Application of data mining techniques to explore predictors of upper urinary tract damage in patients with neurogenic bladder

This study proposed a decision tree model to screen upper urinary tract damage (UUTD) for patients with neurogenic bladder (NGB). Thirty-four NGB patients with UUTD were recruited in the case group, while 78 without UUTD were included in the control group. A decision tree method, classification and regression tree (CART), was then applied to develop the model in which UUTD was used as a dependent variable and history of urinary tract infections, bladder management, conservative treatment, and urodynamic findings were used as independent variables. The urethra function factor was found to be the primary screening information of patients and treated as the root node of the tree; Pabd max (maximum abdominal pressure, >14 cmH2O), Pves max (maximum intravesical pressure, ≤89 cmH2O), and gender (female) were also variables associated with UUTD. The accuracy of the proposed model was 84.8%, and the area under curve was 0.901 (95%CI=0.844-0.958), suggesting that the decision tree model might provide a new and convenient way to screen UUTD for NGB patients in both undeveloped and developing areas.

BMP-2 and titanium particles synergistically activate osteoclast formation

A previous study showed that BMP-2 (bone morphogenetic protein-2) and wear debris can separately support osteoclast formation induced by the receptor activator of NF-κB ligand (RANKL). However, the effect of BMP-2 on wear debris-induced osteoclast formation is unclear. In this study, we show that neither titanium particles nor BMP-2 can induce osteoclast formation in RAW 264.7 mouse leukemic monocyte macrophage cells but that BMP-2 synergizes with titanium particles to enhance osteoclast formation in the presence of RANKL, and that at a low concentration, BMP-2 has an optimal effect to stimulate the size and number of multinuclear osteoclasts, expression of osteoclast genes, and resorption area. Our data also clarify that the effects caused by the increase in BMP-2 on phosphorylated SMAD levels such as c-Fos expression increased throughout the early stages of osteoclastogenesis. BMP-2 and titanium particles stimulate the expression of p-JNK, p-P38, p-IkB, and P50 compared with the titanium group. These data suggested that BMP-2 may be a crucial factor in titanium particle-mediated osteoclast formation.

Adenovirus-mediated siRNA targeting TNF-α and overexpression of bone morphogenetic protein-2 promotes early osteoblast differentiation on a cell model of Ti particle-induced inflammatory response in vitro

Wear particles are phagocytosed by macrophages and other inflammatory cells, resulting in cellular activation and release of proinflammatory factors, which cause periprosthetic osteolysis and subsequent aseptic loosening, the most common causes of total joint arthroplasty failure. During this pathological process, tumor necrosis factor-alpha (TNF-α) plays an important role in wear-particle-induced osteolysis. In this study, recombination adenovirus (Ad) vectors carrying both target genes [TNF-α small interfering RNA (TNF-α-siRNA) and bone morphogenetic protein 2 (BMP-2)] were synthesized and transfected into RAW264.7 macrophages and pro-osteoblastic MC3T3-E1 cells, respectively. The target gene BMP-2, expressed on pro-osteoblastic MC3T3-E1 cells and silenced by the TNF-α gene on cells, was treated with titanium (Ti) particles that were assessed by real-time PCR and Western blot. We showed that recombinant adenovirus (Ad-siTNFα-BMP-2) can induce osteoblast differentiation when treated with conditioned medium (CM) containing RAW264.7 macrophages challenged with a combination of Ti particles and Ad-siTNFα-BMP-2 (Ti-ad CM) assessed by alkaline phosphatase activity. The receptor activator of nuclear factor-κB ligand was downregulated in pro-osteoblastic MC3T3-E1 cells treated with Ti-ad CM in comparison with conditioned medium of RAW264.7 macrophages challenged with Ti particles (Ti CM). We suggest that Ad-siTNFα-BMP-2 induced osteoblast differentiation and inhibited osteoclastogenesis on a cell model of a Ti particle-induced inflammatory response, which may provide a novel approach for the treatment of periprosthetic osteolysis.

A Study on the Patient Location Monitoring System Based on RFID - RSSI / 대한의료정보학회지

OBJECTIVE: The location services has been an important research area in the U-Healthcare. The location services in medical environment can be implemented by Radio Frequency Identification (RFID), and Received Signal Strength Indication (RSSI) which is the location tracking method by RFID. In this study, we was designed the Patient Location Monitoring System based on RFID using RSSI method. METHODS: The RSSI method is a distance measurement method from reference points to object using the Friis's Principle and the Triangulation. The Patient Location Monitoring System was implemented by XML Data transmitted from the Positioning Server to the application. The Patient Location Monitoring System was designed by C# of Visual Studio 2005 and MS-SQL 2005 Express. RESULTS: The Patient Location Monitoring System had the location-tracking average error of 90.50cm, the standard-deviation of 13.34cm in Open-Space test. And, the designed system had the location-tracking average error of 163.24cm, the standard-deviation of 16.85cm in Closed-Space Test. Also, a patient waiting-list guide performance of the Patient Location Monitoring System had successes of 85~100%. CONCLUSION: In this study, the Patient Location Monitoring System, combined with both patient location-tracking function and patient waiting-list guide function, was validated by experiments in medical environment and this system can be applicable to patient management and further applications.

Design of Real-time Ambulance Location Monitoring System using Open API and GPS Based on Web 2.0 / 대한의료정보학회지

OBJECTIVE: The term "Open API" has been recently in use by recent trends in social media and web 2.0. It is currently a heavily sought after solution to interconnect Web sites in a more fluid user-friendly manner. We could have many benefits easily development and high efficiency. In this paper, Real-time ambulance location monitoring system including Integrated Maps was designed by using Maps Open API based on Web 2.0. METHODS: Integrated Maps were used by using Google Maps Open API and Naver Maps Open API respectively. GPS Web Browser was implemented to present integrated Maps on the designed system continuously. The development environments of the designed systems were C# and ASP.NET Platform. RESULTS: The designed systems contained three parts composed to Integrated Maps, Ambulance System, and Center Monitoring System respectively. Integrated Maps could offer Satellite, Map and Hybrid typed maps at Real-time Ambulance Location Monitoring System. CONCLUSION: Real-time Ambulance Location Monitoring System could be developed with low cost using a Open API at available emergency situations. We expect to more using Open API in medical systems.

The Transmission Performance Evaluation of Remote Healthcare Data over Secure Satellite Network / 대한의료정보학회지

OBJECTIVES: We have not only examined telemedicine scenario but also applied IPSec(AH, ESP) algorithms under VPN(Virtual Private Network) for performance evaluation of telemedicine system's security and transmission. METHODS: In this study, we applied IPSec(AH, ESP) algorithms under VPN(Virtual Private Network) protocol when transmit healthcare data through Satellite Network. At that time, we evaluated performance of telemedicine system through RTT(Round Trip Time), Jitter, Bandwidth that indicate to QoS(Quality Of Service). RESULTS: It is possible to transfer remote healthcare data over Satellite Network under provided image of 15 frame and bio-signal of 10 kbps and RTT(Round Trip Time) of 774.53ms, Jitter of 25.2ms. But applying IPsec(AH, ESP) under VPN(Virtual Private Network), it is frequently happened distortion of image data affected SHA-1 and 3DES algorithm. CONCLUSION: In this study, it is possible to use telemedicine system for Secure Satellite Network, but demand to be based QoS(Quality Of Service) limited. We expected that it is possible to use the designed system in the disaster area.

Development of a flexible chest electrode belt for continuous ECG measurement / 대한의료정보학회지

OBJECTIVE: Under ubiquitous-healthcare circumstances, interest of one's health condition has been increased. People were required the measurement of biosignal by the wearable computing technology. The purpose of this paper is to measure the portable ECG (Electro- cardiogram) with the application of wearable computing technology. Therefore, the normal ECG measurement can be measured with a chest belt either in direct contract state or loose contact state. METHODS: The belt type circuit for measuring ECG was developed. In order to remove noises in loosely contact condition, a shield circuit was assembled with the measuring electrodes. Both of High performance differential amplifiers and notch filters were incorporated into the main amplifier circuits. The ECG data was converted from analog to digital form by MCU (Micro Control Unit). The main memory was composed of a memory controller and a memory card. RESULTS: The ECG measurement having bad electrode contact to body would be usually done in daily life, so we measured the biosignal by using the loose contact potable belt for accurate ECG data. The belt can be used to measure ECG by loose contact method. CONCLUSION: In this study, we could measure ECG without any spatial-temporal restriction due to the portable belt. This device is suitable for the ubiquitous-healthcare environment.

Advanced algorithms of motion estimation for an elder at living room using Principal Component Analysis / 대한의료정보학회지

OBJECTIVE: Development of telemedicine for an elder has been an important research area in an aging society, and effective Personal Emergency Response System(PERS) can provide exact medical decision and prompt treatment under emergency conditions. Previous studies have been focused on adapting troublesome sensors or passive calling system to monitor the old in their house. However, these previous systems might have limited applications due to its difficulties in usage and restraints in their daily activities, especially in the emergency. METHODS: In this study, the real time algorithms using surveillance camera was developed to monitor their pose change, such as emergency and falling motion. To estimate the motion of elder people, this research use a ratio of eigenvectors of the Principal Component Analysis (PCA) technique. RESULTS: In this system, no additional motion sensors or devices were applied to the object and it can be automatically controlled and monitor the old from a distance. It was found that this system can successfully monitor the old in living room regardless of surveillance camera angles and a silhouette size depending camera distance as using image processing and PCA. CONCLUSION: This algorithm was validated by experiments in a living room and this technique can be applicable to home monitoring and further applications.

Transcoder based on Proxy for Transmitting Patients' Video Stream / 대한의료정보학회지

OBJECTIVE: The progress in computer and communication technologies is making the Internet increasingly heterogeneous in terms of network, hardware and software capacities. Moreover, this has made it possible for emergency telemedicine services to provide high quality medical services. However, resource availability on the Internet varies unexpectedly. Thus, providing an efficient access to emergency telemedicine services requires that medical multimedia streams be adapted according to the environment constraints. One approach to this issue is based on the use of intermediate nodes within the network to perform such adaptations (media transformations and data transcoding). For this purpose, we have designed and implemented a proxy server for Quality of Service adaptations of medical multimedia streams. METHODS: We have organized a new emergency telemedicine system by designing a proxy server to execute transcoding. The proxy server is located between a patient system and a doctor system over heterogeneous networks. Before a patient system can deliver medical video streams to a doctor system, the proxy server measures uplink bandwidth which is one of the Quality of Service factors, from the proxy server to the doctor system. At this moment, frame rates are determined according to the measured bandwidth, and the proxy server transmits medical video streams modified for new frame rates to the doctor system. We describe the implementation of this proxy server on top of the Microsoft DirectShow(R) environment and report on a performance evaluation which demonstrates the effectiveness of the approach. RESULTS: The quality of requested medical video streams can be predicted when they are adapted to the receiver. With this prediction, adapted medical video streams which meet the frame rates constraints of the receiver can be delivered without additional measurements of bandwidth. CONCLUSION: This study represents a proxy server of a hybrid multimedia telemedicine system over heterogeneous networks. We expect that the designed proxy server can provide not only dynamic Quality of Service monitoring functions along bandwidth measurement, but also medical video adaptations to the receiver in heterogeneous network environments.

Design of Hybrid Multimedia Telemedicine System over Heterogeneous Networks / 대한의료정보학회지

OBJECTIVE: The advancement of computing capabilities and increase of available network bandwidths have resulted in an emergency telemedicine services which can provide high quality medical services. However, existing telemedicine systems mainly have offered a one to one communication configuration instead of a multi-connection configuration. Therefore, we suggested a hybrid multimedia telemedicine system to support the multi-patients services in wired and wireless (heterogeneous) network environments. METHODS: We designed the hybrid multimedia telemedicine system consisting of 4 sub-systems, a patient system, a doctor system, a emergency monitoring system, and a multi-control server system. The patient system could deliver multimedia data of a patient to the emergency monitoring system or to the doctor system according to link configuration. The link configuration was decided as 'Flowing', or 'By-passing' in accordance the connection type of patient systems or doctor systems. At this time, as the multi-control server system considers the hybrid network, it monitored the patient's multimedia data and the state of emergency telemedicine services. RESULTS: The hybrid multimedia telemedicine system including the multi-control server system performed the best communication configuration over heterogeneous networks. This system achieved high quality emergency telemedicine services through dynamic wired and wireless networks at real-time. CONCLUSION: This study represented a hybrid multimedia telemedicine system over heterogeneous networks in emergency cases. We expected that the designed system could provide not only the high quality services, tele-diagnosis and tele-consultation, but also the effective emergency telemedicine services to multi-patients in the heterogeneous network environments.

Design of Wired/Wireless Integrated Medical Information Management System Based on Web Service / 대한의료정보학회지

OBJECTIVE: According to development of web service technology and mobile device supply, mobile web service becomes an essential element of ubiquitous healthcare. But there are many constraints for offering mobile web services on mobile devices. Hence, this paper propose optimal system supplying web services about medical information in wired /wireless network according to resources of device. METHODS: Proposed system consists of web server, database, desktop subscriber, mobile device and mobile context server. When a mobile device requires the web service, a mobile context server rewrites and offers the equivalent contents provided from web server to suit the requiring device's resource. Our proposed system services the same medical information after its recomposition as the network and devices of user. RESULTS: The medical staff may require patient information in wired/wireless environment, web server and mobile context server supports their correct judgment and expeditious response by servicing optimized data of the patient according to the requiring device. CONCLUSION: Proposed system designed the wired/wireless integrated medical information system using web service and mobile web service as the bases of ubiquitous healthcare system. Not only for web service in wired network, to provide the optimal web service in wireless network, we should know the limited resource of mobile devices and appropriately divide the web contents of wired network to fit the mobile device's screen. The future research needs dynamic division of screen according to extension of medical information data.

Development of Bluetooth based Integrated Home Monitoring System for the Aged / 대한의료정보학회지

The remote surveillance system based on the wireless home sensor network, wireless internet connection, and the portable, hand-held device has been designed for the patron to get the emergency alarm for immediate care for the Dementia aged, when the patron is not at home. It consists of transmitting server and the receiving terminal. The transmitting server gathers the information through bluetooth connection regarding to environment threatening the safety of the Dementia aged from five sensors, including fire, gas, conductivity, photo, and motion sensors, and cameras up to the number of 16, fixated within home. It also determines the emergency situation automatically from sensors' environmental condition and the motion detected from the camera output targeted to the aged people, and sends the alarm message with the picture taken from home to the patrol for comprehending the emergency situation remotely. Either the PDA or the cellular phone is used as the receiving terminal device through wireless connectivity without the location limitation for the patrol. The functional evaluation via the implemented prototype system has been performed to initially demonstrate the efficacy, the usefulness, and ease to operate for later use for either solitarily living old people or nursery schools and infantile shelters.

Web-based Secure Access from Multiple Patient Reservoirs / 대한의료정보학회지

OBJECTIVE: For the ubiquity of medical service, when user who has proper authority want to access medical data, user accessability should be assured. And the security of the disclosed medical data is important. This paper presents single user access interface on multiple patient reservoirs and elaborate access control using the Role-Based Access Control(RBAC) system. METHODS: Proposed system consists of 4-tier architecture that is client application, Access Control Central(ACC) agent, Local Access Control(LAC) agent and Hospital Information Systems(HIS). User requests medical data with client application. ACC notarizes user identity and controls access of user request and selectively encrypts medical data. LAC charges data conversion for communication between ACC and HIS. HIS has repositories of medical datum. System provides security service with digital certificate, X.509v3, of user. RESULTS: User requests medical data of several HIS approaching single ACC not by each HIS. Through conversion process of LAC, data that is described XML and is used for communication inter system enables information exchange with single common data format that is independent to several HIS. CONCLUSION: In the proposed system, user accesses medical datum of several HIS regardless of location and has consistent access interface. And using independent format against each HIS makes easy information exchange between several HIS. Transferred data maintains security about significant datum by selective encryption and increases encryption efficiency. Unified access control about multiple patient reservoirs that are scattered in other places provides unified and precise diagnosis of patient information. And it functions the portal of collaborate treatment in inter-HIS.

Real-time Emergency Telemedicine System: Prototype Design and Functional Evaluation

In this paper, an emergency telemedicine system was designed for the transmission of real-time multimedia for remote consultation, including radiological images, patient records, video-conferencing, full-quality video, ECG, BP, respiration, temperature, SpO2, systolic and diastolic pressures and heart rate. The standardized, modular, software-based design architecture, without resorting to external hardware compression boards, enables the low-cost implementation of the telemedicine system, using the unified, systematic and compact integration of multimedia on general personal computers. Experimental tests on local networks analyze the technical aspects of designed systems, and inter-hospital experiments demonstrate its clinical usefulness.