Biomechanical Study on Contiguous Three-Level Cervical Hybrid Surgery and Anterior Cervical Discectomy and Fusion / 医用生物力学

Objective To compare the biomechanical effects of contiguous three-level cervical Hybrid surgery[anterior cervical discectomy and fusion (ACDF) + cervical disc arthroplasty ( CDA)] and three-level ACDF. Methods The finite element model of C1-T1 cervical-thoracic spine was developed based on CT data. Three models were simulated by the implantation of Prestige LP and Zero-P prostheses, including two Hybrid models (AFA, Prestige LP implanted at C3-4 and C5-6 segments and Zero-P implanted at C4-5 segment; FAF, Zero-P implanted at C3-4 and C5-6 segments and Prestige LP implanted at C4-5 segment) and three-level ACDF model(FFF). The changes in range of motion (ROM) of adjacent levels during flexion, extension, lateral bending and axial rotation, the overall ROM, as well as the intradiscal pressure ( IDP) and facet contact force ( FCF) of adjacent levels were compared. Results The ROM in adjacent levels and the overall ROM of the AFA modelwere closer to the intact model, and the maximum increases in the ROM of the adjacent levels for the FAF and FFF models were 15. 0% and 23. 4% , respectively. For AFA, FAF and FFF models, the maximum increases in the maximum IDP of adjacent levels were 19. 0% , 66. 7% , 147. 6% , and the maximum increases in FCF were 17. 4% , 55. 7% , 80. 1% , respectively. Conclusions This study provides biomechanical basis for three-level cervical Hybrid surgery in treating patients with the contiguous three-level cervical degenerative disc disease.

Effects of CDA-G208A gene polymorphism on the efficacy of gemcitabine in the first-line treatment of lung squamous cell carcinoma / 中国临床药理学与治疗学

AIM: To investigate the effect of CDAG208A gene polymorphism on the efficacy and safety of gemcitabine in the first-line treatment of lung squamous cell carcinoma. METHODS: Sixty-five first-line treated patients with locally advanced or metastatic lung squamous cell carcinoma in The First Affiliated Hospital of Wannan Medical College hospital were screened. Group A included 31 patients tested with the GG (wild homozygous) CDAG208A gene, and group B included 34 patients without testing. All patients received gemcitabine plus platinum chemotherapy for at least 2 cycles. The efficacy and safety were evaluated following the RECIST 1.1 standard and the NCI-CTC 5.0 standard, respectively. The primary study endpoint was progression-free survival (PFS), overall survival (OS) and the secondary study endpoints included objective effective rate (ORR), disease control rate (DCR), adverse reactions, and influencing factors of PFS. RESULTS: The results showed that the DCR was 74.5% and 50% in group A and group B, respectively (P=0.045); mPFS was 6.1 months and 5.0 months in group A and group B, respectively (P=0.034); and the mOS was 13.3 months and 12.0 months in group A and group B, respectively, and there was no statistical difference (P=0.388). The number of cases of grade III-IV neutropenia in group A and group B was 2 and 10, respectively (P=0.017); grade III-IV neutropenia was an independent prognostic factor affecting patients with PFS (P=0.045); the group with unknown G208A gene status was more likely to develop grade III-IV neutrophils (P= 0.029). The AUC of CDA-G208A gene predicting neutropenia caused by gemcitabine chemotherapy was 0.756. CONCLUSION: Non-GG type of CDAG208A gene can reduce the metabolic rate of gemcitabine in the body and cause neutropenia after chemotherapy. In severe cases, it can indirectly reduce the clinical efficacy of gemcitabine. The detection of CDA-G208A gene status before treatment can predict the neutropenia caused by gemcitabine chemotherapy.

Propuesta de nuevas funcionalidades para la gestión de la Historia Clínica Electrónica en el sistema XAVIA HIS / New features proposal to the Electronic Health Record management in the XAVIA HIS system

La digitalización de la historia clínica, documento indispensable en la atención de salud y que posee carácter legal, es uno de los focos de atención en la e-Salud. El sistema XAVIA HIS compuesto por módulos que informatizan los procesos e interconectan las diferentes áreas de una institución hospitalaria, posee como atributo fundamental, una historia clínica electrónica única por paciente. Esta se compone por documentos basados en el estándar HL7-CDA. Sin embargo, el sistema XAVIA HIS presenta algunas limitantes en la interacción con otras aplicaciones que gestionen la información de salud. En el trabajo se presentan las modificaciones a realizar al Sistema de Información Hospitalaria XAVIA HIS para mejorar la capacidad de gestión de las historias clínicas electrónicas del sistema. Se realizó un análisis de la literatura disponible sobre la gestión de las HCE y se evaluó el mecanismo que emplean sistemas homólogos nacionales e internacionales. Para guiar el desarrollo de la propuesta se empleó la metodología AUP-UCI; UML se empleó para el modelado de los artefactos de ingeniería y BPMN como lenguaje de notación para los procesos de negocio. Las modificaciones que se presentan, le permitirán al sistema XAVIA HIS interactuar con sistemas externos que generen documentos HL7-CDA. Adicionalmente, se añaden funcionalidades para mejorar la impresión de documentos clínicos que se exportan, así como la generación de resúmenes de la historia clínica(AU)

One of the e-Health approaches is the digitalization of the medical record, an essential document in health care and with a legal character. The XAVIA HIS system, made up of modules to manage the processes and interconnect the different areas of a hospital institution, has as a fundamental attribute, a unique electronic medical record per patient. It is made up of documents based on the HL7-CDA standard. However, the XAVIA HIS system presents some limitations to interaction with other applications also managing health information. This paper presents the new features and changes to be made to the Hospital Information System XAVIA HIS to improve the electronic medical records management of the mentioned system. An analysis of the available literature on EHR management was carried out and the mechanism used by national and international counterpart systems was evaluated. To guide the development of the proposal, the AUP-UCI methodology was used; UML was used for modeling the engineering artifacts and BPMN as a notation language for business processes. The modifications that are presented will allow the XAVIA HIS system to interact with external systems which also generate HL7-CDA documents. Additionally, functionalities are added to improve the printing of clinical documents that are exported, as well as the generation of summaries of the medical record(AU)

Agreements in clinical studies at German university clinics

The article aims to give an overview of the contractual situation in Germany, which arise in clinical studies. The goal of the authors is to show any potential sponsor of a clinical study, who is interested in cooperation with German partners such as universities or other study sites, what kind of agreements may be expected and to give a brief overview about necessary themes included within the contractual negotiations. The different contractual settings are considered from the perspective each different type of agreement. The authors have chosen amongst all possible types the ones which are the most common in a clinical study, such as CDA, MTA, grant agreement, clinical study agreement, CRO-service agreement etc. The authors show the complexity of the contractual setting of a clinical study and emphasize to pay close attention to the contractual settings. Even though the content of the agreement is mostly universal in nature, in some cases, Germany has some very special rules (e.g. regarding employees’ inventions), which any potential sponsor should keep in mind.

Congenital Dyserythropoietic Anaemia Type II: A Rare Blood Disorder in a Nigerian Child

The congenital dyserythropoietic anaemias (CDA) are a rare group of inherited haematological disorders characterized by congenital anaemia, ineffective erythropoiesis in the bone marrow and dysplasia in developing erythroblasts. In Africa where sickle cell anaemia and thalassaemias are common, diagnosis of CDA may be missed. We report a six year old girl who presented in anaemic heart failure with a haemoglobin concentration of 5.1g/dL and a history of recurrent anaemia of two years duration which required multiple blood transfusions. Peripheral blood film features showed red cell anisopoikilocytosis with occasional nucleated red cells- some of which were multinucleated. Her haemoglobin genotype was AA. Bone marrow aspiration revealed a markedly hypercellular marrow with severe erythroid hyperplasia and dyserythropoiesis. Her serum ferritin was also markedly elevated. Based on the clinical, laboratory and characteristic bone marrow findings, a diagnosis of CDA type II was made. She was transfused and placed on iron chelation therapy. Her parents were counseled on treatment options and she is currently on follow up.

Ethnic differences in allele, genotype distributions and lung cancer risk of polymorphisms of gemcitabine metabolic pathway genes in south Indian population

Background: Gemcitabine is a widely used cytotoxic drug in the treatment of a number of solid tumors, for instance, lung, pancreatic as well as breast cancer. As a consequence of the progressive genomic instability, the efficiency rates have eventually lowered. Genetic approach targeting one or several genes in drug targeting pathways facilitates substantially more valuable details in explaining the association between variants and also the efficacy of gemcitabine therapy. In addition, several researchers have reported ethnic discrepancies in clinical response to gemcitabine. Thus, the present study was aimed to establish the normative frequencies of genes associated with the metabolic pathway of Gemcitabine (RRM1 -37C>A (rs12806698), RRM1 -524T>C (rs11030918), CDA 79A>C (rs2072671) and CDA 435 C>T (rs1048977) in South Indian healthy population and compared with 1000 genome population. Additionally, the association of these SNPs with the risk of developing lung cancer was also evaluated.Methods: This study was carried out on 184 healthy subjects and 123 lung cancer patients of South Indian origin and genotyping was done using RT-PCR (Real Time Polymerase Chain Reaction). The frequencies of the above polymorphisms were in Hardy-Weinberg equilibrium (p >0 .05).Results: The minor allele frequencies of the SNPs RRM1 -37C>A (rs12806698), RRM1 -524T>C (rs11030918), CDA 79A>C (rs2072671) and CDA -435 C>T (rs1048977) were 31.3, 36.7, 24.5 and 22.0 respectively.Conclusions: There was a significant difference observed between the genotype and allele frequencies of south Indians with the 1000 genome populations. We also found that SNPs of RRM1 were significantly associated with lung cancer risk.

Toma de decisiones inteligente a partir de registros médicos almacenados en CDA-HL7 / Intelligent decision-making from medical records stored on the CDA-HL7

Debido al incremento exponencial de la información almacenada en las organizaciones, la Sociedad de la Información está siendo superada por la necesidad de nuevos métodos capaces de procesar la información y asegurar su uso productivo. Esto se hace lógicamente extensible a los centros hospitalarios, a partir del uso extendido de las Historias Clínicas en formato electrónico. Disponer de información sistematizada, gestionarla de forma eficiente y segura es esencial para garantizar mejores prácticas en salud. A esto se le añade la necesidad de soportar estándares que permitan el intercambio entre las instituciones de salud; específicamente HL7 se ha convertido en uno de los más utilizados debido a que proporciona el intercambio a partir del metalenguaje XML. En este trabajo se propone una metodología para el descubrimiento de conocimiento implícito en Historias Clínicas en formato semi-estructurado utilizando el contenido y la estructura de los mismos. Los principales resultados son: (1) La metodología para el agrupamiento de Historias Clínicas; (2) La interpretación de los resultados del agrupamiento para asistir la toma de decisiones diagnósticas; (3) La implementación del estándar HL7, para la manipulación de documentos médicos a partir de CDA(AU)

Due to the exponential increase of stored information the organizations, the information society is being overtaken by the need for new methods capable of processing information and ensuring its productive use. This is logically extended to the hospitals, from the widespread use of clinical histories in electronic format. To have systematized information, manage it efficiently and securely is essential to ensure better health practices. In addition, there is the need for standards to support the exchange among health institutions; specifically hl7 has become one of the most widely used because it provides the exchange from xml. In this paper is presented a methodology for the discovery of implicit knowledge in medical records with semi-structured format, using their content and structure. The main results are: (1) the methodology for the clustering of medical records; (2) the interpretation of the results of the clustering to assist diagnostic decision-making; (3) the implementation of the hl7 standard for handling medical records from CDA(AU)

A variation of superficial palmar arch formed alone by ulnar artery: a case report.

Superficial palmar arterial arch is an arterial arcade, which is a dominant vascular structure of the palm. It is defined as the anastomoses between the superficial branch of the ulnar artery and the superficial palmar branch of the radial artery. The superficial palmar arch completed by anastomosing with one of the branches of radial artery, i.e. with arteria radialis indicis, arteria princeps pollicis, arteria nervi mediana. The present study reporting a variation of superficial palmar arch which is formed alone by superficial branch of ulnar artery and it is also giving branches to radial side of index finger and to the thumb. Normally the branch to the radial side of index finger receives branch from superficial terminal branch of radial artery and it is known as arteria radiclis indicis. The ARI was given by ulnar artery from the terminal part of radial side along with the princeps pollicis branch. The knowledge of variations of the vascular arches warrants the surgeons while performing surgeries on hands, such as arterial repairs, vascular graft applications.

Implementación de estándares DICOM SR y HL7 CDA para la creación y edición de informes de estudios imagenológicos / Implementation of DICOM SR and HL7 CDA standards for the creation and edition of digital imaging reports

La aparición de nuevas tecnologías de la información, así como estándares y acuerdos, permite la interoperabilidad entre aplicaciones de sistemas de salud en distintas partes del mundo. El presente artículo introduce un estudio que pretende facilitar el uso de estándares y tecnologías disponibles hacia el sector salud, especialmente hacia instituciones hospitalarias. El trabajo parte del uso de los estándares HL7 CDA y DICOM SR para la edición de informes de estudios imagenológicos, debido a que la emisión de estos informes constituye una de las actividades fundamentales de los departamentos de diagnósticos por imágenes. Se describen las principales funcionalidades y características, como base para un sistema informático capaz de adaptarse a los distintos ambientes y escenarios, permitiendo agilizar y estandarizar el proceso que se informatiza. Con la implementación de estos estándares se lograrían sistemas con fuertes características de estandarización, generalidad, flexibilidad, accesibilidad, bajo costo de implementación, bajas necesidades en infraestructura, perdurables en el tiempo e independientes al cambio de la tecnología(AU)

As new information technologies, standards and agreements appear, it has been possible to increase the interoperability among applications in health care systems in the world. This article shows a study that aims to facilitate the use of standards and technologies that are available to the health care field, mainly in hospitals. The work is focused on the usage of HL7 CDA and DICOM SR standards to the edition of reports from imaging studies, because the issuance of these reports is one of the core activities at the departments of imaging diagnostics. The paper describes the main functionalities and features as a basis for a computer system capable of adapt to different environments and scenarios, allowing streamline and standardize the process to be computerized. With the implementation of these standards, highly standardized systems would be achieved, and also features as generality, flexibility, accessibility, low implementation cost, low infrastructure needs, long-lasting and independence of technology change(AU)

Research on the development of EMR-based hospital information resource management platform / 中华医院管理杂志

The regional medical information system calls for regional information resources and hospital-level information resources be interconnected and intercommunicated.To meet this requirement,a HL7 CDA-based solution was proposed based on analysis of the current hospital information resources management.An information resources service portal was built to harmonize the management of both new and old resources,and the hierarchy management based on information granularity.The technical implementation of the system is compliant with the SOA architecture and health information standards.This ensures the interconnection and intercommunication between inner information and outer one,and uses information resources in an efficient,reasonable and safe manner.

Implementation of Medical Information Exchange System Based on EHR Standard / 대한의료정보학회지

OBJECTIVES: To develop effective ways of sharing patients' medical information, we developed a new medical information exchange system (MIES) based on a registry server, which enabled us to exchange different types of data generated by various systems. METHODS: To assure that patient's medical information can be effectively exchanged under different system environments, we adopted the standardized data transfer methods and terminologies suggested by the Center for Interoperable Electronic Healthcare Record (CIEHR) of Korea in order to guarantee interoperability. Regarding information security, MIES followed the security guidelines suggested by the CIEHR of Korea. This study aimed to develop essential security systems for the implementation of online services, such as encryption of communication, server security, database security, protection against hacking, contents, and network security. RESULTS: The registry server managed information exchange as well as the registration information of the clinical document architecture (CDA) documents, and the CDA Transfer Server was used to locate and transmit the proper CDA document from the relevant repository. The CDA viewer showed the CDA documents via connection with the information systems of related hospitals. CONCLUSIONS: This research chooses transfer items and defines document standards that follow CDA standards, such that exchange of CDA documents between different systems became possible through ebXML. The proposed MIES was designed as an independent central registry server model in order to guarantee the essential security of patients' medical information.

CDA Compression via Automatic Type Inference / 대한의료정보학회지

OBJECTIVE: CDA is a standard for the exchange and sharing of clinical documents among all entities in the healthcare domain. As it proliferates, the number of CDA documents will increase exponentially and it will require huge storage spaces to store them. The main goal of this study is to devise an efficient compression method optimized for CDA documents so that the storage requirement can be lowered. METHODS: The method proposed in this paper is based on a compression method called Xmill which has been designed specifically for XML documents at large, which requires human intervention for the effective compression, especially, of CDA. Our proposed method, CDACOM, automatically extracts type information from CDA documents to infer the data type, assigns data values of the same type to the same data container, and applies an optimized encoder to the container so that a better compression rate can be achieved. RESULTS: Experiments with various types of CDA documents were performed to evaluate the effectiveness of CDACOM over Xmill. The results show that CDACOM indeed outperforms Xmill and can decrease the output file size by about 24.1% on average, compared to Xmill. If documents are combined and compressed together, the gap gets even bigger to about 50%. CONCLUSION: The proposed compression method, CDACOM, is very effective and promising. It will help lowering the cost for systems to transmit and store CDA documents and, hence, expediting the adoption of the standard in the healthcare domain.

Effects of uroacitides on proliferation ability of breast cancer cells / 中国临床药理学与治疗学

AIM: To investigate the growth inhibition effects of CDA-II on breast cancer cells. METHODS: The effects of CDA-II on growth curve and morphology of breast carcinoma cell lines MCF-7 and MDA-MB-231 were observed in vitro cultures. RESULTS: CDA-II reduced the growth speed and proliferation ability. CONCLUSION: CDA-II has remarkable effects on anti-cell-proliferation and shows good prospects of application in the treatment of patients with breast carcinoma.

Effect of uroacitides on the expression of cyclin D1 of breast cancer cells / 解放军医学杂志

Objective To investigate the effect of CDA-Ⅱ on t he expression of cyclin D1 of breast cancer cells. Methods The br east carcinoma cell lines MCF-7 and MDA-MB-231 were cultured in vitro tog ether with CDA-Ⅱ, with retinoic acid as positive control, and the effect of CD A-Ⅱ on the growth curve as well as the expression of cyclin D1 of breast carci noma cell lines was observed. Results CDA-Ⅱ may reduce the gr owth of MCF-7 and MDA-MB-231, cripple their proliferative ability and inhibit the cyclin D1 expression of breast cancer cell lines. Conclusion CDA-Ⅱ may inhibit the growth and proliferation of MCF-7 and MDA-MB-231, reduce the expression of breast carcinoma cell cyclin D1, hence showed a good a pplied prospect for the treatment of breast carcinoma.

A 2-year clinical evaluation of Sculpture crowns / 대한치과보철학회지

STATEMENT OF PROBLEMS: There are only a few studies available that deal with the clinical behavior of ceromer systems as potential substitutes for metal-ceramic crowns. PURPOSE: This prospective study was initiated to evaluate the clinical performance of 35 Sculpture crowns after 2 years in service. MATERIAL AND METHODS: Thirty five Sculpture crowns were placed for 20 patients (7 men and 13 women). All patients were treated by the same dentist, and all restorations were fabricated by the same dental laboratory. Crown placement involved both the anterior and posterior regions of the dental arches. Patients were evaluated by two examiner at baseline, 12, and 24 months using the CDA quality assessment system in addition to periodontal criteria. RESULTS: Of 34 crowns remaining in the study after 2 years, only one crown had experienced a marginal fracture. The crown was replaced as a result of recurrent caries. All remaining crowns were ranked as either excellent or acceptable for surface and color, anatomic form, and marginal integrity. CONCLUSION: The 2-year clinical observations and ranking with the CDA quality assessment criteria supported the conclusion that Sculpture crowns may be used in substitutes for metal- ceramic crowns.

Querying and Searching of XML Electronic Medical Records / 医疗卫生装备

Objective To implement XML-based electronic medical records' searching and querying using new technology of XML storing and indexing.Methods The information in electronic records was expressed with CDA XML standard,and XML Query and XML IR were used for querying of electronic records.Results Based on XML querying and indexing models,a new electronic medical record XML querying and searching system was built.Conclusion Querying and searching over XML database has been paid more attention to,with wide use of data adapting to HL7 CDA XML standard in electronic medical records.