Determining which automatic digital blood pressure device performs adequately: a systematic review

The aim of this study is to systematically examine the proportion of accurate readings attained by automatic digital blood pressure (BP) devices in published validation studies. We included studies of automatic digital BP devices using recognized protocols. We summarized the data as mean and s.d. of differences between measured and observed BP, and proportion of measurements within 5 mm Hg. We included 79 articles (10 783 participants) reporting 113 studies from 22 different countries. Overall, 25/31 (81%), 37/41 (90%) and 34/35 (97%) devices passed the relevant protocols [BHS, AAMI and ESH international protocol (ESH-IP), respectively]. For devices that passed the BHS protocol, the proportion of measured values within 5 mm Hg of the observed value ranged from 60 to 86% (AAMI protocol 47–94% and ESH-IP 54–89%). The results for the same device varied significantly when a different protocol was used (Omron HEM-907 80% of readings were within 5 mm Hg using the AAMI protocol compared with 62% with the ESH-IP). Even devices with a mean difference of zero show high variation: a device with 74% of BP measurements within 5 mm Hg would require six further BP measurements to reduce variation to 95% of readings within 5 mm Hg. Current protocols for validating BP monitors give no guarantee of accuracy in clinical practice. Devices may pass even the most rigorous protocol with as few as 60% of readings within 5 mm Hg of the observed value. Multiple readings are essential to provide clinicians and patients with accurate information on which to base diagnostic and treatment decisions.

Building better surfaces

Developments in electrospinning are set to provide novel nanofibre-based structures including intelligent coatings that promote the growth of bone tissue into an implant.

Anodised titania nanotubes prepared in a glycerol/NaF electrolyte

This paper discusses the preparation of titania nanotubes by anodisation of Ti in a glycerol-based electrolyte containing 0.5% wt of sodium fluoride (NaF). The influence of anodisation voltage and anodisation time on nanotube wall thickness, diameter and length has been investigated. The results indicate that nanotubes can be formed within a voltage range 10-40 V and that the tubular structure is lost when using a higher voltage. The diameter of the nanotubes is voltage dependent, with the widest tubes being obtained at the highest possible applied voltage of 40 V. An initial voltage ramp which increases at 100 mV/s to the anodisation voltage, rather than an instantaneous step, was observed to stabilise the metal-oxide interface. This enabled the growth of anodic films up to 5.5 microm in length by anodising for approximately 48 h. In the absence of a voltage ramp the films tended to collapse and become detached from the titanium electrode after 15-20 h. Electron microscopy observation suggests that the nanotubes in glycerol develop in a similar way to those produced in water-based media. The nanotubes formed using glycerol also exhibit ripples along the tube wall, although, growing at a slower rate, they are generally smoother than those formed in water.

Characterization of germanium linear kinoform lenses at Diamond Light Source

The unprecedented brilliance achieved by third-generation synchrotron sources and the availability of improved optics have opened up new opportunities for the study of materials at the micrometre and nanometre scale. Focusing the synchrotron radiation to smaller and smaller beams is having a huge impact on a wide research area at synchrotrons. The key to the exploitation of the improved sources is the development of novel optics that deliver narrow beams without loss of brilliance and coherence. Several types of synchrotron focusing optics are successfully fabricated using advanced miniaturization techniques. Kinoform refractive lenses are being developed for hard X-ray beamlines, and the first test results at Diamond are discussed in this paper.

Six month follow up on a series of patients treated with an electronic brachytherapy technique for intracavitary accelerated partial breast irradiation

Abstract #5149

Purpose: Phase IV prospective post market study to evaluate the safety and device performance of electronic brachytherapy treatment using the Xoft Axxent System as adjuvant therapy for early stage breast cancer.
 Methods and Materials: 44 patients were enrolled between April 2007 and March 2008, and 13 patients have completed 6 months of follow up to date. Patients were eligible if they were older than 50 years, had completely resected DCIS (<2.0cm) or invasive ductal carcinoma (<2.0cm), and microscopic surgical margins of at least 1mm. The balloon applicator was placed in a closed cavity and a balloon surface to skin distance of at least 7mm was required for treatment. The radiation treatment (RT) consisted of delivering 3.4 Gy/fraction twice a day for 10 total fractions. The primary endpoint was the successful delivery of the prescribed RT. Secondary endpoint was adverse device related events.
 Results: Thirteen of the forty-four patients that were enrolled and treated on this study have been followed a minimum of 6 months. The three month follow-up included cosmesis evaluation using the Harvard Cosmesis Scale, and adverse events. The three month cosmesis evaluated by physicians' showed 100% of the patients rated with excellent to good cosmesis. Related adverse events reported through three months included a total of fifteen CTC v3 Grade One AEs. Events included erythema, itching, induration, skin firmness, rash/ desquamation, fatigue. Of these events 90% were resolved. The six month cosmesis physician evaluations showed 82% of the patients had excellent to good cosmesis. Twelve of the 13 patients rated the appearance of their breast, in addition to the physician assessment, and 12 out of 12 rated their appearance good to excellent, one patient did not select any rating. Adverse events reported at six months were a total of three new CTC v3 Grade One. These AEs included occurrences of induration, skin firmness, and hyperpigmentation. A patient satisfaction survey at 6 months follow-up was completed by the patients. Certain survey questions required an answer using a scale of 0-6 for the ratings, where six was the best score. The patients' mean overall rating of satisfaction with the study participation was 5.55 out of 6 (min 3, max 6), satisfied with the radiation treatment was rated 5.54 out of 6 (min 3, max 6). All 13 patients, 100%, stated they would recommend this treatment to a friend.
 Conclusion: This report provides an early look at the experience of using electronic brachytherapy as a means for intracavitary partial breast radiotherapy. The first cohort has reached a minimum of 6 months of follow up and the results appear promising. Additional patient follow up will be presented at the meeting.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5149.

The metagenomics RAST server - a public resource for the automatic phylogenetic and functional analysis of metagenomes

Background

Random community genomes (metagenomes) are now commonly used to study microbes in different environments. Over the past few years, the major challenge associated with metagenomics shifted from generating to analyzing sequences. High-throughput, low-cost next-generation sequencing has provided access to metagenomics to a wide range of researchers.

Results

A high-throughput pipeline has been constructed to provide high-performance computing to all researchers interested in using metagenomics. The pipeline produces automated functional assignments of sequences in the metagenome by comparing both protein and nucleotide databases. Phylogenetic and functional summaries of the metagenomes are generated, and tools for comparative metagenomics are incorporated into the standard views. User access is controlled to ensure data privacy, but the collaborative environment underpinning the service provides a framework for sharing datasets between multiple users. In the metagenomics RAST, all users retain full control of their data, and everything is available for download in a variety of formats.

Conclusion

The open-source metagenomics RAST service provides a new paradigm for the annotation and analysis of metagenomes. With built-in support for multiple data sources and a back end that houses abstract data types, the metagenomics RAST is stable, extensible, and freely available to all researchers. This service has removed one of the primary bottlenecks in metagenome sequence analysis – the availability of high-performance computing for annotating the data.

Tomato fruit ascorbic acid content is linked with monodehydroascorbate reductase activity and tolerance to chilling stress

Quantitative trait loci (QTL) mapping is a step towards the identification of factors regulating traits such as fruit ascorbic acid content. A previously identified QTL controlling variations in tomato fruit ascorbic acid has been fine mapped and reveals that the QTL has a polygenic and epistatic architecture. A monodehydroascorbate reductase (MDHAR) allele is a candidate for a proportion of the increase in fruit ascorbic acid content. The MDHAR enzyme is active in different stages of fruit ripening, shows increased activity in the introgression lines containing the wild-type (Solanum pennellii) allele, and responds to chilling injury in tomato along with the reduced/oxidized ascorbate ratio. Low temperature storage of different tomato introgression lines with all or part of the QTL for ascorbic acid and with or without the wild MDHAR allele shows that enzyme activity explains 84% of the variation in the reduced ascorbic acid levels of tomato fruit following storage at 4 degrees C, compared with 38% at harvest under non-stress conditions. A role is indicated for MDHAR in the maintenance of ascorbate levels in fruit under stress conditions. Furthermore, an increased fruit MDHAR activity and a lower oxidation level of the fruit ascorbate pool are correlated with decreased loss of firmness because of chilling injury.

Micro-engineered remote palpation device for assessing tissue compliance

This paper concerns the operation of the actuator for a prototype micro-engineered mechanical palpation device for deployment via a cystoscope to measure the dynamic mechanical properties of the prostate gland in vivo. The subassembly consists of a 400x200 microm silicon (Si) piston manufactured using deep reactive ion etching (DRIE) housed within an anodically bonded glass-Si-glass sandwiched housing. The micro-channel on the Si layer was formed by powder blasting and contains the micro-piston with one end pointing to the side of the housing and the other facing a via hole leading to a capillary tube. The opening on the side of the housing was sealed by a 5 microm thick silicone membrane which acts to retain the micro-piston and act as a return spring. A 320 microm diameter capillary forms the connection between the micro-channel and a micro-syringe which is operated by a programmable syringe pump to produce a reciprocating action. A pressure sensor is connected along the capillary tube to measure the dynamic pressure within the system. The micro-piston has already been used, separately actuated to measure the dynamic mechanical properties of known viscoelastic materials and prostate tissue. The purpose of the present work is to assess the functionality of the actuator assembly.

Impaired endothelial function in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) patients suffer from excess cardiac deaths due to accelerated atherosclerosis. Endothelial dysfunction is a marker of early atherosclerosis. We tested the hypothesis that SLE patients have impaired endothelial function and assessed the relationship between endothelial function and clinical outcome over the subsequent five years. Thirty-six female SLE patients were compared with 22 healthy age and sex matched controls. Endothelial dependent vasodilatation (EDD) was assessed at the brachial artery in response to shear stress. Endothelium-independent dilatation induced by glyceryl trinitrate was also measured. Patients were followed for up to five years and the development of damage in the cardiovascular and other systems recorded. SLE patients showed significantly impaired endothelial function (median EDD 5.6%, IQR 3.1-7.2%) compared with healthy controls (median EDD 8.0%, IQR 6.3-9.3%; P = 0.001). Endothelium independent dilatation did not differ between the two groups. Endothelial function was significantly worse in postmenopausal compared with premenopausal women (median EDD 6.6%, IQR 3.9-7.8% versus 3.1%, IQR 2.6-5.1%; P = 0.016). Total cholesterol was inversely correlated with endothelial function in SLE patients (Spearman correlation r = -0.422, P = 0.025). There was no relationship between endothelial function and the development of damage in any organ system, including the cardiovascular system during patient follow-up. Patients with SLE have impaired endothelial Lupus (2007) 16, 84-88.

Preventing the Preventable—Improving thromboprophylaxis in oncology in-patients

19648

Background: Cancer and its treatments are well recognised risk factors for venous thromboembolism (VTE). The risk of VTE complications in malignancy can be increased with surgery, chemotherapy (including adjuvant chemotherapy), hormone therapy and central indwelling catheters. Low molecular weight heparin (LMWH) has been shown to safely reduce the incidence of VTE in cancer patients however it is often not a standard of care within the oncology in-patient setting. Method: A retrospective study was carried out on admissions to the oncology ward for 1 month. Individual VTE risk was assessed using the modified THRiFT II risk assessment model and it was documented whether patients received any form of prophylaxis and the incidence of VTE. Following this study a VTE prophylaxis protocol was designed and implemented on the oncology ward and a repeat prospective study was carried out. Results: The initial study showed that in the very high risk group only 15% patients received thromboprophylaxis. 4 episodes of VTE occurred during the initial study period and these all occurred in patients stratified as very high risk. On the repeat study the results showed 50% of patients assessed as very high risk were now receiving prophylaxis. There was also a reduction in the rate of inappropriate prophylaxis from 17% to 0% in those assessed as lower risk. Conclusion: Primary prevention of VTE helps to reduce the morbidity and mortality associated with this common complication of malignancy. This study shows how a simple risk assessment model coupled with raised awareness of VTE risk improved the prophylaxis of those at highest risk and also reduced inappropriate usage in those at lesser risk.

No significant financial relationships to disclose.

Phonons and Thermodynamics of Unmixed and Disordered Li0.6FePO4

The lithium-storage material Li(0.6)FePO(4) was studied by inelastic neutron scattering and differential scanning calorimetry. Li(0.6)FePO(4) undergoes a transformation from a two-phase mixture (heterosite and triphylite) to a disordered solid-solution at 200 degrees C. Phonon densities of states (DOS) obtained from the inelastic neutron scattering were similar for the two-phase sample measured at 180 degrees C and the disordered sample measured at 220 degrees C. The vibrational entropy of transformation is 1.8 +/-0.9 J/(K mol), which is smaller than the configurational entropy difference of approximately 3.1 J/(K mol). The measured enthalpy of the disordering transition was estimated as 2.5 kJ/mol. The phonon data show a small change in lattice dynamics upon disordering.

Protein classification using ontology classification

MOTIVATION

The classification of proteins expressed by an organism is an important step in understanding the molecular biology of that organism. Traditionally, this classification has been performed by human experts. Human knowledge can recognise the functional properties that are sufficient to place an individual gene product into a particular protein family group. Automation of this task usually fails to meet the 'gold standard' of the human annotator because of the difficult recognition stage. The growing number of genomes, the rapid changes in knowledge and the central role of classification in the annotation process, however, motivates the need to automate this process.

RESULTS

We capture human understanding of how to recognise members of the protein phosphatases family by domain architecture as an ontology. By describing protein instances in terms of the domains they contain, it is possible to use description logic reasoners and our ontology to assign those proteins to a protein family class. We have tested our system on classifying the protein phosphatases of the human and Aspergillus fumigatus genomes and found that our knowledge-based, automatic classification matches, and sometimes surpasses, that of the human annotators. We have made the classification process fast and reproducible and, where appropriate knowledge is available, the method can potentially be generalised for use with any protein family.

AVAILABILITY

All components described in this paper are freely available. OWL ontology http://www.bioinf.man.ac.uk/phosphabase myGrid http://www.mygrid.org.uk Instance Store http://instancestore.man.ac.uk.

Absence of magnetism in hcp iron-nickel at 11 K

Synchrotron Mössbauer spectroscopy (SMS) was performed on an hcp-phase alloy of composition Fe92Ni8 at a pressure of 21 GPa and a temperature of 11 K. Density functional theoretical calculations predict antiferromagnetism in both hcp Fe and hcp Fe-Ni. For hcp Fe, these calculations predict no hyperfine magnetic field, consistent with previous experiments. For hcp Fe-Ni, however, substantial hyperfine magnetic fields are predicted, but these were not observed in the SMS spectra. Two possible explanations are suggested. First, small but significant errors in the generalized gradient approximation density functional may lead to an erroneous prediction of magnetic order or of erroneous hyperfine magnetic fields in antiferromagnetic hcp Fe-Ni. Alternately, quantum fluctuations with periods much shorter than the lifetime of the nuclear excited state would prohibit the detection of moments by SMS.

A biodistribution of 5-fluorouracil co-administered with and without galactomannan derivative, in athymic mice implanted with COLO 205 human xenografts

12027

Background: The polysaccharide [(1–4)-linked β-D-mannopyranose]17- [(1–6)-linked-α-D-galactopyranose]10 (Davanat [D]), enhances activity of 5-Fluorouracil (5-FU) in 5-FU refractory murine colon tumor models. D binds to surface lectins and promotes transport of 5-FU into the tumor cells. Lectins are present in large amounts on the surface of metastatic tumor cells, and may mediate cell association, apoptosis and metastasis. Method: A preclinical biodistribution study was initiated to evaluate the intravenous (i.v.) administration of 5-FU (36 mg/kg/dose) in the absence and presence of D (60 mg/kg/dose) in female athymic mice with tumors. Forty mice either received 5-FU alone or with D on days 24–27 (Q1d × 4) after tumor implantation. On day 27, a (2-14C) labeled 5-FU was added to the regimen. After the injection, ten mice per time point (0.5, 1.5, 4 and 24 h) were bled, euthanized and then the plasma, tumor and tissues were assayed for radioactivity by a liquid scintillation analyzer. Objectives were to determine the biodistribution of 14C-5-FU in the absence and presence of D in plasma, tumor and tissues. Results: 14C-5-FU disappeared in a bi-phasic manner after i.v. injection both in the presence and absence of D. Addition of D increased the amount of 5-FU exposure as measured by area under the curve (AUC) from 1.5 to 24 hours post-dose. This finding confirms results from a Phase I study where administering escalating doses 30 to 280 mg/m2 D with fixed 500 mg/m2 5-FU also demonstrated an increase in 5-FU systemic exposure as the D dose increased to 280 mg/m2 Conclusions: In mice, 14C-5-FU dosed with D increased the overall exposure of 14C-5-FU during the 1.5 to 24 hr sampling time duration in plasma, tumor and kidneys, when compared to 14C-5-FU dosed alone. These results, and the results obtained from a Phase I study where D was co-administered with 5-, warrants further testing in a Phase II/III clinical trial.

[Table: see text]

Cancer information acquisition differs by patient characteristics

16008

Background: While cancer patients have access to multiple sources of information, including mass media, the internet and personal and professional contacts, little is known about use of these sources in decision making. Methods: 43 patients with one of three cancer types (37% breast, 28% colon and 35% prostate, 58% stage 1) randomly recruited through the Pennsylvania Cancer Registry completed semi-structured in-person interviews about cancer related information acquisition and decision making. (Median age 59 (range 40–71), 47% male, 79% white, 74% married, mean education 14.6 years (SD = 2.48). Separate analyses were performed for actively looking for information (seeking) vs. passively coming across information (scanning). The primary endpoint was patient use of information sources in cancer related decision making. Results: All cancer patients reported use of both interpersonal and mass media information sources in making cancer related decisions. Patients with more advanced cancer (stage 3 vs. stage 1 or 2), higher education, and younger age were more likely to actively seek cancer information (χ2 = 4.7, p = .095, χ2 = 10, p = .04 and χ2 = 8.6, p = .07). Breast cancer patients and women were more likely to report passively coming across information (χ2 = 9.1, p = .058 and χ2 = 5.1, p = .078). Conclusions: Cancer information acquisition varied according to patient characteristics. Seeking was reported more in younger patients and those with higher formal education, and more advanced cancer. Highly educated and younger patients may be better at navigating the information environment; patients with more advanced cancer may have increased anxiety causing them to actively seek information. Scanning was more common among breast cancer patients and women. Women may attend to general health related information more than men or information about breast cancer may be more accessible and pervasive than information on colon or prostate cancer.

No significant financial relationships to disclose.

MRI protocols for whole-organ assessment of the knee in osteoarthritis

One of the critical challenges in developing structure-modifying therapies for arthritis, especially osteoarthritis (OA), is measuring changes in progression of joint destruction. Magnetic resonance imaging (MRI) offers considerable promise in this regard. Not only can MRI quantify articular cartilage volume and morphology with high precision and accuracy, but it can also examine several other important articular components, and thus offer a unique opportunity to evaluate the knee and other joints as whole organs. On December 5 and 6, 2002, OMERACT (Outcome Measures in Rheumatology Clinical Trials) and OARSI (Osteoarthritis Research Society International), with support from various pharmaceutical companies listed at the beginning of this supplement, held a Workshop for Consensus on Osteoarthritis Imaging in Bethesda, MD. The aim of the Workshop was to provide a state-of-the-art review of imaging outcome measures for OA of the knee to help guide scientists and pharmaceutical companies who want to use MRI in multi-site studies of OA. Applications of MRI were initially reviewed by a multidisciplinary, international panel of expert scientists and physicians from academia, the pharmaceutical industry and regulatory agencies. The findings of the panel were then presented to a wider group of participants for open discussion. The following report summarizes the results of these discussions with respect to MRI acquisition techniques for whole-organ assessment of the knee in OA. The discussion reviews the selection and qualification of imaging sites for clinical trials, designing imaging protocols for whole-organ assessment of OA, and key considerations in image quality (IQ) control and data management.

Comparison of fixed flexion, fluoroscopic semi-flexed and MTP radiographic methods for obtaining the minimum medial joint space width of the knee in longitudinal osteoarthritis trials

OBJECTIVE

To compare three radiographic techniques (fluoroscopic semi-flexed [Fluoro], fixed flexion [FF], and semi-flexed metatarsophalangeal joint [MTP] views) for measuring medial joint space width (JSW) of the knee in longitudinal osteoarthritis (OA) trials and to identify the percentage of patients with detectable progression.

DESIGN

Retrospective summary of the progression and variability of the change in JSW in knee OA.

MATERIAL AND METHODS

Data from the placebo arms of three separate, structure modifying, knee OA trials were compared including gender, age, baseline JSW, change from baseline in JSW, duration of observation, and number and percent of patients with joint space narrowing of various degrees. Computer evaluation of the joint space at its narrowest point in the medial compartment was used in the studies. It is important to note that the narrowest joint space at baseline may not be in the same anatomic location at subsequent evaluations. No statistical tests were performed.

RESULTS

The average observation times were 0.98, 0.68 and 0.82 years for the Fluoro, FF, and MTP studies, respectively. The amount of progression was different among the three studies. The Fluoro study showed the greatest magnitude of OA structural progression and the lowest variability. The Fluoro study was expected to show the greatest magnitude of structural progression since it was conducted for the longest duration. For all patients, the standard deviation of the change in JSW was 0.42, 0.63, and 0.53 mm for the Fluoro, FF, and MTP studies, respectively. The percent of patients with detectable progression was similar across studies.

CONCLUSION

With these data, information was not sufficient to control for duration of observation and differences in inclusion criteria for the three study populations. Therefore, no definitive conclusions can be made regarding the degree of progression of OA over specific time intervals. However, the data indicate that all three studies contain a cohort of patients that exhibit detectable progression.