Cervical wear pathobiology by robot-simulated 3-year toothbrushing - New methodological approach.

OBJECTIVES: An ex-vivo study was aimed at (i) programming clinically validated robot three-year random toothbrushing, (ii) evaluating cervical macro- and microwear patterns on all tooth groups of different functional age, (iii) documenting and codificating wear related morphological features at the cemento-enamel junction in young teeth and on roots in older teeth. DESIGN: Following ethical approval random toothbrushing (44 strokes per tooth horizontally, rotating, vertically; 2x/d) with manual toothbrushes and low-abrasive dentifrice was performed in an artificial oral cavity with brushing-force 3.5 N on 14 extracted human teeth. Morphological features were examined by SEM at baseline and after simulated 3 years using the replication technique. 3D-SEM analyses were carried out with a four-quadrant back scattered electron detector. Wilcoxon-Mann-Whitney-test was used for statistical analyses. RESULTS: 3-year random toothbrushing with horizontal, rotating and vertical brushing movements revealed morphological features classified as four enamel patterns, one dentin pattern and three cervical patterns. Negative impacts were enamel, cementum and dentin loss. Positive impact on oral health was removing dental calculus and straightening cervical traumatic and iatrogenic damages. The volume loss varied from x̅=34.25nl to x̅=87.75nl. Wear extended apically from 100 to 1500 micrometres. CONCLUSION: Robot simulated toothbrushing in an artificial oral cavity, with subsequent SEM and 3D-SEM assessment, elucidated both negative and oral health-contributing micromorphology patterns of cervical wear after simulated 3-year random toothbrushing. Cervical macro- and microwear of cementum revealed, for the first time, what we describe as overhanging enamel peninsulas and enamel islands on roots in young teeth, but no enamel islands on roots from older teeth after root cementum loss. In contrast, many older teeth exhibited enamel peninsulas.

Morphometry of depth of interhemispheric fissure on Indian cadaveric brain specimens.

Background: During neurosurgeries like resection of interhemispheric lipoma or cyst, surgeon needs to remain within the limits of interhemispheric fissure (IHF). Despite a massive literature search, data regarding the morphometry of IHF is meagre. Therefore, the present study was done to calculate the depth of IHF. Materials and Methods: Twenty-five (fourteen male and eleven female) fresh human cadaveric brain specimens were used. The depth of IHF was measured from frontal pole; three points, anterior to coronal suture (A, B and C); four points, posterior to coronal suture (D, E, F and G) and from two points (via parieto-occipital sulcus and calcarine sulcus) on occipital pole. The measurements were taken from these points up to the floor of IHF. IHF is a midline groove and hence the measurements were taken from each point against both the left and the right cerebral hemispheres. At the end, not much bilateral asymmetry was found, hence the average of the reading for the same point against left and the right cerebral hemisphere was considered for calculation. Result: Maximum depth was found to be 59.60 mm and minimum depth was found to be 19.66 mm among all the points which were considered for evaluation. No statistical difference was found in the depth of IHF among the male and the female groups as well as in the various age groups. Conclusion: This data and knowledge about the depth of interhemispheric fissure will aid the neurosurgeons in order to perform the interhemispheric transcallosal approach as well as surgeries of interhemispheric fissure such as excision of lipoma, cyst, tumor of interhemispheric fissure through the shortest and the safest possible route.

Impact of Wearing Dentures on Dietary Intake, Nutritional Status, and Eating: A Systematic Review.

INTRODUCTION: A key purpose of denture provision is to enable eating, yet the body of evidence pertaining to the impact of dentures on wide-ranging nutritional outcomes has not been systematically reviewed. OBJECTIVES: To systematically review published evidence pertaining to the effect of wearing removable dental prosthesis on dietary intake, nutritional status, eating function, and eating related-quality of life (ERQoL). METHODS: Eight questions relating to the impact of wearing dentures on nutritional outcomes were addressed. The target population was healthy adults aged ≥18 y. Data sources included Medline, Embase, CINAHL, and PubMed. Included were all human epidemiologic studies. The Newcastle-Ottawa score was used for appraisal of study quality. Harvest plots, vote counting, and accompanying narrative provided the basis for synthesis. RESULTS: Of the 1,245 records identified, 134 were retrieved and eligibility assessed by 2 reviewers, and 41 studies were included in the synthesis (14 rated good quality, 20 fair, and 7 poor). The balance of data supported a positive impact of wearing full (5/7 studies) or partial (3/3 studies) dentures (vs. no dentures) on nutritional status, though no clear direction of effect was detected for the impact of dentures on dietary intake. The balance of data clearly showed that objective measures of eating function were compromised in full (14/15 studies) and partial (6/7 studies) denture wearers as compared with the dentate. Data showed that ERQoL was also compromised in denture wearers as compared with the dentate (3/3 studies). However, data showed a positive impact of wearing dentures on ERQoL (5/5 studies) as opposed to wearing no dentures. CONCLUSION: The balance of evidence shows that despite no clear pattern on impact of wearing dentures on measured dietary intake, in those with tooth loss, wearing dentures can have a positive impact on nutritional status and enjoyment of eating. KNOWLEDGE TRANSFER STATEMENT: The results of this systematic review can be used to advocate for health care services to address prosthodontic need to benefit nutritional outcomes. The findings will be of use in educating health care professionals on the impact of wearing dentures and not addressing prosthodontic need on nutritional outcomes.

Sesamol induces cytotoxicity via mitochondrial apoptosis in SCC-25 cells.

Sesamol is the main constituent of sesame seed oil and is obtained from Sesamum indicum. Oral squamous cell carcinoma (OSCC) is one of the most common neoplasms affecting the oral cavity. In this study, we investigated the cytotoxic potentials of sesamol on human oral squamous carcinoma (SCC-25) cells. Human oral squamous carcinoma cells were treated with different concentrations (62.5, 125, and 250 µM/mL) of sesamol for 24 h. Cytotoxicity was analyzed by 3- (4, 5- dimethylthiazol -2- yl) -2, 5-diphenyltetrazolium bromide (MTT) assay. Intracellular reactive oxygen species (ROS) expression was investigated by dichloro-dihydro-fluorescein diacetate assay. Apoptosis-related morphology was analyzed by acridine orange/ethidium bromide staining. Caspase-9 expression was analyzed by confocal microscopic double immunofluorescence staining. Mitochondrial apoptosis-related markers are analyzed using qPCR. Sesamol treatment caused a significant cytotoxic effect in OSCC cells. Sesamol-induced cytotoxic effect was associated with intracellular ROS generation. Sesamol treatments induced a significant increase in the early and late apoptotic cells. This treatment also induced caspase-9 expression in OSCC cells. Sesamol treatments caused downregulation of Harvey rat sarcoma viral oncogene homolog (HRAS) expression at protein and gene levels. Sesamol treatment modulates intrinsic apoptotic marker gene expression in OSCC cells. Overall results confirm the anti-cancer potential of sesamol and it seems to be a promising candidate for OSCC.

Photoprotective activity of zirconia nanoparticles.

The increasing incidence of diseases caused by the harmful effects of UV radiation in skin, predominantly skin cancer, induce the search for more efficient photoprotector agents. Nowadays, titanium dioxide (TiO2) and zinc oxide (ZnO) are the most widely used photoprotectors and therefore form the main components of commercially available sunscreens. Although the outstanding efficiency in absorbing and scattering UV radiation, mainly as nanoparticles, recent studies have raised concerns regarding the safe use of these nanoparticles, especially due to their high generation of reactive oxygen species (ROS). Thereby, this work focus on the evaluation of the photoprotective activity of zirconia nanoparticles (ZrO2 NPs) and their cytotoxicity study in the presence and absence of UV irradiation. The ZrO2 NPs were synthesized by hydrothermal method and their hydrodynamic diameter, Zeta potential and colloidal stability were characterized by dynamic light scattering. The morphology and size were observed by transmission electron microscopy. The synthesis resulted in ZrO2 NPs with 50 nm of diameter and 56 nm of hydrodynamic diameter. The high colloidal stability was evidenced by the high value of Zeta potential (+48 mV) and low polydispersity index (0.09). The UV-vis spectrum of the ZrO2 NPs in aqueous suspension showed an intense light scattering below 250 and a wide absorption band at 285 nm. The poor generation of ROS by ZrO2 NPs was confirmed by the absence of photodegradation of methylene blue after long periods of irradiation. The in vitro assays performed with HaCaT cell line showed that the cell viability did not decrease in the absence of irradiation. However, after 24 h of incubation, the cell viability decreased under UV-irradiation in comparison with irradiated cells that were not incubated with ZrO2 NPs. Notably, in these assays, the cells were incubated with the ZrO2 NPs and after 24 h, they were replaced by fresh culture medium before the cell viability assay. Nevertheless, another in vitro assay was performed in order to evaluate the photoprotective activity of ZrO2 NPs. The cells were irradiated in the presence of ZrO2 NPs suspension. In this case, cell viability did not decrease even after long period of UV-irradiation and at higher concentration of ZrO2 NPs. The present results showed that ZrO2 NPs could be an interesting material to be used for skin photoprotection since they showed low cytotoxicity, absence of ROS generation and protection under UV irradiation. Additionally, the ZrO2 NPs suspension was transparent as usually required for applications in sunscreens.

Green Synthesis of Sodium Alginate Capped -CuInS2 Quantum Dots with Improved Fluorescence Properties.

CuInS2 (CIS) quantum dots (QDs) are known to be ideal fluorophores based on their low toxicity and tunable emission. However, due to low quantum yield (QY) and photostability, the surface is usually passivated by a higher bandgap shell (e.g. ZnS). This always resulted in a blue-shifted emission position which is not usually favourable for biological imaging. To address this problem, we herein report the passivation of green synthesized near infra-red emitting glutathione (GSH) capped CuInS2 QDs using different concentration of sodium alginate (SA) at different temperatures. The as-synthesized QDs are small (~ 3.2 nm), highly crystalline and emitted in the near infra-red region. The optical results showed a 36% increase in photostability and a 2-fold increase in quantum yield at ratio 1:8 (SA: CIS) which is suitable for prolonged biological imaging applications. Transmission electron microscope and X-ray diffraction (XRD) analyses showed that the materials are highly crystalline without any change in shape and size after passivation with the biopolymer. Graphical Abstract.

Sodium alginate passivated CuInS2/ZnS QDs encapsulated in the mesoporous channels of amine modified SBA 15 with excellent photostability and biocompatibility.

We herein report the synthesis of CuInS2/ZnS (CIS/ZnS) quantum dots (QDs) via a greener method followed by sodium alginate (SA) passivation and encapsulation into mesoporous channels of amine modified silica (SBA15-NH2) for improved photostability and biocompatibility. The as-synthesized CIS/ZnS QDs exhibited near infrared emission even after SA passivation and silica encapsulation. Transmission electron microscopy (TEM) and Small angle X-ray diffraction (XRD) revealed the mesoporous nature of the SBA-15 remained stable after loading with the SA-CIS/ZnS QDs. The effective encapsulation of SA-CIS/ZnS QDs inside the pores of SBA15-NH2 matrix was confirmed by Brunauer-Emmett-Teller (BET) pore volume analysis while the interaction between the QDs and SBA15-NH2 was confirmed using Fourier transform infrared (FTIR) spectroscopy. The photostability of the QDs was greatly enhanced after these modifications. The resultant SA-CIS/ZnS-SBA15-NH2 (QDs-silica) composite possessed remarkable biocompatibility towards lung cancer (A549) and kidney (HEK 293) cell lines making it a versatile material for theranostic applications.

Pomegranate Juice Enhances Iron Dialysability and Assimilation in In-Vitro Cell Free and Cell-Based Models.

Despite concerted programmatic efforts iron deficiency anemia (IDA) continues to be a global health problem. Per Ayurveda, an Indian Traditional Medical System, natural plant materials such as pomegranate juice (PJ) is indicated as a food supplement to manage IDA. We hypothesized that pomegranate could play a role in improving absorption and assimilation of iron. A cell free in vitro model simulating the gastric and intestinal digestive processes coupled with cell based (Caco-2 and HepG2) models were used to assess iron (FeSO4 form) dialysability in the presence of PJ. Iron assimilation into cells was measured in terms of the cellular ferritin content. PJ (containing ~13 mg/100 ml natural ascorbic acid equivalent) increased the dialysability of iron by >3 fold when compared to control in the cell free model. An equivalent concentration of ascorbic acid alone increased it only by 1.6-fold. PJ increased the iron uptake in Caco2 cells by ~6-fold and ferritin content by 30% when compared to the ascorbic acid control. Similarly, PJ enhanced the iron uptake in HepG2 cells by ~3 fold and iron assimilation by about 50%. This study establishes a scientific evidence for Ayurveda's claim of using pomegranate in the management of IDA by facilitating iron absorption and assimilation. It provides a simple solution for addressing the global problem of IDA. Synergistic action of multiple phytochemicals, over and above ascorbic acid, in PJ may be responsible for improving iron bioavailability.

Optimizing the fermentation conditions and enhanced production of keratinase from Bacillus cereus isolated from halophilic environment.

Keratinase degrading Bacillus cereus was isolated from the halophilic environment in Tamilnadu, India and keratinase production was optimized using wheat bran substrate. Of the screened bacterial isolates, four were found to have the ability to produce keratinolytic enzyme. The process parameters were optimized using one-variable-at-a-time approach and response surface methodology. Supplementation of 1% lactose supported more keratinase production (120 U/g). Among the selected nitrogen sources, addition of casein significantly enhanced maximum keratinase production (132.5 U/g). Among the ions, manganese chloride significantly enhanced keratinsase production (102.6 U/g), however addition of zinc sulphate and copper sulphate decreased keratinase production. The maximum keratinase production was obtained in the wheat bran medium containing 1% lactose, 0.5% manganese with 80% moisture (292 U/g). Statistics based contour plots were generated to explore the variations in the response surface and to find the relationship between the keratinase yield and the bioprocess conditions.

High-depth, high-accuracy microsatellite genotyping enables precision lung cancer risk classification.

There remains a large discrepancy between the known genetic contributions to cancer and that which can be explained by genomic variants, both inherited and somatic. Recently, understudied repetitive DNA regions called microsatellites have been identified as genetic risk markers for a number of diseases including various cancers (breast, ovarian and brain). In this study, we demonstrate an integrated process for identifying and further evaluating microsatellite-based risk markers for lung cancer using data from the cancer genome atlas and the 1000 genomes project. Comparing whole-exome germline sequencing data from 488 TCGA lung cancer samples to germline exome data from 390 control samples from the 1000 genomes project, we identified 119 potentially informative microsatellite loci. These loci were found to be able to distinguish between cancer and control samples with sensitivity and specificity ratios over 0.8. Then these loci, supplemented with additional loci from other cancers and controls, were evaluated using a target enrichment kit and sample-multiplexed nextgen sequencing. Thirteen of the 119 risk markers were found to be informative in a well powered study (>0.99 for a 0.95 confidence interval) using high-depth (579x±315) nextgen sequencing of 30 lung cancer and 89 control samples, resulting in sensitivity and specificity ratios of 0.90 and 0.94, respectively. When 8 loci harvested from the bioinformatic analysis of other cancers are added to the classifier, then the sensitivity and specificity rise to 0.93 and 0.97, respectively. Analysis of the genes harboring these loci revealed two genes (ARID1B and REL) and two significantly enriched pathways (chromatin organization and cellular stress response) suggesting that the process of lung carcinogenesis is linked to chromatin remodeling, inflammation, and tumor microenvironment restructuring. We illustrate that high-depth sequencing enables a high-precision microsatellite-based risk classifier analysis approach. This microsatellite-based platform confirms the potential to create clinically actionable diagnostics for lung cancer.

Pivotal role of families in doctor-patient communication in oncology: a qualitative study of patients, their relatives and cancer clinicians.

Families are a unique source of support for many cancer patients. Most advanced communication skills training for oncologists are patient centred and do not cover interactions with family members. The current study used in-depth qualitative interviews of patients, relatives and cancer clinicians with thematic analysis to explore the role of family members in the communication process. Forty-one participants included 10 cancer patients, 10 relatives ensuring proportionate representation of both gender and primary cancer site and 21 doctors representing both medical and surgical oncology. Nineteen of 20 patients and relatives wanted an "open and honest" discussion with their doctors. All patients, relatives and doctors preferred involvement of the family at most stages of cancer treatment. Five themes were identified in relation to communication with family members. The participants highlighted the "importance of family for physical and psychological care," they emphasised the need to "balance patient autonomy and relatives desire to be protective" using varied "negotiating strategies" that are influenced by "socioeconomic circumstances of both patient and family." The doctor-patient-relative communication process was not static with preferences changing over time. The data suggests that communication skills training of cancer clinicians should incorporate modules on better communication with relatives.

Acquisition of estrogen independence induces TOB1-related mechanisms supporting breast cancer cell proliferation.

Resistance to therapies targeting the estrogen pathway remains a challenge in the treatment of estrogen receptor-positive breast cancer. To address this challenge, a systems biology approach was used. A library of small interfering RNAs targeting an estrogen receptor (ER)- and aromatase-centered network identified 46 genes that are dispensable in estrogen-dependent MCF7 cells, but are selectively required for the survival of estrogen-independent MCF7-derived cells and multiple additional estrogen-independent breast cancer cell lines. Integration of this information identified a tumor suppressor gene TOB1 as a critical determinant of estrogen-independent ER-positive breast cell survival. Depletion of TOB1 selectively promoted G1 phase arrest and sensitivity to AKT and mammalian target of rapmycin (mTOR) inhibitors in estrogen-independent cells but not in estrogen-dependent cells. Phosphoproteomic profiles from reverse-phase protein array analysis supported by mRNA profiling identified a significant signaling network reprogramming by TOB1 that differed in estrogen-sensitive and estrogen-resistant cell lines. These data support a novel function for TOB1 in mediating survival of estrogen-independent breast cancers. These studies also provide evidence for combining TOB1 inhibition and AKT/mTOR inhibition as a therapeutic strategy, with potential translational significance for the management of patients with ER-positive breast cancers.

Correlates of quality of life in an Arab schizophrenia sample.

OBJECTIVES: We focused on the subjective quality of life (QOL) indicators of the Lancashire quality of life profile, European version (LQoLP-EU) in a Kuwaiti schizophrenia sample. The objectives were: First, to assess the reliability and validity of the questionnaire. Second, to highlight the patients' QOL profile, in comparison with the results of the European five-nation study. Third, to examine the association of perceived needs for care, caregiver burden, service satisfaction, self-esteem and psychopathology, with three indices of global QOL: total life satisfaction or perceived QOL (PQOL) score; general wellbeing (GW) and Cantril's ladder (CL). METHOD: Consecutive outpatients in stable condition and their family caregivers were interviewed with the LQoLP, and measures of needs for care, service satisfaction, caregiver burden and psychopathology. RESULTS: There were 130 patients (66.1%m, mean age 36.8). Majority of the patients (56%) felt satisfied with the nine domains of life investigated, and 44.6% felt "averagely" happy. Their clinical severity was moderate (BPRS-18 = 44.4). In exploratory factor analysis (FA), the original domains were mostly replicated. Reliability indices were significant (>0.7). In stepwise regression analyses, the associations of PQOL were more in number and mostly different from those of GW and CL. The correlates of PQOL included, social unmet need (8.1% of variance), staff perception of unmet need (10.3%), general satisfaction with services (11.3%), burden of caregiver supervision (3.7%), self-esteem (2.9%) and positive symptoms (2.6%). Of the nine life domains, health was the most important correlate of GW and CL, indicating the centrality of health status in judgments of subjective QOL. In secondary FA, GW and CL loaded together, but separately from life domains, implying that these are separable parts of the subjective wellbeing construct. CONCLUSION: The profile of QOL scores was mostly similar to European data. The significant multivariate association with patients/staff perceptions of unmet need for care and service satisfaction indicate the usefulness of staff professional development and service improvement in outcome; and imply that promotion of QOL should be an institutional objective. Our finding about the relationship between the three global measures of QOL has added support to the emerging QOL theory.

Positron-emission tomography/computed tomography (PET/CT) in the initial staging of primary rectal cancer.

OBJECTIVE: The aim of this study was to assess the role of (18)flourodeoxyglucose positron-emission tomography/computed tomography (PET/CT) in the initial staging of primary rectal adenocarcinoma. METHOD: A total of 20 patients with adenocarcinoma of the rectum were assessed with both PET/CT and conventional staging (CT chest/abdomen/pelvis, MRI rectum). Discordance with conventional imaging and incidental findings on PET were recorded and the patients presented to a colorectal cancer multidisciplinary team to assess management changes. Patients were followed up so that discordant or incidental findings could be verified by intra-operative examination, imaging or histology where possible. RESULTS: Positron-emission tomography/computed tomography correctly identified the primary tumour in all 20 patients. Comparing PET/CT with conventional staging modalities, there were 11 discordant or incidental findings in nine patients (45%). This resulted in a potential change in stage in 30% (four patients downstaged and two upstaged). PET/CT suggested additional neoplastic pathology in three patients and excluded the same in two patients. The incidental neoplastic findings were of minor clinical significance and one was eventually deemed false positive. While PET/CT resulted in potential management changes in five patients (25%), no changes in surgical management occurred. When tumours were grouped according to conventional stage, PET/CT resulted in fewer changes in stage in stage I (0%), compared with stages II to IV (43%) (P = 0.08). CONCLUSION: Positron-emission tomography/computed tomography provides additional information to conventional staging in primary rectal cancer. This information produced minor management changes in this study and did not effect surgical management. PET/CT may be most appropriately used selectively in more advanced stages and where indeterminate findings exist with conventional staging.

Considerations for introduction of a rotavirus vaccine in Oman: rotavirus disease and economic burden.

Rotavirus is the most common cause of fatal childhood diarrhea worldwide. We provide the first estimates of the health care and economic burden of severe rotavirus disease in Oman. We conducted active, hospital-based surveillance of rotavirus disease at 11 regional public hospitals in Oman, using the guidelines suggested by the generic World Health Organization protocol. From July 2006 through June 2008, all children aged <5 years who were hospitalized for acute gastroenteritis were enrolled in the surveillance program, and their stool samples were tested for rotavirus using a commercially available enzyme immunoassay (ID EIA Rotavirus Test; Dako Diagnostics). Rotavirus was detected in samples from 1712 (49%) of 3470 children. These children were hospitalized for a median of 3 days for severe diarrhea. A marked seasonal peak was evident with a majority of the cases occurring from December through May. Of the rotavirus cases, 69% occurred in children aged 6-17 months. We identified a diverse strain pattern in Oman, with G2 (37%), G1 (38%), and G9 (11%) accounting for most of typeable strains. By our burden estimates, the Omani government spends an estimated US$791,817 and US$1.8 million annually to treat rotavirus-associated diarrhea in the outpatient and hospital settings, respectively. A rotavirus vaccination program might substantially reduce the burden of severe diarrhea among children in Oman.

Treatment of chronic hepatitis C genotype 4 with peginterferon alpha-2a plus ribavirin.

BACKGROUND/AIM: Peginterferon plus ribavirin is the treatment of choice for chronic hepatitis C (HCV). HCV genotype 4 is considered difficult to treat and data regarding the efficacy of antiviral therapy for this genotype are scanty. The aim of the study was to asses the efficacy and tolerability of fixed dose peginterferon alpha 2a plus ribavirin for the treatment of HCV genotype 4. METHODOLOGY: A prospective open label study was done on 30 middle eastern treatment naive chronic hepatitis C patients. They were treated with 180 mcg of peginterferon alpha 2a subcutaneous weekly plus oral ribavirin of 1200 mg daily if body weight > 75 kg. The treatment was continued for 48 weeks and patients were followed up for 24 weeks post-treatment. The early and sustained virological responses were were defined as the absence of HCV RNA from serum at 12 weeks and 72 weeks respectively. The data was analyzed on an intention to treat basis. RESULTS: The early and sustained virological responses were 83.3% and 63.3% respectively. The EVR in patients with minimal or absent fibrosis (96.6%). The SVR in patients with BMI =/> 25 (81.8%) were not significantly different from those of patients with BMI < 25 (87.5%) even with the fixed dose peginterferon. CONCLUSION: Peginterferon alpha 2a in combination with ribavirin is effective in the treatment of HCV genotype 4 and treatment response is intermediate between that of genotype 1 and genotype 2 or 3.

Peak selection from MALDI-TOF mass spectra using ant colony optimization.

MOTIVATION: Due to the large number of peaks in mass spectra of low-molecular-weight (LMW) enriched sera, a systematic method is needed to select a parsimonious set of peaks to facilitate biomarker identification. We present computational methods for matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) spectral data preprocessing and peak selection. In particular, we propose a novel method that combines ant colony optimization (ACO) with support vector machines (SVM) to select a small set of useful peaks. RESULTS: The proposed hybrid ACO-SVM algorithm selected a panel of eight peaks out of 228 candidate peaks from MALDI-TOF spectra of LMW enriched sera. An SVM classifier built with these peaks achieved 94% sensitivity and 100% specificity in distinguishing hepatocellular carcinoma from cirrhosis in a blind validation set of 69 samples. Area under the receiver operating characteristic (ROC) curve was 0.996. The classification capability of these peaks is compared with those selected by the SVM-recursive feature elimination method. AVAILABILITY: Supplementary material and MATLAB scripts to implement the methods described in this article are available at http://microarray.georgetown.edu/web/files/bioinf.htm. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Right ventricular diastolic function after repair of tetralogy of Fallot.

The objective of this study was quantitate diastolic dysfunction in the postoperative phase of tetralogy of Fallot (TOF) and to correlate it with the type of surgical procedure and clinical parameters. Fifty consecutive patients (mean age, 5.0 years; mean weight, 13.5 kg), operated for TOF during the period November 2004 to May 2005, were prospectively studied [infundibular resection, 23; infundibular resection and transannular patch (TAP), 19; right ventricle --> pulmonary artery conduit, 8). Detailed echocardiography was done on postoperative days 3 and 9 with a focus on Doppler indices of right ventricular (RV) function, Antegrade late diastolic flow in the right ventricular outflow tract (RVOT) was taken as the marker of restrictive RV physiology. The previous parameters were correlated to the type of surgery and clinical indices of RV dysfunction. There was no mortality. Twenty-four patients showed restrictive RV physiology. This finding correlated with lower values of E/A ratio (0.98 +/- 0.17 vs 1.33 +/- 0.49, p < 0.002), tricuspid valve E-wave deceleration time (86.9 +/- 21.7 vs 151.4 +/- 152 msec, p < 0.05), index of myocardial performance (0.15 +/- 0.06 vs 0.26 +/- 0.09, p < 0.001), isovolumic relaxation time (19.4 +/- 17 vs 39+/-30 msec, p < 0.009), and a higher central venous pressure (15.1 +/- 1.5 vs 12.7 +/- 1.9, p < 0.001). Restrictive RV physiology correlated with prolonged intensive case unit (ICU) stay (5.1 +/- 3.7 vs 2.8 +/- 2 days, p < 0.015), longer duration of inotropic support (108.3 +/- 56.2 vs 55.5 +/- 28.3 hours, p < 0.02), and higher dosage of diuretics. RV diastolic dysfunction is demonstrable by Doppler echocardiography in the first week following surgery for TOF and tends to be worse with TAP. Restrictive physiology demonstrated by RVOT pulse Doppler predicts longer duration of inotropic support, prolonged ICU stay, and higher dosage of diuretics.