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Context: Several observational studies and meta-analyses have reported increased mortality of patients taking sulfonylurea and insulin. The impact of patient profiles and concomitant therapies often remains unclear., Objective: The objective of the study was to quantify survival of patients after starting glucose-lowering agents (GLAs) and compare it with control subjects, matched for risk profiles and concomitant therapies., Design: This was a retrospective, controlled, cohort study., Setting: The study is based on health expenditure records of the largest Belgian health mutual insurer, covering more than 4.4 million people., Patients: A total of 115 896 patients starting metformin, sulfonylurea, or insulin (alone or in combination) between January 2003 and December 2007 participated in the study. Control subjects without GLA therapy were matched for age, gender, history of cardiovascular events, and therapy with antihypertensives, statins and blood platelet aggregation inhibitors., Intervention(s): There were no interventions., Main Outcome Measure: Five-year survival after the start of GLA was measured., Results: Profiles of patients using different GLAs varied, with patients on sulfonylurea being oldest and patients on insulin having more frequently a history of cardiovascular disease. Excess mortality differed across GLA therapies compared with matched controls without GLAs, even after adjusting for observable characteristics. Only metformin monotherapy was not associated with an increased 5-year mortality compared with matched controls, whereas individuals on a combination of sulfonylurea and insulin had the highest mortality risks. Age and concomitant use of statins strongly affect survival., Conclusions: Differences exist in 5-year survival of patients on GLA, at least partly driven by the risk profile of the individuals themselves. Metformin use was associated with lowest 5-year mortality risk and statins dramatically lowered 5-year mortality throughout all cohorts.

Motivation: Clinical data, such as patient history, laboratory analysis, ultrasound parameters--which are the basis of day-to-day clinical decision support--are often underused to guide the clinical management of cancer in the presence of microarray data. We propose a strategy based on Bayesian networks to treat clinical and microarray data on an equal footing. The main advantage of this probabilistic model is that it allows to integrate these data sources in several ways and that it allows to investigate and understand the model structure and parameters. Furthermore using the concept of a Markov Blanket we can identify all the variables that shield off the class variable from the influence of the remaining network. Therefore Bayesian networks automatically perform feature selection by identifying the (in)dependency relationships with the class variable., Results: We evaluated three methods for integrating clinical and microarray data: decision integration, partial integration and full integration and used them to classify publicly available data on breast cancer patients into a poor and a good prognosis group. The partial integration method is most promising and has an independent test set area under the ROC curve of 0.845. After choosing an operating point the classification performance is better than frequently used indices.

Microarray classification can be useful to support clinical management decisions for individual patients in, for example, oncology. However, comparing classifiers and selecting the best for each microarray dataset can be a tedious and non-straightforward task. The M@CBETH (a MicroArray Classification BEnchmarking Tool on a Host server) web service offers the microarray community a simple tool for making optimal two-class predictions. M@CBETH aims at finding the best prediction among different classification methods by using randomizations of the benchmarking dataset. The M@CBETH web service intends to introduce an optimal use of clinical microarray data classification.

Motivation: Microarrays are capable of determining the expression levels of thousands of genes simultaneously. In combination with classification methods, this technology can be useful to support clinical management decisions for individual patients, e.g. in oncology. The aim of this paper is to systematically benchmark the role of non-linear versus linear techniques and dimensionality reduction methods., Results: A systematic benchmarking study is performed by comparing linear versions of standard classification and dimensionality reduction techniques with their non-linear versions based on non-linear kernel functions with a radial basis function (RBF) kernel. A total of 9 binary cancer classification problems, derived from 7 publicly available microarray datasets, and 20 randomizations of each problem are examined., Conclusions: Three main conclusions can be formulated based on the performances on independent test sets. (1) When performing classification with least squares support vector machines (LS-SVMs) (without dimensionality reduction), RBF kernels can be used without risking too much overfitting. The results obtained with well-tuned RBF kernels are never worse and sometimes even statistically significantly better compared to results obtained with a linear kernel in terms of test set receiver operating characteristic and test set accuracy performances. (2) Even for classification with linear classifiers like LS-SVM with linear kernel, using regularization is very important. (3) When performing kernel principal component analysis (kernel PCA) before classification, using an RBF kernel for kernel PCA tends to result in overfitting, especially when using supervised feature selection. It has been observed that an optimal selection of a large number of features is often an indication for overfitting. Kernel PCA with linear kernel gives better results.

INCLUSive is a suite of algorithms and tools for the analysis of gene expression data and the discovery of cis-regulatory sequence elements. The tools allow normalization, filtering and clustering of microarray data, functional scoring of gene clusters, sequence retrieval, and detection of known and unknown regulatory elements using probabilistic sequence models and Gibbs sampling. All tools are available via different web pages and as web services. The web pages are connected and integrated to reflect a methodology and facilitate complex analysis using different tools. The web services can be invoked using standard SOAP messaging. Example clients are available for download to invoke the services from a remote computer or to be integrated with other applications. All services are catalogued and described in a web service registry. The INCLUSive web portal is available for academic purposes at http://www.esat.kuleuven.ac.be/inclusive.

Motivation: Microarray experiments generate a considerable amount of data, which analyzed properly help us gain a huge amount of biologically relevant information about the global cellular behaviour. Clustering (grouping genes with similar expression profiles) is one of the first steps in data analysis of high-throughput expression measurements. A number of clustering algorithms have proved useful to make sense of such data. These classical algorithms, though useful, suffer from several drawbacks (e.g. they require the predefinition of arbitrary parameters like the number of clusters; they force every gene into a cluster despite a low correlation with other cluster members). In the following we describe a novel adaptive quality-based clustering algorithm that tackles some of these drawbacks., Results: We propose a heuristic iterative two-step algorithm: First, we find in the high-dimensional representation of the data a sphere where the "density" of expression profiles is locally maximal (based on a preliminary estimate of the radius of the cluster-quality-based approach). In a second step, we derive an optimal radius of the cluster (adaptive approach) so that only the significantly coexpressed genes are included in the cluster. This estimation is achieved by fitting a model to the data using an EM-algorithm. By inferring the radius from the data itself, the biologist is freed from finding an optimal value for this radius by trial-and-error. The computational complexity of this method is approximately linear in the number of gene expression profiles in the data set. Finally, our method is successfully validated using existing data sets., Availability: http://www.esat.kuleuven.ac.be/~thijs/Work/Clustering.html

INCLUSive allows automatic multistep analysis of microarray data (clustering and motif finding). The clustering algorithm (adaptive quality-based clustering) groups together genes with highly similar expression profiles. The upstream sequences of the genes belonging to a cluster are automatically retrieved from GenBank and can be fed directly into Motif Sampler, a Gibbs sampling algorithm that retrieves statistically over-represented motifs in sets of sequences, in this case upstream regions of co-expressed genes.