the algorithm automatically detects the endocardial and epicardial borders of images from the basal to the apical levels. From these, the ventricular areas and chamber volumes are computed. The algorithm uses the Fuzzy Hough Transform, region-growing schemes, and optimal border-detection techniques. The cross-sectional areas and the chamber volumes computed with this technique were compared with those from manually traced images using canine hearts in vitro (n = 8) and studies in clinical patients (n = 27).

RESULTS

Though the correlation was good (r = .88), the algorithm overestimated the LV epicardial area by 4.8 +/- 6.4 cm2, though this error was not statistically different from zero (P > .05). There was no difference in endocardial areas (r = .95, P > .05). The algorithm tended to underestimate the end-diastolic volume (r = .94) and the end-systolic volume (r = .94), although these errors were not statistically different from zero (P > .05). The algorithm tended to underestimate the ejection fraction (r = .80), although this error was not statistically different from zero (P > .05).

CONCLUSIONS

Automatic detection of myocardial borders provides the clinician with a useful tool for calculating chamber volumes and ejection fractions. The algorithm, with the corrections suggested, provides an accurate estimation of areas and volumes. This algorithm may be useful for contour border identification with ultrasound, positron-emission tomography, magnetic resonance imaging, and other imaging modalities in the heart, as well as other structures.

Automatic chromosome analysis. II. Karyotyping of banded human chromosomes using band transition sequences

Human chromosomes, represented by band transition sequences, chromosome area, centromeric index by area and centromeric index by density, were karyotyped by computer. A reference set of chromosomes provided frequencies of occurrence of each density class and difference class of the band transition sequence as well as of each of the three global features. The karyotyping program was designed to handle all metaphases, even those from which severely bent and overlapped chromosomes were excluded. In one experiment, 21 metaphases were karyotyped on the basis of a reference set and the results were compared with earlier results of visual analysis of band transition profiles developed from band transition sequences: 0.8% errors were made in the visual experiment and 1.4% errors were made in the computer based experiment. In a second experiment, 179 metaphases were divided into reference and test sets and karyotyped by computer with an error rate of 3.4%. By further analysis it was found that metaphases with many misclassified chromosomes could often be automatically distinguished from metaphases with few errors. Thus by automatic rejection of 7% of the metaphases the error rate could be reduced to 2.6%. The computer program for chromosome karyotyping will now be implemented in a semi-automatic system for practical clinical chromosome analysis.