Predicting severe angiographic coronary artery disease using computerization of clinical and exercise test data

Currently the standard exercise test is shifting from being a tool for the cardiologist to utilization by the nonspecialist. This change could be facilitated by computerization similar to the interpretation programs available for the resting ECG. Therefore, we sought to determine if computerization of both exercise ECG measurements and prediction equations can substitute for visual analysis performed by cardiologists to predict which patients have severe angiographic coronary artery disease. We performed a retrospective analysis of consecutive patients referred for evaluation of possible or known coronary artery disease who underwent both exercise testing with digital recording of their exercise ECGs and coronary angiography at two university-affiliated Veteran's Affairs medical centers and a Hungarian hospital. There were 2,385 consecutive male patients with complete data who had exercise tests between 1987 and 1997. Measurements included clinical and exercise test data, and visual interpretation of the ECG paper tracings and > 100 computed measurements from the digitized ECG recordings and compilation of angiographic data from clinical reports. The computer measurements had similar diagnostic power compared with visual interpretation. Computerized ECG measurements from maximal exercise or recovery were equivalent or superior to all other measurements. Prediction equations applied by computer were only able to correctly classify two or three more patients out of 100 tested than ECG measurements alone. beta-Blockers had no effect on test characteristics while ST depression on the resting ECG decreased specificity. By setting probability limits using the scores from the equations, the population was divided into high-, intermediate-, and low-probability groups. A strategy using further testing in the intermediate group resulted in 86% sensitivity and 85% specificity for identifying patients with severe coronary disease. We conclude that computerized exercise ST measurements are comparable to visual ST measurements by a cardiologist and computerized scores only minimally improved the discriminatory power of the test. However, using these scores in a stratification algorithm allows the nonspecialist physician to improve the discriminatory characteristics of the standard exercise test even when resting ST depression is present. Computerization permitted accurate identification of patients with severe coronary disease who require referral.     

Controlled Hollow Cathode Effect: New Possibilities for Heating Low-Pressure Furnaces

The uncontrolled hollow cathode effect may arise in dc plasma surface treatment (nitriding, nitrocarburizing, etc.) of steel parts having small-diameter holes or narrow channels. This may cause nonuniform heating of a part or a batch consisting of parts with markedly different surface/mass ratios. It has been noticed that if the hollow cathode effect is made controllable, it becomes suitable for heating in low-pressure or vacuum furnaces. Additional advantages can be obtained by combining the controlled effect of the hollow cathode with “active screen” plasma treatment due to the removal of the negative influence of the formed arc, of the heating nonuniformity, and of edge effect, as well as by controlling the cathode sputtering. Some experimental results on the topic are presented and the possibilities of application of the effect in industry are outlined.     

Molecular cloning, sequencing, purification, and characterization of Pseudomonas aeruginosa ribosome recycling factor

Ribosome recycling factor (RRF) is required for release of 70S ribosomes from mRNA on reaching the termination codon for the next cycle of protein synthesis. The RRF-encoding gene (frr) of Pseudomonas aeruginosa PAO1 was functionally cloned by using a temperature-sensitive frr mutant of Escherichia coli and sequenced. The P. aeruginosa frr was mapped at 30 to 32 min of the P. aeruginosa chromosome. The deduced amino acid sequence of RRF showed a 64% identity to that of E. coli RRF. In an assay including E. coli polysome and elongation factor G, purified recombinant RRF of P. aeruginosa released monosomes from polysomes. This is the first case in which an RRF homologue was found to be active in heterogeneous ribosome recycling machinery. The genes for ribosomal protein S2 (rpsB), elongation factor Ts (tsf), and UMP kinase (pyrH) are located upstream of frr. The arrangement of the genes, rpsB-tsf-pyrH-frr, resembles those reported for E. coli and Bacillus subtilis. Even in the cyanobacterium genome, the arrangement pyrH-frr is conserved. Although RRF homologues are found in eukaryotic cells, phylogenetic analysis suggests that they were originally present within the members of the phylogenetic tree of prokaryotic RRF. This finding suggests that the ribosome recycling step catalyzed by RRF is specific for prokaryotic cells and that eukaryotic RRF is required for protein synthesis in organelles, which are believed to be phylogenetically originated from prokaryotes.     

Computer probability estimates of angiographic coronary artery disease: transportability and comparison with cardiologists' estimates.

A computer algorithm for estimating probabilities of any significant coronary obstruction and triple vessel/left main obstructions was derived, validated, and compared with the assessments of cardiac clinician angiographers. The algorithm performed at least as well as the clinicians when the latter knew the identity of the patients whose angiograms they had decided to perform. The clinicians were more accurate when they did not know the identity of the subjects but worked from tabulated objective data. Referral and value induced bias may affect physician judgment in assessing disease probability. Application of computer aids or consultation with cardiologists not directly involved with patient management may assist in more rational assessments and decision making.