Improving hybrid image and structure-based deformable image registration for large internal deformations

Objective.Deformable image registration (DIR) is a widely used technique in radiotherapy. Complex deformations, resulting from large anatomical changes, are a regular challenge. DIR algorithms generally seek a balance between capturing large deformations and preserving a smooth deformation vector field (DVF). We propose a novel structure-based term that can enhance the registration efficacy while ensuring a smooth DVF.Approach.The proposed novel similarity metric for controlling structures was introduced as a new term into a commercially available algorithm. Its performance was compared to the original algorithm using a dataset of 46 patients who received pelvic re-irradiation, many of which exhibited complex deformations.Main results.The mean Dice Similarity Coefficient (DSC) under the improved algorithm was 0.96, 0.94, 0.76, and 0.91 for bladder, rectum, colon, and bone respectively, compared to 0.69, 0.89, 0.62, and 0.88 for the original algorithm. The improvement was more pronounced for complex deformations.Significance.With this work, we have demonstrated that the proposed term is able to improve registration accuracy for complex cases while maintaining realistic deformations.

VIEWDEX 3.0-RECENT DEVELOPMENT OF A SOFTWARE APPLICATION FACILITATING ASSESSMENT OF IMAGE QUALITY AND OBSERVER PERFORMANCE

ViewDEX (Viewer for Digital Evaluation of X-ray Images) is an image viewer compatible with Digital Imaging and Communications in Medicine (DICOM) that has been especially designed to facilitate image perception and observer performance studies within medical imaging. The software was first released in 2004 and since then a continuous development has been ongoing. One of the major drawbacks of previous versions of ViewDEX has been that they have lacked functionality enabling the possibility to evaluate multiple images and/or image stacks simultaneously. This functionality is especially requested by researchers working with modalities, where an image acquisition can result in multiple image stacks (e.g. axial, coronal and sagittal reformations in computed tomography). In ViewDEX 3.0 this functionality has been added and it is now possible to perform image evaluations of multiple images and/or image stacks simultaneously, by using multiple monitors and/or multiple image canvases in monitors. Additionally, some of the previously available functionality has been updated and improved. This paper describes the recent developments of ViewDEX 3.0.

VIEWDEX: A STATUS REPORT

ViewDEX (Viewer for Digital Evaluation of X-ray images) is an image viewer and task manager suitable for research and optimisation tasks in medical imaging. The software has undergone continuous development during more than a decade and has during this time period been used in numerous studies. ViewDEX is DICOM compatible, and the features of the interface (tasks, image handling and functionality) are general and flexible. The set-up of a study is determined by altering properties in a text-editable file, enabling easy and flexible configuration. ViewDEX is developed in Java and can run from any disc area connected to a computer. It is free to use for non-commercial purposes and can be downloaded from http://www.vgregion.se/sas/viewdex The purposes of the present article are to give a short overview of the development of ViewDEX and to describe recent updates of the software. In addition, a description on how to configure a viewing session in ViewDEX is provided.

Nonstoichiometric intensities in core photoelectron spectroscopy

X-ray photoemission spectroscopy is used in a great variety of research fields; one observable is the sample's stoichiometry. The stoichiometry can be deduced based on the expectation that the ionization cross sections for innershell orbitals are independent of the molecular composition. Here we used chlorine-substituted ethanes in the gas phase to investigate the apparent carbon stoichiometry. We observe a nonstoichiometric ratio for a wide range of photon energies, the ratio exhibits x-ray-absorption fine structure spectroscopy (EXAFS)-like oscillations and hundreds of eV above the C1s ionization approaches a value far from 1. These effects can be accounted for by considering the scattering of the outgoing photoelectron, which we model by multiple-scattering EXAFS calculations, and by considering the effects of losses due to monopole shakeup and shakeoff and to intramolecular inelastic scattering processes.

Therapeutic targeting of Chk1 in NSCLC stem cells during chemotherapy

Cancer stem cell (SC) chemoresistance may be responsible for the poor clinical outcome of non-small-cell lung cancer (NSCLC) patients. In order to identify the molecular events that contribute to NSCLC chemoresistance, we investigated the DNA damage response in SCs derived from NSCLC patients. We found that after exposure to chemotherapeutic drugs NSCLC-SCs undergo cell cycle arrest, thus allowing DNA damage repair and subsequent cell survival. Activation of the DNA damage checkpoint protein kinase (Chk) 1 was the earliest and most significant event detected in NSCLC-SCs treated with chemotherapy, independently of their p53 status. In contrast, a weak Chk1 activation was found in differentiated NSCLC cells, corresponding to an increased sensitivity to chemotherapeutic drugs as compared with their undifferentiated counterparts. The use of Chk1 inhibitors in combination with chemotherapy dramatically reduced NSCLC-SC survival in vitro by inducing premature cell cycle progression and mitotic catastrophe. Consistently, the co-administration of the Chk1 inhibitor AZD7762 and chemotherapy abrogated tumor growth in vivo, whereas chemotherapy alone was scarcely effective. Such increased efficacy in the combined use of Chk1 inhibitors and chemotherapy was associated with a significant reduction of NSCLC-SCs in mouse xenografts. Taken together, these observations support the clinical evaluation of Chk1 inhibitors in combination with chemotherapy for a more effective treatment of NSCLC.

Large tunable Rashba spin splitting of a two-dimensional electron gas in Bi2Se3

We report a Rashba spin splitting of a two-dimensional electron gas in the topological insulator Bi(2)Se(3) from angle-resolved photoemission spectroscopy. We further demonstrate its electrostatic control, and show that spin splittings can be achieved which are at least an order-of-magnitude larger than in other semiconductors. Together these results show promise for the miniaturization of spintronic devices to the nanoscale and their operation at room temperature.

Succinate independently stimulates full platelet activation via cAMP and phosphoinositide 3-kinase-β signaling

BACKGROUND

The citric cycle intermediate succinate has recently been identified as a ligand for the G-protein-coupled receptor (GPCR) SUCNR1. We have previously found that this receptor is one of the most highly expressed GPCRs in human platelets.

OBJECTIVE

The aim of this study was to investigate the role of SUCNR1 in platelet aggregation and to explore the signaling pathways of this receptor in platelets.

METHODS AND RESULTS

Using real-time-PCR, we demonstrated that SUCNR1 is expressed in human platelets at a level corresponding to that of the P2Y(1) receptor. Light transmission aggregation experiments showed dose-dependent aggregation induced by succinate, reaching a maximum response at 0.5 mM. The effect of succinate on platelet aggregation was confirmed with flow cytometry, showing increased surface expression of activated glycoprotein IIb-IIIa and P-selectin. Intracellular SUCNR1 signaling was found to result in decreased cAMP levels, Akt phosphorylation mediated by phosphoinositide 3-kinase-β activation, and receptor desensitization. Furthermore, succinate-induced platelet aggregation was demonstrated to depend on Src, generation of thromboxane A(2), and ATP release. Platelet SUCNR1 is subject to desensitization through both homologous and heterologous mechanisms. In addition, the P2Y(12) receptor inhibitor ticagrelor completely prevented platelet aggregation induced by succinate.

CONCLUSIONS

Our experiments show that succinate induces full aggregation of human platelets via SUCNR1. Succinate-induced platelet aggregation depends on thromboxane A(2) generation, ATP release, and P2Y(12) activation.

A rotatable electron spectrometer for multicoincidence experiments

We have developed a rotatable hemispherical spectrometer with good energy and angular resolution, which can be positioned with the lens axis arbitrarily within a solid angle of 1 pi. The collection angle of the emitted electrons with respect to the polarization axis of the light is set by means of a three-axes goniometer, operating under vacuum. An important requirement for this setup was the possibility to perform coincidences between the electron analyzed by the spectrometer and one or several other particles, such as ions, electrons, or photons. The lens system and the hemispheres have been designed to accommodate such experimental demands, regarding parameters such as the resolving power, the acceptance angle, or the width of the kinetic energy window which can be recorded for a given pass energy. We have chosen to detect the impact position of the electron at the focal plane of the hemispherical analyzer with a delay line detector and a time-to-digital converter as acquisition card rather than using a conventional charge-coupled device camera.

The diagnostic accuracy of dual-view digital mammography, single-view breast tomosynthesis and a dual-view combination of breast tomosynthesis and digital mammography in a free-response observer performance study

The purpose of the present study was to compare the diagnostic accuracy of dual-view digital mammography (DM), single-view breast tomosynthesis (BT) and BT combined with the opposite DM view. Patients with subtle lesions were selected to undergo BT examinations. Two radiologists who are non-participants in the study and have experience in using DM and BT determined the locations and extents of lesions in the images. Five expert mammographers interpreted the cases using the free-response paradigm. The task was to mark and rate clinically reportable findings suspicious for malignancy and clinically relevant benign findings. The marks were scored with reference to the outlined regions into lesion localization or non-lesion localization, and analysed by the jackknife alternative free-response receiver operating characteristic method. The analysis yielded statistically significant differences between the combined modality and dual-view DM (p < 0.05). No differences were found between single-view BT and dual-view DM or between single-view BT and the combined modality.

VIEWDEX: an efficient and easy-to-use software for observer performance studies

The development of investigation techniques, image processing, workstation monitors, analysing tools etc. within the field of radiology is vast, and the need for efficient tools in the evaluation and optimisation process of image and investigation quality is important. ViewDEX (Viewer for Digital Evaluation of X-ray images) is an image viewer and task manager suitable for research and optimisation tasks in medical imaging. ViewDEX is DICOM compatible and the features of the interface (tasks, image handling and functionality) are general and flexible. The configuration of a study and output (for example, answers given) can be edited in any text editor. ViewDEX is developed in Java and can run from any disc area connected to a computer. It is free to use for non-commercial purposes and can be downloaded from http://www.vgregion.se/sas/viewdex. In the present work, an evaluation of the efficiency of ViewDEX for receiver operating characteristic (ROC) studies, free-response ROC (FROC) studies and visual grading (VG) studies was conducted. For VG studies, the total scoring rate was dependent on the number of criteria per case. A scoring rate of approximately 150 cases h(-1) can be expected for a typical VG study using single images and five anatomical criteria. For ROC and FROC studies using clinical images, the scoring rate was approximately 100 cases h(-1) using single images and approximately 25 cases h(-1) using image stacks ( approximately 50 images case(-1)). In conclusion, ViewDEX is an efficient and easy-to-use software for observer performance studies.

Outcome after severe brain damage, what makes the difference?

OBJECTIVE

To assess and compare the consequences for outcome in terms of the dimensions of activity and participation for two groups: group A, which received early formalized rehabilitation, and group B, which received late or no formalized rehabilitation.

RESEARCH DESIGN

A cross-sectional study.

PROCEDURE

Twenty-six patients (A: n = 14 and B: n = 12) with severe brain damage were included. The participants were assessed a mean of 26.6 months (SD 7.1, median 25, range 14-41) after the incident using the structured form for the Swedish Neuro database, the Glasgow Outcome Scale (GOS), the Extended Glasgow Outcome Scale (GOSE) and the Functional Independence Measure (FIM).

RESULTS

The study reveals a better outcome for group A. No patient remained in a vegetative state in group A as compared with three in group B. In group A, 50% were independent as compared with 17% in group B. The frequency of return to work was 43% in group A, but no patient in group B had returned to work.

Vacuum assisted wound closure in patients with lower extremity arterial disease. The experience from two tertiary referral-centres

AIM

The purpose of this investigation was to analyze predictors for wound healing, amputation and mortality after vacuum assisted closure (VAC) therapy of wounds in the lower limb in patients with arterial disease.

METHODS

One hundred and twenty one wounds were treated and followed for 12 months at two vascular centres in Uppsala and Malmö, Sweden. VAC therapy was applied in the wound at a topical negative pressure of 125 mmHg.

RESULTS

Median age of the patients was 74 years and critical lower limb ischemia was present in 87% of the patients at admission. Intestinal flora was cultivated in 74% of the wounds. VAC associated bleeding occurred in four patients. Complete wound healing was achieved in 66%. Deep groin infections were associated with synthetic graft infection (P<0.001), treatment outside hospital (P<0.001), faster healing (P<0.01) and lower amputation rate (P<0.005). Diabetes mellitus (OR 2.7; [95% CI 1.2-6.2]) and foot wound (OR 3.0; [95% CI 1.2-7.4]) were independent predictors for amputation. The absence of complete wound healing was the strongest factor for both amputation (P<0.001) and death (P<0.001).

CONCLUSIONS

VAC therapy of complex wounds in the lower limbs in patients with vascular disease was associated with high healing rates. Non-healed wounds after VAC therapy were predictors for amputation and death.

Localized versus delocalized excitations just above the 3d threshold in krypton clusters studied by Auger electron spectroscopy

We present Auger spectroscopy studies of large krypton clusters excited by soft x-ray photons with energies on and just above the 3d(52) ionization threshold. The deexcitation spectra contain new features as compared to the spectra measured both below and far above threshold. Possible origins of these extra features, which stay at constant kinetic energies, are discussed: (1) normal Auger process with a postcollision interaction induced energy shift, (2) recapture of photoelectrons into high Rydberg orbitals after Auger decay, and (3) excitation into the conduction band (or "internal" ionization) followed by Auger decay. The first two schemes are ruled out, hence internal ionization remains the most probable explanation.

Adsorption of polar molecules on krypton clusters

The formation process of binary clusters has been studied using synchrotron based core level photoelectron spectroscopy. Free neutral krypton clusters have been produced by adiabatic expansion and doped with chloromethane molecules using the pickup technique. The comparison between the integrated intensities, linewidths, and level shifts of the cluster features of pure krypton and of chloromethane-krypton clusters has been used to obtain information about the cluster geometry. We have shown that most of the chloromethane molecules remain on the surface of the clusters.

Synchrotron radiation study of chloromethane clusters: Effects of polarizability and dipole moment on core level chemical shifts

Free neutral chloromethane clusters have been produced by adiabatic expansion and investigated by means of photoelectron spectroscopy. By studying the differences between the cluster binding energy shifts at the Cl 2p and C 1s thresholds we have shown that antiparallel packing is the dominant local structure of the clusters. This geometry is induced by the polar character of the constituent molecules, and it accords with the structures of chloromethane solids and dimers. Furthermore, results obtained from the analysis of the outer valence levels of the clusters support the suggested local structure. The roles of the polarizability and of the dipole moment of the constituent molecules in the cluster binding energy shifts are discussed in comparison with a recent investigation of bromomethane clusters.

Self-assembled heterogeneous argon/neon core-shell clusters studied by photoelectron spectroscopy

Clusters formed by a coexpansion process of argon and neon have been studied using synchrotron radiation. Electrons from interatomic Coulombic decay as well as ultraviolet and x-ray photoelectron spectroscopy were used to determine the heterogeneous nature of the clusters and the cluster structure. Binary clusters of argon and neon produced by coexpansion are shown to exhibit a core-shell structure placing argon in the core and neon in the outer shells. Furthermore, the authors show that 2 ML of neon on the argon core is sufficient for neon valence band formation resembling the neon solid. For 1 ML of neon the authors observe a bandwidth narrowing to about half of the bulk value.

Sample preserving deep interface characterization technique

We propose a nondestructive technique based on atomic core-level shifts to characterize the interface quality of thin film nanomaterials. Our method uses the inherent sensitivity of the atomic core-level binding energies to their local surroundings in order to probe the layer-resolved binary alloy composition profiles at deeply embedded interfaces. From an analysis based upon high energy x-ray photoemission spectroscopy and density functional theory of a Ni/Cu fcc (100) model system, we demonstrate that this technique is a sensitive tool to characterize the sharpness of a buried interface. We performed controlled interface tuning by gradually approaching the diffusion temperature of the multilayer, which lead to intermixing. We show that core-level spectroscopy directly reflects the changes in the electronic structure of the buried interfaces, which ultimately determines the functionality of the nanosized material.

Two size regimes of methanol clusters produced by adiabatic expansion

Free neutral methanol clusters produced by adiabatic expansion have been studied by photoelectron spectroscopy and line shape modeling. The results show that clusters belonging to two distinct size regimes can be produced by changing the expansion conditions. While the larger size regime can be well described by line shapes calculated for clusters consisting of hundreds of molecules, the smaller size regime corresponds to methanol oligomers, predominantly of cyclic structure. There is little contribution from dimers to the spectra.

Preferential site occupancy of krypton atoms on free argon-cluster surfaces

Argon clusters have been doped with krypton atoms in a pick-up setup and investigated by means of ultraviolet and x-ray photoelectron spectroscopy (UPS and XPS). The width of the krypton surface feature in the XPS spectra from mixed krypton/argon clusters has been studied and found to be narrower than in the case of homogeneous krypton clusters. By considering known spectral broadening mechanisms of the cluster features and the electron binding energy shift of the cluster surface feature relative to the atomic signal, we conclude that krypton ad-atoms preferentially occupy high-coordination surface sites on the argon host-cluster.

Size of neutral argon clusters from core-level photoelectron spectroscopy

Theoretical models of lineshapes in Ar2p photoionization spectra have been calculated for free, neutral argon clusters of different sizes. The lineshape models are fitted to experimental spectra and used to estimate the mean cluster size realized in the experiment. The results indicate that size estimators working from stagnation conditions [R. Karnbach, M. Joppien, J. Stapelfeldt, J. Wörmer and T.Möller, Rev. Sci. Instrum., 1993, 64, 2838] may underestimate the mean cluster size.

The far from equilibrium structure of argon clusters doped with krypton or xenon

Heterogeneous clusters created by doping Ar host clusters with Kr or Xe are shown to have radically different structures from the mixed clusters of the same type created by co-expansion of Ar-Kr or Ar-Xe gas mixtures. In contrast to the co-expansion case, the doped mixed clusters can be produced with Kr or Xe on the surface and Ar in the bulk. With the doping technique it is thus possible to control the surface composition of a specific cluster. A study of the cluster properties as a function of the doping pressure is also reported for the case of Ar clusters doped with Xe. The clusters have been studied by means of synchrotron radiation based X-ray photoelectron spectroscopy.

Postcollision interaction in noble gas clusters: Observation of differences in surface and bulk line shapes

The surface and bulk components of the x-ray photoelectron spectra of free noble gas clusters are shown to display differences in the influence of postcollision interaction between the photoelectron and the Auger electron on the spectral line shape; the bulk component is observed to be less affected than the surface and atomic parts of the spectra. A model for postcollision interaction in nonmetallic solids and clusters is also provided which takes the polarization screening into account. Core-level photoelectron spectra of Ar, Kr, and Xe have been recorded to verify the dependence of the postcollision interaction effect on the polarizability of the sample.

Constant-atomic-final-state filtering of dissociative states in the O1s→σ* core excitation in O2

The below-threshold region in core-excited O2 is very complex, consisting of a multitude of exchange-split states with mixed molecular orbital-Rydberg character. We have investigated the nature of these intermediate states by resonant Auger spectroscopy. In particular, we have obtained constant-atomic-final-state yield curves for several atomic peaks in the electron decay spectra which are stemming from ultrafast dissociation. The relative intensity of Auger decay leading to atomic final states is considered a signature of the relative weight of the sigma* character. This method allows one to "filter out" intermediate states with dissociative character. Extensive calculations have been performed by multi-reference configuration interaction at different interatomic distances in order to evaluate the potential curves of the core-excited states and propose a qualitative description of the dissociative molecular dynamics. The calculations show that the core-excited states have a relevant admixture of excitations to orbitals with Rydberg character and excitations to the sigma* orbital with different spin couplings. A diabatization of the adiabatic potential curves shows that the coupling between Rydberg and sigma* diabatic states is very different at the different crossing points and ultrafast dissociation occurs more easily on the lowest sigma* diabatic potential curve. As a consequence, the observation of atomic peaks only in the lower-energy region of the absorption curve is well justified.

The electronic structure of free water clusters probed by Auger electron spectroscopy

(H2O)(N) clusters generated in a supersonic expansion source with N approximately 1000 were core ionized by synchrotron radiation, giving rise to core-level photoelectron and Auger electron spectra (AES), free from charging effects. The AES is interpreted as being intermediate between the molecular and solid water spectra showing broadened bands as well as a significant shoulder at high kinetic energy. Qualitative considerations as well as ab initio calculations explain this shoulder to be due to delocalized final states in which the two valence holes are mostly located at different water molecules. The ab initio calculations show that valence hole configurations with both valence holes at the core-ionized water molecule are admixed to these final states and give rise to their intensity in the AES. Density-functional investigations of model systems for the doubly ionized final states--the water dimer and a 20-molecule water cluster--were performed to analyze the localization of the two valence holes in the electronic ground states. Whereas these holes are preferentially located at the same water molecule in the dimer, they are delocalized in the cluster showing a preference of the holes for surface molecules. The calculated double-ionization potential of the cluster (22.1 eV) is in reasonable agreement with the low-energy limit of the delocalized hole shoulder in the AES.

Angular distribution of different vibrational components of the X and B states reached after resonant Auger decay of core-excited H2O: Experiment and theory

Vibrationally resolved spectra have been obtained for the lowest-lying cationic states X (2)B(1), A (2)A(1), and B (2)B(2) of the water molecule reached after participator resonant Auger decay of core-excited states. The angular distribution has been measured of the first four vibrational components of the X state in the photon energy regions including the O 1s-->4a(1) and the O 1s-->2b(2) core excitations, and for different portions of the vibrational envelope of the B state in the photon energy region including the O 1s-->2b(2) core excitation. For the X state, a large relative spread in beta values of the different vibrational components is observed across both resonances. For the B state, a very different trend is observed for the high binding energy side and the low binding energy side of the related spectral feature as a function of photon energy. A theoretical method based on the scattering K matrix has been used to calculate both the photoabsorption spectrum and the beta values, by taking both interference between direct and resonant photoemission and vibrational/lifetime interference into account. The numerical results show qualitative agreement with the trends detected in the experimental values and explain the conspicuous variations of the beta values primarily in terms of coupling between direct and resonant photoemission by interaction terms of different sign for different final vibrational states.

A software tool for increased efficiency in observer performance studies in radiology

Observer performance studies are time-consuming tasks, both for the participating observers and for the scientists collecting and analysing the data. A possible way to optimise such studies is to perform them in a completely digital environment. A software tool-ViewDEX (Viewer for Digital Evaluation of X-ray images)-has been developed in Java, enabling it to function on almost any computer. ViewDEX is designed to handle several types of studies, such as visual grading analysis (VGA), image criteria scoring (ICS) and receiver operating characteristics (ROC). The results from each observer are saved in a log file, which can be exported for further analysis in, for example, a special software for analysing ROC results. By using ViewDEX for an ROC experiment, an evaluation rate of approximately 200 images per hour can be achieved, compared to approximately 25 images per hour using hard copy evaluation. The results are obtained within minutes of completion of the viewing. The risk of human errors in the process of data collection and analysis is also minimised. The viewer has been used in a major trial containing approximately 2700 images.

Femtosecond interatomic Coulombic decay in free neon clusters: large lifetime differences between surface and bulk

A quantitative determination of 2s vacancy lifetimes in surface and bulk atoms of free Ne clusters has been made. While for free atoms the 2s inner-valence hole has a ps lifetime, it reduces to 6+/-1 fs for cluster bulk atoms. For surface atoms, the lifetime is on average longer than 30 fs. The lifetime estimate was obtained from fits of high-resolution photoelectron spectra of Ne clusters. The shortening of the lifetime is attributed to the coordination dependent interatomic Coulombic decay, which is extremely sensitive to internuclear distances.

Human and rodent type 1 11beta-hydroxysteroid dehydrogenases are 7beta-hydroxycholesterol dehydrogenases involved in oxysterol metabolism

Interconversion between cortisone and the glucocorticoid receptor ligand cortisol is carried out by 11beta-hydroxysteroid dehydrogenase (11beta-HSD)isozymes and constitutes a medically important example of pre-receptor control of steroid hormones. The enzyme 11beta-HSD type 1 (11beta-HSD1) catalyzes the conversion of cortisone to its active receptor-binding derivative cortisol, whereas 11beta-HSD type 2 performs the reverse reaction. Specific inhibitors against the type 1 enzyme lower intracellular levels of glucocorticoid hormone, with an important clinical application in insulin resistance and other metabolic disorders. We report here on the in vitro oxysterol-metabolizing properties of human and rodent 11beta-HSD1. The enzyme, either as full-length, membrane-attached, or as a transmembrane domain-deleted, soluble form, mediates exclusively conversion between 7-ketocholesterol and 7beta-hydroxycholesterol with similar k(cat) values as observed with glucocorticoid hormones. Thus, human, rat, and mouse 11beta-HSD1 have dual enzyme activities like the recently described 7alpha-hydroxysteroid dehydrogenase/11beta-hydroxysteroid dehydrogenase from hamster liver, but differ fundamentally from the latter in that 7beta-OH rather than 7alpha-OH dehydrogenase constitutes the second activity. These results demonstrate an enzymatic origin of species differences in 7-oxysterol metabolism, establish the origin of endogenous 7beta-OH cholesterol in humans, and point to a possible involvement of 11beta-HSD1 in atherosclerosis.

Adverse events and patients' perceptions of antihypertensive drug effectiveness

Adverse events that patients attribute to their drug treatment are generally considered to reduce adherence to medication. However, some patients interpret such symptoms as indicating drug effectiveness. If perceivedly effective drugs are more likely to be taken then adverse events may increase adherence. The extent to which patients interpret adverse events as indicating drug effectiveness is not well known. We investigated this in a cross-sectional questionnaire study of 1013 drug-treated hypertensive patients from 55 primary health-care centres and 11 internal medicine clinics in Sweden. We hypothesized that estimates of future risk of complications of hypertension made by hypertensive patients who had adverse events would be lower than estimates made by patients who did not have adverse events, and that these estimates would only differ when patients were estimating their risks in a setting where they continued taking antihypertensive drugs. Patients' risk estimates were measured with visual analogue scales and adverse events were detected by an open question. Contrary to our hypothesis, patients with adverse events (25.7%) gave higher estimates of future risk in the continuing medication setting. This association persisted in a multivariate analysis, where a number of factors related to adverse events and risk were controlled for (OR 1.76 (95% CI, 1.26-2.45), P=0.001 for the most highly correlated risk measure), but risk estimates did not differ between patients with and without adverse events in the setting of not continuing medication. Possible explanations for these findings are pre-existing differences in attitude towards drugs and level of fear of complications.