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September 2017 -
Volume 15, Issue 7
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From the Editor

 
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In Memoriam
Professor Orhan Ekrem Müftüoglu
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Original Contribution / Clinical Investigation












 











































Cholelithiasis and cholecystectomy may lower the low density lipoprotein cholesterol in plasma
DOI:
10.5742/MEWFM.2017.93010
[pdf version]
Mehmet Rami Helvaci, Mursel Davarci, Orhan Veli Ozkan, Ersan Semerci, Abdulrazak Abyad, Lesley Pocock


Serum and follicular fluid vitamin D and follicular response among infertile women undergoing ICSI
DOI: 10.5742/MEWFM.2017.93011
[pdf version]
Sedighe Esmaeilzadeh, Maryam Aliasgharpour, Parvaneh Mirabi, Azita Ghanbarpour
Maede Fasihian

Studying the relation of quality of work life with socio-economic status and general health among the employees working in Students Welfare Fund of Ministry of Health and Medical Education in 2016
DOI: 10.5742/MEWFM.2017.93012
[pdf version]
Saeed Reza Azami, Nasrin Shaarbafchizadeh, Soheil Mokhtari, Ali Maher

On the Effect of Cognitive Behavioural Counseling on Sexual Satisfaction of Mothers with Autistic Children: A Randomized Clinical Trial
DOI:
[pdf version]
Leila Arbil, Mitra Kolivand, Farzaneh Golboni, Effat MerghatiKhoei, Mansour Rezaei

Pre-operative sublingual misoprostol and intra-operative blood loss during total abdominal hysterectomy: a randomized single-blinded controlled clinical trial
DOI: 10.5742/MEWFM.2017.93013
[pdf version]
Taravat Fakheri, Tayebe Noori

Investigating the Effect of Endotracheal Tube Cuff Pressure on Sore Throat, Hoarseness and Cough in Patients with Coronary Artery Bypass Surgery
DOI: 10.5742/MEWFM.2017.93014
[pdf version]
Ali Akbar Vaezi, Mohammad Hassan Mondegari Bamakan

Comparing the Self-Esteem and Resiliency between Blind and Sighted Children and Adolescents in Kermanshah City
DOI: 10.5742/MEWFM.2017.93015
[pdf version]
Saeedeh Bakhshi, Nafiseh Montazeri , Babak Nazari, Arash Ziapour, Hashem Barahooyi,
Fatemeh Dehghan

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Population and Community Studies

 

 

 

 

 

 

 






 

 










Frequency of Uric Acid Levels, Symptomatic and Asymptomatic Hyperuricemia among the Pakistani Population
DOI: 10.5742/MEWFM.2017.93016
[pdf version]
Waris Qidwai, Masood Jawaid

Determinants of Tooth Brushing among Primary School Students
DOI: 10.5742/MEWFM.2017.93017
[pdf version]
Mohammad Mahboubi, Mohammad Ismail Motlagh, Mehdi Mirzaei-Alavijeh, Farzad Jalilian, Hassan Gharibnavaz,
Mohammad Fattahi

Depression in patients suffering from gender dysphoria: The hospitalized patients of Legal Medicine Center in Southwest of Iran
DOI: 10.5742/MEWFM.2017.93018
[pdf version]
Zahra Gorjian, Mohammad Zarenezhad, Mohhamad Mahboubi, Saeid Gholamzadeh,
Nahid Mahmoodi

An epidemiological study of suicide attempts and to determine the correlation between attempted suicide causes and demographic characteristics of people in Kermanshah Province during a year
DOI: 10.5742/MEWFM.2017.93019
[pdf version]
Hamid Reza Shetabi, Samira Rostami, Mohsen Mohammadi, Mahsa Cheleii, Lida Saedi, Saba Amiri Nasab,
Shirin Zardui GolAnbari

The effectiveness of life skills training on happiness, mental health, and marital satisfaction in wives of Iran-Iraq war veterans
DOI: 10.5742/MEWFM.2017.93038
[pdf version]
Kamal Solati

The Role of Self-Compassion Factors in Predicting the Marital Satisfaction of Staff at Kermanshah University of Medical Sciences
DOI:10.5742/MEWFM.2017.93020
[pdf version]
Parisa Janjani, Lida Haghnazari, Farahnaz Keshavarzi, Alireza Rai

Mediating role of irrational beliefs in the relationship between the quality of family communication and marital satisfaction
DOI:10.5742/MEWFM.2017.93021
[pdf version]
Parisa Janjani, Khodamorad Momeni, Alireza Rai, Mohammad Reza Saidi

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Review Article



New Methods in Treatment of Renal failure in Patients with Multiple Myeloma: A Review with Immunological Approach
DOI: 10.5742/MEWFM.2017.93022
[pdf version]
Ali Saeedi-Boroujeni, Sara Iranparast, Majid Shirani

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International Health Affairs



Congenital anomalies: Overview and a brief report on promising new research
DOI: 10.5742/MEWFM.2017.93023
[pdf version]
Lesley Pocock, Mohsen Rezaeian, Majid Asadi-Samani, Alireza Seidavi, Mansour Nazari Chafjiri

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Education and Training































Investigating the Use of Smartphones for Learning Purposes by Iranian Dental Students
DOI: 10.5742/MEWFM.2017.93024
[pdf version]
Mohammad Shooriabi, Abdolreza Gilavand

The Effect of Educational Training on Nurses' Clinical Function of Cardiopulmonary Resuscitation
DOI: 10.5742/MEWFM.2017.93025
[pdf version]
Makieh Jokari, Zahra Gorjian

Comparison of the attitude toward stigma among the staff and students and faculty at Abadan School of Medical Sciences
DOI: 10.5742/MEWFM.2017.93026
[pdf version]
Mohammad Mahboobi, Saeid Gholamzadeh, Mohammad Zarenezhad, Zeynab Namadmaliani Zadeh, Nahid Mahmoodi

The effectiveness of sexual skills training with a cognitive-behavioral approach on sexual dysfunction among infertile women
DOI: 10.5742/MEWFM.2017.93038
[pdf version]
Nasrin Jalilian, Zahra Mokari

How to prepare a poster for a scientific presentation
DOI: 10.5742/MEWFM.2017.93027
[pdf version]
Maryam Rezaeian, Mahsa Rezaeian, Mohsen Rezaeian

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Clinical Research and Methods









































Adaptive LASSO Logistic Regression applied on gene expression of prostate cancer
DOI: 10.5742/MEWFM.2017.93028
[pdf version]
Amir Hossein Hashemian, Maryam Ghobadi Asl, Soodeh Shahsavari, Mansour Rezaei,
Hadi Raeisi Shahraki

The prevalence of brain and neck injuries in patients with maxillofacial fractures in teaching hospitals of Rasht in 2016
DOI: 10.5742/MEWFM.2017.93029
[pdf version]
Seyed Mohammad Talebzadeh, Ali Khalighi Sigaroudi, Babak Alijani, Safa Motevasseli,
Saied Dashtyari, Mahsa Shariati, Zeinab Davoudmanesh

Cultural competency: a concept analysis in TUMS (Tehran University of Medical Science) DOI: 10.5742/MEWFM.2017.93030
[pdf version]
Foruzan Khatamidoost, Mandana Shirazy, Hamid Khankeh, Nemat Allah Musapour
Majid Sadeghi, Kamran Soltani Arabshahi

The Effect of Proprioceptive Neuromuscular Facilitation (PNF) on Activities of Daily Living of client with Cerebrovascular accident
DOI: 10.5742/MEWFM.2017.93031
[pdf version]
Najafi Doulatabad Shahla, Afrasiabifar Ardashir, Parandvar Yaghoub

Evaluation of the ratio of T helper 17 and T regulatory cells in patients with chronic idiopathic urticaria
DOI: 10.5742/MEWFM.2017.93032
[pdf version]
Hossein Shahriari, Farahzad Jabbari, Seyyed Abdolrahim Rezaee, Houshang Rafatpanah
Majid Jafari, Reza Farid Hosseini, Majid Asadi-Samani

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Model and System of Primary Care




The Effect of Health System Development Plan on Reduction of First Cesarean in Kohgiluyeh and Boyer Ahmad in 2016
DOI: 10.5742/MEWFM.2017.93033
[pdf version]
Hajar Shokoohi Asl, Parviz Aghaei Barzabad, Abbas Yazdanpanah

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Case Series and Case Reports








<<Iran>>
Carbamazepine-induced toxic epidermal necrolysis treated with intravenous immunoglobulin and amniotic membrane: A case report
DOI: 10.5742/MEWFM.2017.93035
[pdf version]
Mohammadreza Mobayen, Abbas Darjani, Roghayeh Aghebati , Ramyar Farzan

<<Iran>>
Right Thoracotomy Beating Heart Technique in Emergency Re-Do Mitral Valve Surgery: Is it Still Justified?
DOI: 10.5742/MEWFM.2017.93034
[pdf version]
Hassan Mir Mohammad Sadeghi


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September 2017 - Volume 15, Issue 7

Adaptive LASSO Logistic Regression applied on gene expression of prostate Cancer


Amir Hossein Hashemian (1,4)
Maryam Ghobadi Asl
(2)
Soodeh Shahsavari
(3)
Mansour Rezaei
(4)
Hadi Raeisi Shahraki
(5)

(1) Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran.
(2) Department of Biostatistics and Epidemiology, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
(3) Department of Biostatistics and Epidemiology, School paramedics, Kermanshah University of Medical Sciences, Kermanshah, Iran.
(4) Department of Biostatistics and Epidemiology, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
(5) Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

Correspondence:
Maryam Ghobadi Asl
Department of Biostatistics and Epidemiology,
School of Public Health,
Kermanshah University of Medical Sciences,
Kermanshah, Iran
Email: ghobadiasl92@gmail.com

Abstract

Introduction: The high number of prostate cancer patients has signified the importance of identifying its risk factors. The aim of the present study was to employ stratification method and penalized logistic regression with the adaptive LASSO for selecting appropriate and important genes in prostate cancer.

Materials and Methods: Microarray data used in this study include a prostate cancer gene expression dataset with [HG_U95B] Affymetrix Human Genome U95B Array platform which consisted of 12,620 genes and 167 subjects, among whom 76 subjects were unaffected and the rest were affected with cancer. Using adaptive Lasso regression, important genes in prostate cancer were stratified and the results were analyzed using ROC analysis and gene ontology annotation. To modify and conduct primary measures on the dataset, SPSS software version 22 was used. To fit the models and draw the diagrams, R software version 3.3.1 and penalty specific packages were used.

Findings: According to this research, the obtained adaptive Lasso regression accuracy and confidence interval (CI) were 0.99 and 0.97-0.99, respectively. Considering criteria such as area under the curve and gene ontology annotation, it can be argued that adaptive Lasso regression was fairly effective in stratification and selection of appropriate genes in prostate cancer.

Conclusion: Based on the results of this study, it can be said that in gene expression data, where there are both linear and large scale data, techniques such as adaptive Lasso can be useful in diagnosis of effective genes.

Key words: Regression with adaptive LASSO, Prostate cancer, Gene expression, Stratification, Gene Ontology annotation.


INTRODUCTION

Prostate cancer is the most common and most dangerous cancer among men, the fifth most common cancer worldwide, and the second most common cancer among men(1). In 2012, 1.1 million men were diagnosed with prostate cancer and 307,000 of them died(2). This cancer is the most common cancer among men in 84 countries; it mostly affects developed countries and is rising in developing countries. Recent incidence rates of prostate cancer in developed countries and developing countries are 19% and 5%, respectively(3). Autopsy studies indicated that about one-third of over 50 men have microscopic evidence of prostate cancer; however, most of these cancers are so slow growing that they never risk the lives of the affected individuals. Thus, most of men die of prostate cancer rather than other types of cancer(4).

Although prostate cancer may occur at any age, 80% of men diagnosed with this type of cancer are 65 years of age and it rarely occurs in men under 50 years. Only 2% of prostate cancer patients are <50 years of age. The average age of diagnosis of prostate cancer is 68 years and 63% of cases are diagnosed after 65. About 1 out of 9 men will be diagnosed with prostate cancer in his lifetime. In recent years, annual rate of prostate cancer has increased by 4% in the United States. Prostate cancer is responsible for 11% of deaths from cancer among American men(5, 6).
Doctors rarely know why a man develops prostate cancer and another does not, but statistical studies show a set of causes for incidence of prostate cancer in men, the most important of which are age, genetics, inflammation, infection, genetic predisposition, dietary factors,

sexually transmitted diseases, lack of vitamin D, vasectomy, smoking, fat diet, obesity, some medicines- e.g. daily use of medications such as anti-inflammatory drugs, prostate specific changes, and genome-specific changes(6, 7).

Unfortunately, most prostate cancers are asymptomatic and have no significant symptoms or problems for months or even years. In general, to identify warning symptoms for prostate cancer, we should be familiar with blood in urine, burning while urinating, slow urinary stream, urinary incontinence, urinary retention, abdominal pain, general symptoms of cancer, acute erectile dysfunction, and intense pain during intercourse. These symptoms may also be seen in benign enlargement of the prostate. The main difference between these two is that in benign enlargement of prostate, symptoms appear progressively, but prostate cancer may start quite suddenly(7).

High number of prostate cancer patients has signified the importance of identifying its risk factors. With the onset of microarray technology in 1995, measures were taken to stratify cancers based on genotypic characteristics(8). Several studies have shown that only a small subset of genes have significant association with the investigated diseases and according to cancer stratification, many genes are proved to be non-related. These genes may represent ‘noise’ to data and reduce stratification accuracy. In addition, these genes may cause more fitting to model and leave adverse effects on stratifications and due to the presence of the importance of such issues, it was necessary to introduce methods for effective gene selection given the situation and improve the accuracy of prediction. Several statistical methods have been introduced for cancer stratification among which logistic regression is regarded as a powerful method for gene differentiation; however, this method is neither appropriate nor applicable for stratification of large scale data and thus repetitive methods such as Newton-Raphson cannot be applied. Recently, penalized methods have been used for stratification of large-scale cancer data. In order to estimate coefficients of genes and select appropriate genes, Penalized Logistic Regression has been successful in stratification of large-scale cancer data(9). Therefore, the current research was conducted to employ effective stratification method and Adaptive LASSO Logistic Prognosis for selecting appropriate and important genes in prostate cancer.

MATERIAL AND METHODS

This is a cross-sectional study aimed at measuring the application of logistic regression using Adaptive LASSO in studying the association between different genes and prostate cancer. Required information were downloaded from ncbi.nlm.nih.gov website, GEO gene expression data sets. Here, a prostate cancer gene expression dataset with [HG_U95B] Affymetrix Human Genome U95B Array platform was used. A total of 167 subjects participated among whom 76 subjects were unaffected and the rest were affected. Also, 12,620 genes were analyzed. Thus, the prostate cancer gene expression dataset dimension was 12,620 x 167.

Since data obtained from the matrix of microarray technology for prostate cancer data are raw data and require pre-processing to be used, various statistical methods, called normalization, were performed to remove or minimize some of the unwanted changes brought about by biases and laboratory or technical inconsistencies. Then, they were imputed for missing values and filtering methods were used to remove large-scale data effects. Quantiles were used in this method; values less than the first quarter and larger than the third quarter were excluded. Using filtering method, the number of examined genes was reduced to 3,145. To select the most important and significant features used in stratification, the next step was to select important variables which were allowed to participate in stratification. In order to be able to identify significant genes, data scale should be reduced. PLS method was used for reducing data dimensions. PLS model was conducted because of having large scale and correlated data. PLS-DA regression was used for gene expression. Adaptive LASSO method was employed for stratification of important genes in prostate cancer. To modify and conduct primary measures on the dataset, SPSS software version 22 was used. To fit the models and draw the diagrams R software version 3.3.1 and penalty specific packages were used. Finally, the results were analyzed using ROC analysis and gene ontology annotation.

FINDINGS

PLS-DA model fitting for selecting important variables in stratification analysis
After normalization, the goal was to select important variables in stratification. Thus, according to PLS-DA model, variables with p-value <0.01 were included (n=1700) (p-value calculation for Variable Importance in the Projection index). Figure 1 shows variables’ significance based on their P-values.

Click here for
Figure 1: The importance of studied genes using PLS-DA model fitting

The Application of Lasso Adaptive Regression Model for the studied data Regularization Parameter Estimation
To find the best regularization parameter, 47 different modes are regulated for 47 Lasso adaptive regressions with estimated regularization parameter so as to find the best for the best value (Figure 2).

Click here for Figure 2: Regularization parameter estimation in 47 different modes

Then, adaptive Lasso regression model with estimated regularization parameter was carried out on the study dataset based on which the variables were stratified. Accuracy of area under the ROC curve was 0.99 (95% CI:0.97-0.99) (Figure 3).

Click here for
Figure 3: ROC curve obtained from stratification based on adaptive Lasso regression model with estimated regularization parameter

Biovalidation of data from stratification of prostate cancer gene expression data
In order to properly measure predicted models for stratification of prostrate cancer gene expression data using Gene Ontology (GO), it was determined that, based on a specific GO interpretation in different models, whether the set of genes obtained from stratification are significant or not. The most significant GO terms used to describe the identified genes at P-value<0.05 are shown. Stratification rate of the studied models were between 76 to 89% (Table 1).

Table 1: GO analysis of prostate cancer gene expression data

DISCUSSION

Medical studies in recent years, and especially after the publication of information about sequencing the human genome project, have experienced a new field that opens promising ways for researchers to identify and treat incurable diseases, such as cancer. Yet, unlike medical data collected in earlier studies where researchers have been dealing with a small number of variables, the new field of cellular and molecular Medicine is faced with a very high volume of information which is being produced by laboratory-based methods and techniques.

One of the most efficient methods to extract genetic information is microarray method which has given researchers very high potential for extracting huge volumes of information instantaneously and according to arbitrary conditions. It is one of the most controversial scientific topics in the field of computational methods, management methods, and analysis of this type of data. Given the researchers’ goal of using microarray techniques in data mining, which is understanding the function of genes in cell activities, computational methods related to this area, known as stratification methods, are also more important and one of the most important questions which have been raised on the use of these methods was to identify the method or methods with proper function of gene stratification. Adaptive Lasso regression was evaluated in different conditions.

The best value estimated for regularization parameter in 47 different modes was 3.79, with 99% accuracy and CI between 97%-99% for area under the ROC curve which was a very suitable model with more acceptable performance than other values estimated for regularization parameter. Tibshirani investigated the effect of 8 variables on prostate specific antigen using data from the prostate cancer in analysis of Lasso model performance and its comparison with least squares method and the best subset. Results showed equality of the best subset and Lasso and both introduced 3 variables as influential ones(10). He also used penalized model, for the first time in 1997, for survival analysis and variable selection in Cox model. Using Lasso method, he studied the effect of 6 variables on survival time of patients with lung cancer(11).

Li and Fan (2001) introduced 3 features for a good penalty model, i.e. unbiasedness, sparsity and continuity. As Lasso model may lead to over-estimation with big penalty coefficient, it is not unbiased in all conditions. Techniques, such as ridge regression, lack sparsity features, as well, because it has not the potential of excluding insignificant variables from the model. Also, criteria such as Akaike criterion (for variable selection) or the best subset method lack the third feature because of instability in variable selection. Yet, given these 3 features, Fan proposed a penalty function called Smoothly Clipped Absolute Deviation (SCAD). The major difference between SCAD and Lasso is that the former considers fixed penalties for coefficients bigger than a. Considering 7.3 as an optimum value for “a” resulted in SCAD method notation solely with subscript(12).

Efron et al. (2004) introduced least angle regression. Inspired by forward selection, in each step of this method, only one variable can be entered. The advantage of Least Angle Regression (LARS) is that, with a simple modification and no need for complex mathematical algorithms, all estimates may be calculated using Lasso(13).

Zou and Hastie (2005) used elastic net and blood cancer data to identify genetic factors affecting cancer and predict its types (I or II) by these genes. They used blood cancer data of 7,129 genes selected by t1000 gene statistics which had the highest significance level. Sample sizes of training data and test were 38 and 34, respectively(14).
Huang et al. (2008) compared Lasso and iterative Lasso (adaptive Lasso with reverse weight of Lasso coefficients) using breast cancer data. At first, they selected 500 genes with the largest absolute values of correlation coefficients and obtained missed values using median values. Then, Leave-one-out cross validation (LOOCV) method was used to calculate prediction error. The obtained results suggested more sparsity of the model proposed by iterative Lasso so that it selected only 22 genes while Lasso selected 42 genes with the same function(15).

Raeisi Shahraki et al. (2016) used Lasso and adaptive Lasso to identify genes affecting bladder cancer. In this study, with sample size of 48, expression of 22 different genes in peripheral blood of people with bladder cancer was compared with control group using logistic regression, Lasso, and adaptive Lasso so as to identify genes which can increase or decrease the risk of bladder cancer. The first notable point was that Lasso and adaptive Lasso methods could be fitted to data, despite high correlation between some variables, by considering all 22 variables; however, logistic regression was not able to converge even by taking one third of variables into account. By controlling the multicollinearity, adaptive Lasso method was well fitted to data and estimated coefficients with a very high accuracy and low error. The model proposed by this method was a reliable model with many other optimal features such as reliability, compatibility, predictability, sparsity, and ideal flexibility(16).

Due to massive amounts of gene expression data, which is an important characteristic of this study, results obtained from various studies showed that all the previous research has been conducted on a limited number of genes. Since 1996, introduction of microarray technology in simultaneous expression of thousands of genes revolutionized analysis of genes so as not to limit gene analysis to few number of genes. Considering that microarray knowledge is used in this study, various models are predicted and compared, final results are evaluated using ROC analysis and validation of gene ontology, and the most appropriate stratification method is carried out to identify significant genes, it is not so much similar to previous studies.

CONCLUSION

Based on the results of this study, in gene expression data, where there are both linear and large scale data, techniques such as adaptive Lasso provide higher performance in stratification aid diagnosis of effective genes.

Acknowledgment:
This research is derived from a thesis approved by deputy of research at Kermanshah University of Medical Science numbered 95072.

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11. Tibshirani R. The lasso method for variable selection in the Cox model. Statistics in medicine. 1997;16(4):385-95.
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13. Efron B, Hastie T, Johnstone I, Tibshirani R. Least angle regression. The Annals of statistics. 2004;32(2):407-99.
14. Zou H, Hastie T. Regularization and variable selection via the elastic net. Journal of the Royal Statistical Society: Series B (Statistical Methodology). 2005;67(2):301-20.
15. Huang J, Ma S, Zhang C-H. The iterated lasso for high-dimensional logistic regression. The University of Iowa, Department of Statistics and Actuarial Sciences. 2008.
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