Making better decisions: construction of clinical scoring systems by the Spiegelhalter-Knill-Jones approach.

A study was carried out assessing the practical use of a simple system of scoring information which can help in making a diagnosis or establishing a prognosis in an individual patient. The system was introduced in 1984 for use in gastroenterology, but it can be employed in a wide range of medical and surgical settings. This series was concerned with predicting postoperative respiratory complications in a group of elderly surgical patients. The system combines elements from Baye''s theorem and logistic regression, though no mathematical knowledge is required to apply it in clinical practice. The method by which results are presented is easy to understand, yet at the same time more complex ideas such as conflict of evidence and doubt may be embraced if the clinician so desires.     

Reduced expression of alpha-1,2-mannosidase I extends lifespan in Drosophila melanogaster and Caenorhabditis elegans

Exposure to sub-lethal levels of stress, or hormesis, was a means to induce longevity. By screening for mutations that enhance resistance to multiple stresses, we identified multiple alleles of alpha-1,2-mannosidase I ( mas1 ) which, in addition to promoting stress resistance, also extended longevity. Longevity enhancement is also observed when mas1 expression is reduced via RNA interference in both Drosophila melanogaster and Caenorhabditis elegans. The screen also identified Edem1 ( Edm1 ) , a gene downstream of mas1, as a modulator of lifespan. As double mutants for both mas1 and Edm1 showed no additional longevity enhancement, it appeared that both mutations function within a common pathway to extend lifespan. Molecular analysis of these mutants revealed that the expression of BiP , a putative biomarker of dietary restriction (DR), is down-regulated in response to reductions in mas1 expression. These findings suggested that mutations in mas1 may extend longevity by modulating DR.     

Structural analysis of dextrans containing 4-O-α-d-glucosylated α-d-glucopyranosyl residues at the branch points,by use of 13c-nuclear magnetic resonance spectroscopy and gas-liquid chromatography-mass spectrometry

Dextran fractions from NRRL strain Streptococcus sp. B-1526 and the native, structurally homogeneous dextrans from Acetobacter capsulatum B-1225, Leuconostoc mesenteroides B-1307, and L. dextranicum B-1420 were examined by ¹³C-n.m.r. spectroscopy at 90°. Dextran B-1526 fraction I and dextran B-1420 were also examined by g.l.c:-m.s., methylation-structural analysis. All of these dextrans and dextran fractions branch, either primarily or exclusively, through α-d-(1→4)-glucopyranosyl linkages; however, their degrees of branching differ. Several ¹³C-n.m.r. resonances that are diagnostic for 4,6-di-O-substituted α-d-glucopyranosyl residues have been identified. Comparison was made with dextrans from L. mesenteroides B-742 fraction L and Streptobacterium dextranicum B-1254 fraction S[L], for which previously published, methylation-structural analyses had established the presence of 4,6-di-O-substituted α-d-glucopyranosyl residues at the branch points. These fermentation culture, and in a sedimented gum-phase (fraction I). The product from the soluble phase is designated here as fraction S in order to simplify the terminology. Originally⁷, this product was not designated a fraction, because it was, by definition⁸, the main dextran product. The same distinction also applies to the pairs of products from strains B-1380, B-1420, and b-1394 (see ref. 7). The attempts thus made to establish the significance of the phase separation were indeterminant.Methods.— Methods previously described were used for the mythylation⁹ of the dextrans and for structural analysis^6.38 by combined g.l.c-electron-impact mass spectrometry of the aldononitriles. For each permethylation, three successive Hakomori³⁹ methylations were employed on an initial, 40-mg sample, with ～80% (final weight) recovery of each permethylated dextran. Successive formolysis and acetic acid hydrolysis were employed, and, after each step, the resulting solutions were clear, colorless, and free from suspended material. All mass spectra were recorded with a Hewlett-Packard 5980A GC/MS integrated g.l.c.-m.s.-computer system. The g.l.c. peak-integrals reported in Table II were obtained with a Barber-Coleman Series 5000 g.l.c. instrument equipped with hydrogen-flame detectors. On-column injection with glass columns (2mmi.d. x 1.23m) was employed for all chromatograhy.The ¹³C-n.m.r. conditions and the methods for the preparation of dextran samples have been described⁴. In general, a Varian XL-100-15 spectrometer equipped with a Nicolet TT-100 system was employed in the Fourier-transform mode. The dextran samples, ～0.3g/4 mL of deuterium oxide, were maintained at 90°. Chemical shifts are expressed in p.p.m. relative to external tetramethylsilane, but were actually calculated by reference to the solvent lock-signal. The convolution-difference resolution-enhancement (c.d.r.e.) technique has been described⁴⁰.