Costs of multidrug-resistant TB treatment in Finland and Estonia affected by the 2019 WHO guidelines

BACKGROUND:

Multidrug-resistant TB (MDR-TB) is a growing problem in the effort to end the global TB epidemic. In 2019, the WHO adopted a new standardised regiment for MDR-TB, consisting of only oral medications.

METHODS:

We estimated the impact of the new guidelines on the costs of TB treatment in Estonia and Finland. For both countries, the costs of the two most common new drug regimens were calculated, including drug costs, as well as care- and monitoring-related costs.

RESULTS:

In Turku, Finland, treatment costs with the old regimen were €178,714; this could either increase by 10% or decrease by 18%, depending on the duration of bedaquiline use (6 months vs. 20 months). In Estonia, treatment costs with the old regimen were €33,664, whereas the new regimens were associated with a 40% increase in overall costs.

CONCLUSIONS:

The 2019 WHO guidelines have led to significant changes in the costs of MDR-TB treatment in Finland and Estonia. These changes depend mostly on the drug regimen administered and on care-related practices, with important differences between countries and even within the same country due to local practices.

OMEGA-open-source emission tomography software

In this paper we present OMEGA, an open-source software, for efficient and fast image reconstruction in positron emission tomography (PET). OMEGA uses the scripting language of MATLAB and GNU Octave allowing reconstruction of PET data with a MATLAB or GNU Octave interface. The goal of OMEGA is to allow easy and fast reconstruction of any PET data, and to provide a computationally efficient, easy-access platform for development of new PET algorithms with built-in forward and backward projection operations available to the user as a MATLAB/Octave class. OMEGA also includes direct support for GATE simulated data, facilitating easy evaluation of the new algorithms using Monte Carlo simulated PET data. OMEGA supports parallel computing by utilizing OpenMP for CPU implementations and OpenCL for GPU allowing any hardware to be used. OMEGA includes built-in function for the computation of normalization correction and allows several other corrections to be applied such as attenuation, randoms or scatter. OMEGA includes several different maximum-likelihood and maximum a posteriori (MAP) algorithms with several different priors. The user can also input their own priors to the built-in MAP functions. The image reconstruction in OMEGA can be computed either by using an explicitly computed system matrix or with a matrix-free formalism, where the latter can be accelerated with OpenCL. We provide an overview on the software and present some examples utilizing the different features of the software.

Contrast enhancement in EIT imaging of the brain

We consider electrical impedance tomography (EIT) imaging of the brain. The brain is surrounded by the poorly conducting skull which has low conductivity compared to the brain. The skull layer causes a partial shielding effect which leads to weak sensitivity for the imaging of the brain tissue. In this paper we propose an approach based on the Bayesian approximation error approach, to enhance the contrast in brain imaging. With this approach, both the (uninteresting) geometry and the conductivity of the skull are embedded in the approximation error statistics, which leads to a computationally efficient algorithm that is able to detect features such as internal haemorrhage with significantly increased sensitivity and specificity. We evaluate the approach with simulations and phantom data.

Fecal calprotectin concentration predicts outcome in inflammatory bowel disease after induction therapy with TNFα blocking agents

BACKGROUND

Fecal calprotectin (FC) concentration is a useful surrogate marker for mucosal healing (MH) during tumor necrosis factor alpha (TNFα)-blocking therapy for inflammatory bowel disease (IBD). Our aim was to evaluate whether a normal FC after induction therapy with TNFα antagonist predicts the outcome of IBD patients during maintenance therapy.

METHODS

Sixty IBD patients (34 Crohn's disease [CD], 26 ulcerative colitis [UC]), treated with TNFα antagonists, either infliximab (n = 42) or adalimumab (n = 18), and having a documented FC level at baseline and after induction therapy were included. Disease activity was evaluated by partial Mayo score without endoscopy or Harvey-Bradshaw index at baseline, after induction, and at 12 months during maintenance therapy.

RESULTS

After induction, FC was normalized (≤ 100 μg/g) in 31 patients (52%, median 42 μg/g, range 0-97), whereas the level remained elevated in 29 patients (48%, median 424 μg/g, range 116-5859). At ≈12 months, 26/31 (84%, 18 CD, 8 UC) of the patients with normal FC after induction were in clinical remission, whereas only 11/29 (38%, 9 CD, 2 UC) of those with an elevated (≥ 100 μg/g) postinduction FC were in clinical remission, P < 0.0001. After induction therapy with TNFα antagonists, a cutoff concentration of 139 μg/g for FC had a sensitivity of 72% and a specificity of 80% to predict a risk of clinically active disease after 1 year.

CONCLUSIONS

A normal FC after induction therapy with TNFα antagonists predicts sustained clinical remission in the majority of patients on scheduled therapy with active luminal disease.

Helicobacter pylori infection induces a reversible expression of the CDX2 transcription factor protein in human gastric epithelium

OBJECTIVE

The homeobox gene CDX2 is implicated in the appearance of intestinal metaplasia in Helicobacter pylori gastritis. The aim of this study was to investigate whether CDX2 expression in gastric mucosa occurs before the appearance of overt intestinal metaplasia in H. pylori gastritis, and whether or not this expression is reversible.

MATERIAL AND METHODS

CDX2 was studied by immunohistochemistry in a cohort of 38 patients with H. pylori gastritis before and after eradication (mean follow-up 6.3 years) of H. pylori. A cohort of 49 individuals with healthy stomachs was analysed as a control.

RESULTS

In the control group no immunostaining of CDX2 in the epithelial cells of the gastric body was found, while in 57% of the cases a mild, aberrant nuclear immunostaining of CDX2 in the non-metaplastic epithelial cells in antrum, designated as "positive staining of single cells" (PSSC), was found. In H. pylori gastritis, the PSSC was seen in antrum and corpus in 100% and 26% of the cases, respectively. The prevalence of antral PSSC was significantly increased (on average by 4-fold) in H. pylori gastritis as compared with controls. After eradication of H. pylori, the prevalence of PSSC decreased significantly in antrum but not in corpus.

CONCLUSIONS

Expression of CDX2 at low intensity is common in the epithelium of normal antrum, and this expression is enhanced in H. pylori gastritis. Expression of CDX2 is reversible at least in antrum after eradication of H. pylori infection.

A measurement system and image reconstruction in magnetic induction tomography

Magnetic induction tomography (MIT) is a technique for imaging the internal conductivity distribution of an object. In MIT current-carrying coils are used to induce eddy currents in the object and the induced voltages are sensed with other coils. From these measurements, the internal conductivity distribution of the object can be reconstructed. In this paper, we introduce a 16-channel MIT measurement system that is capable of parallel readout of 16 receiver channels. The parallel measurements are carried out using high-quality audio sampling devices. Furthermore, approaches for reconstructing MIT images developed for the 16-channel MIT system are introduced. We consider low conductivity applications, conductivity less than 5 S m(-1), and we use a frequency of 10 MHz. In the image reconstruction, we use time-harmonic Maxwell's equation for the electric field. This equation is solved with the finite element method using edge elements and the images are reconstructed using a generalized Tikhonov regularization approach. Both difference and static image reconstruction approaches are considered. Results from simulations and real measurements collected with the Philips 16-channel MIT system are shown.

Approximation errors and model reduction in optical tomography

Model reduction is often required in optical diffusion tomography (ODT), typically due to limited available computation time or computer memory. In practice, this often means that we are bound to use sparse meshes in the model for the forward problem. Conversely, if we are given more and more accurate measurements, we have to employ increasingly accurate forward problem solvers in order to exploit the information in the measurements. In this paper we apply the approximation error theory to ODT. We show that if the approximation errors are estimated and employed, it is possible to use mesh densities that would be unacceptable with a conventional measurement model.

Characterizing genetically stable and unstable gastric cancers by microsatellites and array comparative genomic hybridization

Gastric cancer (GCA) displays a variety of genomic aberrations, including DNA copy number alterations, microsatellite instability (MSI), and loss of heterozygosity (LOH). The main aim of the present work was to determine the copy number aberrations in tumors with and without MSI or LOH. Fifteen fresh-frozen GCA samples, 11 of the intestinal and 4 of the diffuse type, were grouped by microsatellite analysis into high-level MSI (MSI-H, n = 2), LOH (n = 5), and microsatellite stable, LOH not detected (MSS/LOH-N, n = 8) tumors. The DNA samples were subsequently analyzed by array comparative genomic hybridization with 16,000 cDNA clones. As expected, the LOH tumors showed more copy number changes; however, the frequency of small-size amplifications was similar across all tumor groups. In addition, the cDNA arrays detected two apparently single-gene amplicons, at 11q13 (CCND1) and 12p12.1 (K-RAS), the presence of which were confirmed using oligonucleotide arrays. A novel amplicon at 5q13.2 was found only in diffuse-type tumors, which were otherwise genetically stable. The results suggest that DNA copy number changes may also occur in gastric cancers that show genomic stability in microsatellite analysis.

DNA copy number aberrations in intestinal-type gastric cancer revealed by array-based comparative genomic hybridization

Genomic instability can be divided into 2 categories: chromosomal instability (CIN) and microsatellite instability (MSI). CIN has been linked to aneuploidy and chromosomal aberrations, and high-level loss of heterozygosity (LOH-H) has been suggested to be an indicator of CIN. High-level MSI (MSI-H), which results from nonfunctional mismatch repair, has previously been suggested to be mutually exclusive with CIN. Four MSI-H and three LOH-H primary gastric tumors of intestinal histology were used for copy number analysis by array-based comparative genomic hybridization (aCGH) with 13,000 cDNA targets. The MSI-H group showed fewer gains (0-12, average 4.5) and losses (0-10, average 2.5) per tumor as compared to the LOH-H group (9-15 gains, average 11.6 and 1-6 losses, average 4). Two MSI-H tumors did not show any copy number changes and one showed only gains of whole chromosomes. The most common alterations were gains of 20q (5/7 samples), 1q, 8, and 10p (3/7 samples) and losses of 1p and 5p (3/7 samples). The minimal amplified regions in 1q and 20q were localized to 1q21.1 approximately q21.2, 1q21.3, 20q11.2, 20q13.12, and 20q13.3 approximately qter. No copy number change was found to be specific for MSI-H or LOH-H. The results suggest that the LOH-H phenotype revealed by microsatellite analysis predicts reliably copy number abnormalities on aCGH and that a subset of MSI-H and all LOH-H tumors share the CIN phenotype.

A biopsy-based quick test in the diagnosis of duodenal hypolactasia in upper gastrointestinal endoscopy

BACKGROUND AND STUDY AIMS

The usefulness of a new quick test for endoscopic diagnosis of adult-type hypolactasia was tested in duodenal biopsies. In this test, an endoscopic biopsy from the postbulbar duodenum is incubated with lactose on a test plate, and a color reaction develops within 20 min as a result of hydrolyzed lactose (a positive result) in patients with normolactasia, whereas no reaction (a negative result) develops in patients with severe hypolactasia.

PATIENTS AND METHODS

Two postbulbar duodenal biopsies were taken from 80 prospectively enrolled adult outpatients with dyspepsia. The biopsies were used for the Quick Lactase Test (Biohit PLC, Helsinki, Finland) and in biochemical disaccharidase (lactase, sucrase, and maltase) assays. In addition, the C/T (-13,910) genotype was determined from DNA extracted from gastric antral biopsies using polymerase chain reaction sequencing in genomic analysis of adult-type hypolactasia.

RESULTS

Twenty-one of 22 patients (95 %; 95 % CI, 87 - 100 %) with biochemical lactase activity < 10 U/g protein, but none of the 58 patients with lactase activity of 10 U/g protein or more had a negative result in the Quick Lactase Test. Seven of the 80 patients (9 %; 95 % CI, 3 - 15 %) had a Quick Lactase Test result that indicated mild hypolactasia (a mild color reaction). All patients with celiac disease (n = 6) had a negative Quick Lactase Test result. Nine of 74 patients (six patients with celiac disease were excluded) had a CC (-13,910) genotype in genomic testing, indicating adult-type hypolactasia. All of them had negative test results with the Quick Lactase Test. Twenty-six patients had a TT genotype, indicating normolactasia, and none of these patients had a negative test result in the Quick Lactase Test. Six of 39 patients (15 %; 95 % CI, 4 - 27 %) with a CT genotype had a negative result in the Quick Lactase Test.

CONCLUSIONS

The Quick Lactase Test effectively identifies patients with severe duodenal hypolactasia. In comparison with CC (adult-type hypolactasia) and TT individuals (normolactasia), the sensitivity and specificity of the Quick Lactase Test result was 100 %. In comparison with biochemical lactase assays, the sensitivity and specificity of a negative Quick Lactase Test for indicating hypolactasia (lactase activity < 10 U/g protein) were 95 % (95 % CI, 87 - 100 %) and 100 %, respectively.

Differences in genomic instability between intestinal- and diffuse-type gastric cancer

BACKGROUND

Microsatellite instability (MSI) and loss of heterozygosity (LOH) are lesions in the genome found with different frequencies in gastric carcinomas (GCAs). Despite a great body of studies, no systematic approach to the detailed classification of MSI and LOH in the two major types of GCA has been published.

METHODS

Thirty-seven advanced GCAs, 25 intestinal-type (IGCAs) and 12 diffuse-type (DGCAs), were assayed with 15 autosomal tetranucleotide markers on 14 chromosomal arms. The observed frequencies and types of microsatellite alterations allowed stratification into subgroups, i.e., high- and low-grade MSI (MSI-H, MSI-L) or microsatellite-stable (MSS), and high- or low-grade, or non-detectable LOH (LOH-H, LOH-L, LOH-N).

RESULTS

Collectively, the markers detected MSI-H tumors with sensitivity equal to that of BAT-26 (a single marker highly specific for MSI-H). Likewise, the markers detected LOH at chromosomal arms 5q, 18q, and 21q with a sensitivity equal to markers used previously. Seven (19%) MSI-H and six (16%) LOH-H tumors were found, with a significant association (P = 0.027) with IGCA: 92% of MSI-H and LOH-H occurred in IGCA patients only. Conversely, in DGCA, a significantly higher prevalence of a stable (LOH-N/MSS) phenotype was found as compared with IGCA (75.1% vs 28.0%; P = 0.035). The MSI-L phenotype was found in 57.9% of non-MSI-H IGCA tumors and was associated significantly (P = 0.015) with LOH-H.

CONCLUSION

A clear difference in genomic instability between IGCA and DGCA was found. In IGCA, the MSI and LOH pathways were more commonly involved, whereas in DGCA, a stable phenotype was predominant. As a novel finding, MSI-L as a true phenomenon and its association with LOH was observed in IGCA.

Pathology and molecular biology of gastric cancer

Several attempts to classify gastric cancer (GCA) have been made over the past decades. Most successful, and widely used, is the classification by Laurén, which distinguishes, by microscopical morphology alone, two main cancer pathogeneses, diffuse (DGCA) and intestinal (IGCA) subtypes, which appear clearly as dissimilar clinical and epidemiological entities. Here we review the main differences in epidemiology, histopathology, and molecular pathology of the two main subtypes of gastric carcinomas based on Laurén classification. In clinical practice, however, clinical staging, particularly in predicting the survival, still remains superior to all classifications of gastric cancer independent of cancer type. The existence of local precursor lesions or conditions of IGCA tumours, i.e. Helicobacter pylori gastritis, atrophic gastritis (AG), intestinal metaplasia (IM), adenoma, dysplasia, and intramucosal neoplasia, is firmly established. The links of DGCA with intestinal-type epithelium, AG or IM are poor, or do not exist. So far, H. pylori gastritis is the only universal precursor condition for DGCA. It implies that AG and achlorhydria are of minor significance and infrequent in the development of DGCA but are important steps in that of IGCA. Despite an increasing body of data, the overall view on molecular pathology of GCA remains fragmentary. No consistent differences in the molecular pathology of GCA subtypes to meet the Laurén classification have been established. With the exception of TP53, no gene mutation occurring regularly in both histological types of GCA has been reported. Chromosomal aberrations and loss of heterozygosity seem to be non-specific and do not follow any consistent route in the progression of GCA. Microsatellite instability is more commonly found in IGCA than in DGCA. The present epigenetic data suggest that most of the decrease (or loss) of gene expression may be explained by promoter hypermethylation which is more often found in IGCA. In DGCA specific genes such as CDH1 are more often hypermethylated. Compared with GCA, in premalignant condition lesions gene mutations and chromosomal aberrations are infrequent. Epigenetic dysregulation might also represent a major mechanism for altered gene expression in premalignant stages in gastric carcinogenesis.

Low circulating levels of gastrin-17 in patients with Barrett's esophagus

AIM: To examine whether the fasting levels of serum gastrin-17 (G-17) are lower in Barrett's esophagus (BE) patients than in non-Barrett controls.

METHODS: Nineteen patients with BE (presenting with a tubular segment ≥2 cm long in lower esophagus and intestinal metaplasia of incomplete type ("pecialized columnar epithelium") in endoscopic biopsies from the tubular segment below the squamocolumnar junction were collected prospectively from outpatients referred to diagnostic gastroscopy. The controls comprised 199 prospectively collected dyspeptic outpatients without BE or any endoscopically visible lesions in the upper GI tract. Fasting levels of serum G-17 (G-17fast) were assayed with an EIA test using a Mab highly specific to amidated G-17. None of the patients and controls received therapy with PPIs or other antisecretory agents.

RESULTS: The mean and median levels of G-17fast in serum were significantly lower (P = 0.001) in BE patients than in controls. The positive likelihood ratios (LR+) of low G-17fast to predict BE in the whole study population at G-17fast levels <0.5, <1, or <1.5 pmol/L were 3.5, 3.0, and 2.8, respectively. Among patients and controls with healthy stomach mucosa, the LR+ were 5.6, 3.8, and 2.6, respectively. In the whole study population, serum G-17 was below 2 pmol/L in 15 of 19 BE patients (79%). The corresponding prevalence was 66 of 199 (33%) in controls (P<0.001). The G-17fast was 5 pmol/L or more in only one of the 19 BE patients (5%). In controls, 76 of the 199 patients (38%) had such high serum G-17fast levels (P<0.01).

CONCLUSION: Serum levels of G-17fast tend to be lower in native patients with BE than in healthy controls.

Correlation between the allelic distribution of STRs in a Finnish population and phenotypically different gastrointestinal tumours: a study using four X-chromosomal markers (DXS7423, DXS8377, ARA, DXS101)

Microsatellite instability in tumours has been suggested as a model to study the process of short tandem repeat (STR) mutations. In the present study we have determined the allelic variation of four X-STRs (DXS7423, DXS8377, DXS101 and ARA) in a Finnish population of 103 individuals, and assessed whether a comparable allelic distribution could be found in a series of gastrointestinal cancers differing by the level of microsatellite instability. Fifty-seven gastric and colorectal cancers were stratified by autosomal STRs, and the mononucleotide marker BAT-26 into stable, low-level unstable and high-level unstable microsatellite (MSI-H) cancers, of which the last produced the majority of X-STR alleles. For the four markers analysed, a significant correlation of allele distribution between our Finnish population sample and MSI-H tumours was noted. Together, the eight MSI-H tumours found represented 80%, 66-80% and 100% of the DXS101 alleles in the Finnish, and in previously described Caucasian and Korean population samples, respectively. Of the ARA, DXS7423 and DXS8377 alleles in the Finnish population, 42%, 75% and 79% were found in the MSI-H cancers, respectively. The results suggest that analysis of STR variation in a relatively small number of MSI-H cancers may aid in pre-evaluation of their allelic distribution in a population.

Modelling the transport of ionizing radiation using the finite element method

Radiation therapy treatment planning is based on the calculation of the absorbed dose in the patient domain. For exact dose calculations, the solution of three coupled Boltzmann transport equations (BTEs) is needed to cover the transport of photons, electrons and positrons. In many situations, however, two coupled systems for photons and electrons are enough. The use of numerical methods in finding the exact solution of the unknown particle fluxes is necessary. In the stationary case, the BTE has six variables, three spatial, two directional and one energy variable. In this paper, we describe an approach in which the finite element method (FEM) is used to solve the six-dimensional problem. For the coupled photon-electron system, the variational formulation and the existence and uniqueness of the solution are derived. We simulate the solution of two coupled BTEs describing the travelling of photons and electrons in two spatial dimensions. The results are compared to Monte Carlo calculations with good agreement.

Typing of XY (male) genotype from malignant neoplastic tissue by the amelogenin-based sex test

DNA profiling of a cancer tissue can be problematic because of genomic instability. Here we have analyzed gastrointestinal cancer specimens from 46 males, of which seven (15%) showed aberrations in determination of gender by the widely used amelogenin test. The X-type amelogenin allele in all cases remained intact. All male tumor samples showing frequent autosomal loss of heterozygosity had a decreased signal of the Y allele from the amelogenin marker. When tested with an alternate set of primers for the amelogenin locus, the Y-type allele showed loss of heterozygosity in the same seven cases. However, when amplified with 15 Y-specific STR primers, all the cancerous tissue Y chromosomes seemed to be intact. These results indicate when malignant neoplastic tissue specimens are used, that amelogenin-based gender determination should be carefully interpreted.

Evaluation of gastrointestinal cancer tissues as a source of genetic information for forensic investigations by using STRs

Malignant tissue samples may sometimes be the only source of biological material for forensic investigations, including identification of individuals or paternity testing. However, in use of such samples, uncertainties due to microsatellite instability (MSI) and loss of heterozygosity (LOH) often associated with neoplasias may be encountered. In this study, we have analysed the applicability of autosomal tetranucleotide short tandem repeat (STR) markers, which are routinely used in forensic analysis, to gain genetic information. MSI and LOH were analysed in 41 surgically removed gastrointestinal cancer specimens and the adjascent non-cancerous tissue marginals. The cancer specimens showed great variability in their genetic phenotypes due to MSI or LOH, with only 32% being microsatellite-stable. Of the 15 autosomal STR loci analysed, only TH01 had no MSI-type alteration in these samples. The loci most frequently affected by MSI were D8S1179, D21S11, D18S51 and D19S433 (MSI in 15-17% of cases). LOH-type alterations were observed at all of the loci, including the amelogenin locus used for sex determination. The highest LOH frequency was found at locus D18S51 (27%). The genetic alterations at the marker loci may indicate false homozygosity or heterozygosity, and false gender may result from erroneous deduction of DNA profiles. Therefore, typing of autosomal STRs from malignant tissues in forensic settings warrants careful interpretation of MSI and LOH results together with microscopic analysis of a tissue specimen. Results by two commercially available and widely used forensic DNA profiling kits used here were comparable.

Non-endoscopic diagnosis of atrophic gastritis with a blood test. Correlation between gastric histology and serum levels of gastrin-17 and pepsinogen I: a multicentre study

BACKGROUND AND AIMS

Serum levels of gastrin-17 (S-G-17) and pepsinogen I (S-PGI) are biomarkers of gastric antral and corpus mucosa, respectively. In a prospective multicentre investigation, we determined whether these tests, together with the assay of Helicobacter pylori antibodies, are a non-endoscopic tool for the diagnosis of atrophic gastritis.

MATERIALS AND METHODS

The series comprised 404 consecutive adult outpatients undergoing diagnostic upper-gastrointestinal endoscopy for various dyspeptic symptoms in five outpatient clinics. Gastric biopsies from the antrum and corpus (at least two biopsies from both sites) were available from all patients, and they were evaluated according to the guidelines of the updated Sydney system. S-PGI and S-G-17 were assayed with ELISA methods using monoclonal antibodies to pepsinogen I and amidated gastrin-17. In addition to the fasting level (S-G-17(fast)), a postprandial S-G-17 (S-G-17(prand)) level was measured 20 min after ingestion of a protein-rich drink. H. pylori antibodies were determined using a polyclonal EIA method.

RESULTS

S-G-17(prand) (and S-G-17(fast)) and S-PGI levels decreased with increasing grade of atrophy of the antrum or corpus, respectively. S-G-17(prand) levels were significantly lower in patients with advanced (moderate or severe) atrophic antral H. pylori gastritis than in those with non-atrophic H. pylori gastritis. All patients with a resected antrum demonstrated S-G-17(prand) levels that were almost undetectable. Of the nine patients with an H. pylori-positive moderate or severe atrophic antral gastritis, six had S-G-17(prand) levels below 5 pmol/l. Similarly, S-PGI levels were significantly lower in patients with advanced corpus atrophy than in those without. Of the 45 patients with moderate or severe corpus atrophy in endoscopic biopsies, 35 patients had S-PGI levels < 25 microg/l. By using the cut-off levels for S-G-17(prand) and S-PGI with the best discrimination, the sensitivity and specificity of the blood test panel in delineation of patients with advanced atrophic gastritis (either in the antrum or the corpus, or both) were 83% and 95%, respectively. The predictive values of the positive and negative test results were 75% and 97%, respectively. In the diagnosis of atrophic gastritis, the application of S-G-17(fast) showed a slightly lower sensitivity and specificity than the application of S-G-17(prand) as a biomarker for antral atrophy.

CONCLUSIONS

The diagnosis of atrophic gastritis obtained with the blood test panel of S-G-17, S-PGI and H. pylori antibodies is in good agreement with the endoscopic and biopsy findings. The panel is a tool for non-endoscopic diagnosis and screening of atrophic gastritis.

A new computational approach for cortical imaging

Estimation of current or potential distribution on the cortex is used to obtain information about neural sources from the scalp recorded electroencephalogram. If the active sources in the brain are superficial, the estimated field distribution on the cortex also yields information about the active source configuration. In these cases, these methods can be used as source localization methods. In this study, we concentrate on finite-element-based cortex potential estimation. Usually these methods require surface interpolation of the recorded voltages at the electrodes onto the entire scalp surface. We propose a new computational approach which does not require the use of surface interpolation but does it implicitly and uses only the recorded data at the electrodes. We refer to this method as the systematic approach (SA). We compare the SA with the surface interpolation approach (IA) and show that the SA is able to produce somewhat better accuracy than the IA. However, the main asset is that the sensitivity of the cortical potential maps to the regularization parameter is significantly lower than with the IA.

A MATLAB package for the EIDORS project to reconstruct two-dimensional EIT images

The EIDORS (electrical impedance and diffuse optical reconstruction software) project aims to produce a software system for reconstructing images from electrical or diffuse optical data. MATLAB is a software that is used in the EIDORS project for rapid prototyping, graphical user interface construction and image display. We have written a MATLAB package (http://venda.uku.fi/ vauhkon/) which can be used for two-dimensional mesh generation, solving the forward problem and reconstructing and displaying the reconstructed images (resistivity or admittivity). In this paper we briefly describe the mathematical theory on which the codes are based on and also give some examples of the capabilities of the package.

Recovery of piecewise constant coefficients in optical diffusion tomography

In optical diffusion tomography the reconstruction of the absorbtion and scattering coefficients is conventionally carried out in a pixel basis. The resulting number of unknowns makes the associated inverse problem severely ill-posed. We have recently proposed a new approach in which the goal is to reconstruct boundaries of piecewise constant tissue regions as well as the diffusion and absorption coefficients within these regions. This method assumes that there is a feasible initial guess on the domain boundaries. In this paper we propose an extension to this approach in which the initial estimate for the boundary and coefficient estimation is extracted from a conventional pixel based reconstruction using standard image processing operations. In the computation of the pixel based reconstruction the output least squares problem is augmented with an approximated total variation prior. The performance of the proposed approach is evaluated using simulated frequency domain data. It is shown that since the total variation type approach favors domains with constant coefficients it is well suited for the fixing of the starting point for the actual boundary and coefficient reconstruction method.

Simultaneous reconstruction of internal tissue region boundaries and coefficients in optical diffusion tomography

In this paper we propose a new numerical method to the inverse problem in optical diffusion tomography. We consider the reconstruction of the diffusion and absorption coefficients (kappa, mu(a)) within a domain omega which is known to consist of a set of disjoint regions of distinct tissue types. The assumption is that the regions of different tissues are bounded by smooth boundary curves and have constant absorption and diffusion coefficients. The goal in the proposed method is to reconstruct simultaneously the boundaries of the tissue regions together with the absorption and diffusion coefficients within these regions. The solution of the problem is based on the finite element method and subdivision of the elements. The performance of the proposed method is evaluated by simulations in which the optical parameters (kappa, mu(a)) are relevant in medical applications of optical tomography. It is shown that the proposed method is able to recover both the boundaries and the coefficients with good accuracy.

Effects of electrode properties on EEG measurements and a related inverse problem

A trend in EEG measurements is to increase the number of measurement electrodes in order to improve the spatial resolution of the recorded voltage distribution at the scalp. It is assumed that this would implicate better accuracy in the EEG inverse estimates. However, this does not necessarily hold. The reason for this is that the electrodes create a well conducting shunting "layer" on the scalp which affects the voltage distribution. This may decrease the information obtained and may therefore worsen the inverse estimates. Electrodes in EEG inverse problems are commonly modeled as point electrodes. This model cannot take into account the possible shunting effect of the electrodes. In this study the measurement electrodes are modeled using the so-called complete electrode model which takes into account the actual size of the electrode, the contact impedance between the skin and the electrode and also the shunting effect of the electrodes. In this paper the effects of the electrode size and the contact impedance on the voltage distribution are studied by simulations. It is shown that, depending on the size and the contact impedance of the electrodes, increasing the number of electrodes does not necessarily improve the accuracy of the inverse estimates. We also conclude that the use of the point electrode model is quite adequate in normal EEG studies. The use of a complete electrode model is necessary if electrodes cover more than 50% of the surface area.

Sensitivity matrix and reconstruction algorithm for EIT assuming axial uniformity

In electrical impedance tomography (EIT) two-dimensional models continue to be applied despite their known inability to provide correct reconstruction. In this paper, a reconstruction algorithm that assumes a translationally invariant conductivity distribution is described. A more precise forward solver is obtained by taking off-slice currents into consideration. An appropriate sensitivity matrix is derived. Numerical evidence for the improvement in precision compared to two-dimensional reconstruction is given.

Errors due to the truncation of the computational domain in static three-dimensional electrical impedance tomography

In electrical impedance tomography (EIT), an approximation for the internal resistivity distribution is computed based on the knowledge of the injected currents and measured voltages on the surface of the body. The currents spread out in three dimensions and therefore off-plane structures have a significant effect on the reconstructed images. A question arises: how far from the current carrying electrodes should the discretized model of the object be extended? If the model is truncated too near the electrodes, errors are produced in the reconstructed images. On the other hand if the model is extended very far from the electrodes the computational time may become too long in practice. In this paper the model truncation problem is studied with the extended finite element method. Forward solutions obtained using so-called infinite elements, long finite elements and separable long finite elements are compared to the correct solution. The effects of the truncation of the computational domain on the reconstructed images are also discussed and results from the three-dimensional (3D) sensitivity analysis are given. We show that if the finite element method with ordinary elements is used in static 3D EIT, the dimension of the problem can become fairly large if the errors associated with the domain truncation are to be avoided.

Three-dimensional electrical impedance tomography based on the complete electrode model

In electrical impedance tomography an approximation for the internal resistivity distribution is computed based on the knowledge of the injected currents and measured voltages on the surface of the body. It is often assumed that the injected currents are confined to the two-dimensional (2-D) electrode plane and the reconstruction is based on 2-D assumptions. However, the currents spread out in three dimensions and, therefore, off-plane structures have significant effect on the reconstructed images. In this paper we propose a finite element-based method for the reconstruction of three-dimensional resistivity distributions. The proposed method is based on the so-called complete electrode model that takes into account the presence of the electrodes and the contact impedances. Both the forward and the inverse problems are discussed and results from static and dynamic (difference) reconstructions with real measurement data are given. It is shown that in phantom experiments with accurate finite element computations it is possible to obtain static images that are comparable with difference images that are reconstructed from the same object with the empty (saline filled) tank as a reference.

Subspace regularization method for the single-trial estimation of evoked potentials

A method for the single-trial estimation of the evoked potentials is proposed. The method is based on the so-called subspace regularization approach in which the second-order statistics of the set of the measurements is used to form a prior information model for the evoked potentials. The method is closely related to the Bayesian estimation. The performance of the proposed method is evaluated using realistic simulations. As a specific application the method is applied to the estimation of the target responses in the P300 test.

Effects of local skull inhomogeneities on EEG source estimation

The accuracy of the head model affects the solutions of the EEG inverse problems. If a simple three-sphere model and standard conductivity values for brain, skull and scalp regions are used, significant errors may occur in the dipole localisation. One of the most sensitive head model parameters is the conductivity of the skull. A realistic three-dimensional finite-element model provides a method to study the effect of inhomogeneities of the skull on the solutions of EEG inverse problems. In this paper the effect of a local skull conductivity inhomogeneity on source estimation accuracy is analyzed by computer simulations for different numbers of electrodes. It is shown that if the inhomogeneity of the skull conductivity is not taken into account, localisation errors of approximately 1 cm can be encountered in the equivalent current dipole estimation. This modelling error introduces a bias to the solution which cannot be compensated by increasing the number of electrodes.

Tikhonov regularization and prior information in electrical impedance tomography

The solution of impedance distribution in electrical impedance tomography is a nonlinear inverse problem that requires the use of a regularization method. The generalized Tikhonov regularization methods have been popular in the solution of many inverse problems. The regularization matrices that are usually used with the Tikhonov method are more or less ad hoc and the implicit prior assumptions are, thus, in many cases inappropriate. In this paper, we propose an approach to the construction of the regularization matrix that conforms to the prior assumptions on the impedance distribution. The approach is based on the construction of an approximating subspace for the expected impedance distributions. It is shown by simulations that the reconstructions obtained with the proposed method are better than with two other schemes of the same type when the prior is compatible with the true object. On the other hand, when the prior is incompatible with the true object, the method will still give reasonable estimates.

A Kalman filter approach to track fast impedance changes in electrical impedance tomography

In electrical impedance tomography (EIT), an estimate for the cross-sectional impedance distribution is obtained from the body by using current and voltage measurements made from the boundary. All well-known reconstruction algorithms use a full set of independent current patterns for each reconstruction. In some applications, the impedance changes may be so fast that information on the time evolution of the impedance distribution is either lost or severely blurred. In this paper, we propose an algorithm for EIT reconstruction that is able to track fast changes in the impedance distribution. The method is based on the formulation of EIT as a state-estimation problem and the recursive estimation of the state with the aid of the Kalman filter. The performance of the proposed method is evaluated with a simulation of human thorax in a situation in which the impedances of the ventricles change rapidly. We show that with optimal current patterns and proper parameterization, the proposed approach yields significant enhancement of the temporal resolution over the conventional reconstruction strategy.

Iodine-123 labeled nor-beta-CIT as a potential tracer for serotonin transporter imaging in the human brain with single-photon emission tomography

Iodine-123 labelled 2beta-carbomethoxy-3beta-(4-iodophenyl) (nor-beta-CIT) is an analogue of beta-CIT, which has high affinity to the serotonin transporter. Initial single-photon emission tomography (SPET) studies with [123I]nor-beta-CIT were performed in five healthy volunteers. In addition, its metabolism in plasma was investigated with gradient high performance liquid chromatography. [123I]nor-beta-CIT was prepared by a method which gave a specific radioactivity of more than 180 GBq/micromol. Unchanged [123I]nor-beta-CIT in plasma accounted for 43% and 19% of total radioactivity after 30 and 180 min, respectively. The dynamic SPET studies demonstrated a high and rapid uptake of radioactivity in the brain (6%/ID at 30 min). Highest accumulation was observed in the striatum, the mid-brain and the thalamus. The specific binding in the mid-brain was 33% higher compared with that of [123I]beta-CIT. The high radioactivity in the mid-brain is assumed to represent the accumulation of [123I]nor-beta-CIT in the serotonin transporter-rich regions, which indicates that [123I]nor-beta-CIT might be a potential tracer for visualization of serotonin transporter sites in the human brain with SPET.

Assessment of errors in static electrical impedance tomography with adjacent and trigonometric current patterns

In electrical impedance tomography (EIT), difference imaging is often preferred over static imaging. This is because of the many unknowns in the forward modelling which make it difficult to obtain reliable absolute resistivity estimates. However, static imaging and absolute resistivity values are needed in some potential applications of EIT. In this paper we demonstrate by simulation the effects of different error components that are included in the reconstruction of static EIT images. All simulations are carried out in two dimensions with the so-called complete electrode model. Errors that are considered are the modelling error in the boundary shape of an object, errors in the electrode sizes and localizations and errors in the contact impedances under the electrodes. Results using both adjacent and trigonometric current patterns are given.

Degradation of pyrene-labelled phospholipids by lysosomal phospholipases in vitro. Dependence of degradation on the length and position of the labelled and unlabelled acyl chains

The hydrolysis of pyrenylacyl phosphatidylcholines (PyrnPCs)(n indicates the number of aliphatic carbons in the pyrene-chain) by crude lysosomal phospholipases in vitro was investigated. PyrnPCs consist of several sets in which the length of the pyrene-labelled or the unlabelled acyl chain, linked to the sn-1 or sn-2 position, was systematically varied. Lysophosphatidylcholine and fatty acid were the only fluorescent breakdown products detected, thus indicating that PyrnPCs were degraded by A-type phospholipases and lysophospholipases. Of these, mainly A1-type phospholipases appear to be involved, as determined from the relative amounts of labelled fatty acid and lysolipid released from the positional isomers. Based on the effects of the length and position of the pyrene-labelled and unlabelled chains it is suggested that (1) the lysosomal A-type phospholipases acting on PyrnPCs recognize the carboxy-terminal part of the lipid acyl chains and (2) the relevant part of the binding site is relatively narrow. Thus phospholipids with added bulk in the corresponding region, such as those that are peroxidized and polymerized, may not be good substrates for the lysosomal phospholipases mentioned. The impaired hydrolysis of the most hydrophobic PyrnPCs indicates that lysosomal phospholipases may not be able to penetrate significantly into the substrate interphase, but upward movement of the lipid may be required for efficient hydrolysis. Finally, the rate of hydrolysis of many pyrenyl derivatives was found to be comparable to that of a natural phosphatidylcholine species, both in micelles and in lipoprotein particles, indicating that these derivatives can be used as faithful reporters of lysosomal degradation of natural lipids in vivo and in vitro.

Lateral organization of liquid-crystalline cholesterol-dimyristoylphosphatidylcholine bilayers. Evidence for domains with hexagonal and centered rectangular cholesterol superlattices

The lateral organization of fluid cholesterol-dimyristoylphosphatidylcholine (DMPC) bilayers was studied by measuring the response of fluorescent membrane probes, dipyrenylphosphatidylcholines (diPyrxPCs) or merocyanine 540, to the variation of cholesterol concentration. Parallel absorbance and light-scattering measurements were also carried out. The excimer-to-monomer ratio of diPyrxPCs displayed abrupt deviations at particular cholesterol mole fractions (CMFs). The most notable of these occurred at CMFs of 0.15, 0.33, and 0.67. Deviations were also frequently observed at CMFs of 0.12, 0.20, 0.25, and 0.40. Merocyanine 540 reproducibly reported deviations at CMFs of 0.15 and 0.33 and frequently reported values close to 0.12, 0.20, and 0.25. In absorbance (turbidity) and light scattering versus CMF plots, well-defined kinks were observed at CMFs of 0.16, 0.33, 0.52, and 0.67. The occurrence of kinks or other deviations at those particular CMFs is most readily explained in terms of a superlattice model previously developed to explain the lateral distribution of pyrenylphospholipids in bilayers [Somerharju, et al. (1985) Biochemistry 24, 2773-2781; Virtanen, J. A., et al. (1988) J. Mol. Electron. 4, 233-236]. This model is based on the assumptions that (i) each cholesterol molecule replaces a single acyl chain in a hexagonal lattice, (ii) cholesterol molecules, because of their larger size, perturb the lattice, (iii) this perturbation is minimized when the cholesterol molecules are maximally separated from each other, and (iv) the maximal separation is achieved when the cholesterol molecules form a hexagonal or centered rectangular superlattice. All detected critical CMFs, except that at CMF 0.67, are predicted by the model, thus strongly supporting its validity. The critical CMF at 0.67 is a limiting case, which can be accounted for by assuming that cholesterol and phospholipid molecules form alternating rows, i.e., formation of a cholesterol superlattice with rectangular symmetry. As predicted by the superlattice model, composition-driven order-to-disorder transitions occur between the critical CMFs, as indicated by increased data scatter and sample fluctuations in those regions. Another important prediction of the superlattice model is that domains with different cholesterol superlattices should coexist at most cholesterol concentrations. Such domains do not have to be extensive to account for the critical events observed here; rather, they are expected to be dynamic entities of limited size. It is very likely that such microscopic domains with distinct cholesterol superlattices also coexist in biological membranes. This is expected to have remarkable effects on both the structure and functions of these membranes.

Transversal distribution of acyl-linked pyrene moieties in liquid-crystalline phosphatidylcholine bilayers. A fluorescence quenching study

Quenching of the fluorescence of pyrene-labeled phospholipids by dibromolipids was used to determine the chain length dependence of the bilayer depths of the pyrenyl moieties. Six 1-palmitoyl-2-(pyrenyl-n-acyl)-phosphatidylcholines (PyrnPC) were examined, with end-labeled pyrenyl chains varying in length, n, from 4 to 14 carbons. These lipids were incorporated, at a concentration of 0.3 mol%, into bilayers composed of various mixtures of 1-palmitoyl-2-oleoylphosphatidylcholine (POPC) and of one of three 1-palmitoyl-2-(x,y-dibromostearoyl)phosphatidylcholine quencher lipids (Brx,yPC; x,y = 6,7; 9,10; or 11,12). Parallel experiments were carried out with bilayers containing 50 mol % cholesterol. Quenching in these systems is dynamic, as demonstrated by the identical dependence of steady-state fluorescence intensities and excited state lifetimes of Pyr8PC on the mole fraction of Br6,7PC. Stern--Volmer analysis of the Brx,PC mole fraction dependence of PyrnPC fluorescence yielded apparent quenching constants, KSV, which show a systematic relation with both the length of the pyrenyl acyl chain and the position of the bromine atoms. The quenching data were further analyzed by plotting KSV as a function of n (defined above), or b (the average of the two bromine positions for each PyrnPC), or n--b (the separation between pyrenes and bromines). In all cases, the data were fit by Gaussian functions yielding estimates of the centers and the apparent 1/e half-widths of the transversal distributions of the pyrenyl moieties in methylene units (mu). Both in the absence and in the presence of cholesterol, the position of each PyrnPC Gaussian center is equal to the sum of n plus a constant d approximately 2.5 mu, corresponding to the distance from the effective center of the pyrenyl moiety to its point of attachment to the acyl chain.(ABSTRACT TRUNCATED AT 250 WORDS)

Distraction bone healing

Bone formation by distraction was studied using three different experimental models: (1) Physeal distraction of the sheep radius was performed in 20 animals. (2) Distraction after osteotomy of the radius was carried out in 39 sheep. (3) Mandibular distraction after osteotomy was performed in 17 sheep. Formation of the organic matrix and osteogenesis were studied by radiographic, histologic, and biochemical methods as well as by electron microscopy. The mode of osteogenesis was essentially similar in all of these distraction models. Bone formation was preceded by organization of the collagenous matrix in the distraction area. In the beginning of the distraction, the gap was composed of a heterogeneous cell population, with large polymorphic fibroblast-like cells. The cells in the central part differentiated into fibroblasts, which remained functionally active as long as distraction proceeded. During physeal distraction, bone formed from the epiphyseal and metaphyseal sides as well as from the surrounding perichondrium. Also, in osteotomy distraction of both tubular bone and mandible, bone formed centripetally from the osteotomized bone ends toward the center of the gap. The organic matrix was composed almost solely of Type I collagen in the earliest stages, suggesting that the mode of osteogenesis differs from bone repair by fracture callus. The structure of the distracted segment was mainly lamellar trabecular. Corticalization of the lengthened bone segment occurred gradually after several months.

Dipyrenylphosphatidylcholines as membrane fluidity probes. Pressure and temperature dependence of the intramolecular excimer formation rate

We have measured the pressure dependence of the intramolecular excimer formation rate, K(p), for di-(1'-pyrenedecanoyl)-phosphatidylcholine (dipy10PC) probes in single-component lipid multilamellar vesicles (MLV) as a function of temperature. Apparent volumes of activation (V(a)) for intramolecular excimer formation are obtained from the slopes of plots of log K(p) versus P. For liquid-crystalline saturated lipid MLV (DMPC and DPPC), these plots are linear and yield a unique V(a) at each temperature, whereas for unsaturated lipids (POPC and DOPC) they are curvilinear and V(a) appears to decrease with pressure. The isothermal pressure induced phase transition is marked by an abrupt drop in the values of K(p). The pressure to temperature equivalence values, dPm/dT, estimated from the midpoint of the transitions, are 47.0, 43.5, and 52.5 bar degree C-1 for DMPC, DPPC, and POPC, respectively. In liquid-crystalline DMPC, V(a) decreases linearly as a function of temperature, with a coefficient -dVa/dT = 0.65 +/- 0.11 ml degree C-1 mol-1. Using a modified free volume model of diffusion, we show that this value corresponds to the thermal expansivity of DMPC. Both the apparent energy and entropy of activation, Ea and delta Sa, increase with pressure in DMPC, whereas both decrease in POPC and DOPC. This difference is attributed to the sensitivity of the dynamics and/or packing of the dipy10PC probes to the location of the cis-double bonds in the chains of the unsaturated host phospholipids. Finally, the atmospheric pressure values of Ea and delta Sa for the four host MLV examined are shown to be linearly related. The relevance of this finding with respect to the structure of the excimers formed by the dipy10PC probes is briefly discussed.

Substrate specificity and activation mechanisms of collagenase from human rheumatoid synovium

Substrate specificity studies of collagenase extracted from human rheumatoid synovium suggest that synovial pannus tissue overlying articular cartilage may not be particularly active in degradation of cartilage type II collagen, which, considering the poor inherent healing capacity of the articular hyaline cartilage, may exert a protective function against inadvertant tissue damage. Rheumatoid synovial tissue was also used to establish synovial fibroblast cell lines. Treatment of these cells in monolayer cultures with IL-1 leads to collagenase gene activation, increased collagenase production and an almost complete autoactivation of secreted collagenase. Interleukin-1 also activated stromelysin gene suggesting this as a possible mechanism effecting autoactivation. Latent human fibroblast and macrophage collagenase purified from culture medium were efficiently activated by phenylmercuric chloride but also by gold thioglucose, gold sodium thiomalate and HCIO. These new observations support the Cys73 switch activation mechanism. In contrast to neutrophil collagenase, the activation by gold(I) compounds and HCIO was associated with a change in the apparent molecular weight of the fibroblast procollagenase. In addition, gold(I) compounds rendered collagenase more susceptible to thermal denaturation. Thus the fibroblast-type interstitial collagenase, probably derived from fibroblast- and macrophage-like synoviocytes, seems to provide the predominant collagenolytic potential in human rheumatoid synovial tissue. Furthermore, the conditions in synovitis tissue may be such as to favor at least initial activation of collagenase synthesized and secreted in situ.

Collagenase reserves in polymorphonuclear neutrophil leukocytes from synovial fluid and peripheral blood of patients with rheumatoid arthritis

Degradation of cartilage in rheumatoid arthritis (RA) may be in part due to release of collagenase from specific granules of polymorphonuclear neutrophil leukocytes (PMNs) during degranulation. We decided to study, not synovial fluid (SF) collagenase, but PMN collagenase reserves. PMN were isolated from parallel SF and peripheral blood (PB) samples obtained from 7-arthritis patients. PMNs were stimulated in vitro by tetradecanoyl-phorbol-13-acetate (TPA). Collagenase activity in the supernatant without and with phenylmercuric chloride activation was studied. Compared to PB PMNs, there was no consistent decrease in the total collagenase reserves in the inflammatory SF PMNs. This suggests that the release of collagenase in the inflammatory synovial fluid does not deplete SF PMNs of the collagenase synthesized at the myelocyte stage. The role of PMN collagenase in pathogenesis of cartilage destruction would then seem to be more dependent on local release and autoactivation at cartilage surface by adherent PMNs and not excessive collagenase release from free floating SF PMNs at single cell level. Furthermore, under the experimental conditions used the proportion of collagenase released in active form was higher in SF PMN specimens than in PB PMN specimens (p less than 0.01). The predominant collagenous component of adult cartilage, native type II collagen, was degraded by PMN collagenase as fast as native type I collagen. These findings suggest an important role for this enzyme in destruction of the free cartilage surface in RA.