[EFFECTIVENESS OF CYTOFLAVIN FOR THE CORRECTION OF COGNITIVE IMPAIRMENTS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS].

Authors studied the efficacy of cytoflavin in the correction of cognitive impairment in patients with type 2 diabetes mellitus and the drug influence on the level of brain-derived neurotrophic factor (BDNF) in blood serum. The results of treatment and examination of 60 patients with type 2 diabetes diagnosis have been analyzed. The majority (49-81.6%) of patients initially exhibited light (35-71.4%) and moderate (14-28.6%) cognitive impairments. All patients received standard treatment with oral antidiabetic drugs: metformin monotherapy (26 patients or 43.3%) and combined therapy (metformin + gliclazide, 34 patients or 56.6%). In addition, 30 patients (main group) received a complex metabolic drug cytoflavin daily intravenously (10 mL in 200 mL of 0.9% sodium chloride) for 10 days with transition to the tablet form in a dose of 2 tablets (with 0.6 succinic acid, 0.1 riboxin, 0:05 nicotinamide, 0.01 riboflavin) two times a day for 25 days. The control group (n = 30) consisted of patients who received only basic hypoglycemic therapy. The inclusion of cytoflavin in the scheme of complex treatment of patients with type 2 diabetes ensured a more effective correction of cognitive impairments as compared to the group receiving basic therapy. This is confirmed by the results of neuropsychological testing (MoCA test) and improved optical and spatial activity, attention, abstract thinking, and memory on the average by 14.2% compared to the value before treatment (p < 0.01) in patients of standard treatment group. Patients in the control group showed positive dynamics of same parameters amounted on the average to 7.9%. The study of BDNF in the blood serum showed a significant increase in this index over time in patients who have received cytoflavin (from 1475.13 + 421.26 pg/ml to 1839.44 + 494.78 pg/mL, p < 0.01) in contrast to the control group (1625.41 + 322.53 pg/mL to 1592.04 + 373.47 pg/mL) and revealed positive correlation between the MoCA test and BDNF level in the blood serum for optico-spatial activity (r = 0.589, p < 0.01), naming (animals) (r = 0.346, p < 0.01), attention (r = 0.401, p < 0.01), memory (r=0.595, p< 0.01) and total rating in the test (r = 0.708, p < 0.01). In addition, a negative correlation was revealed between the level of carbohydrate metabolism (HbA1c) and BDNF levels in the blood serum (r = -0.494, p < 0.01) in both groups.

An automated results notification system for PACS.

The purpose of this study was to determine if the interval between an examination being ordered by an Emergency Department physician and his or her review of the report and images could be shortened by notifying the physician that the results were available. This hypothesis was based on work done previously in the Medical Intensive Care Unit that showed that physicians would wait to review results for a time considerably longer than the time required for the radiologist to review the images and provide a preliminary report. The software developments operate properly and show that even simple integration of multiple information systems (PACS, RIS, speech recognition) can provide useful features. Early results indicate that the Emergency Department (ED) physicians prefer the notification system over the previous (travel to check on images and reports) methods. The hypothesized time reductions did occur, although it is not clear that the notification system accounted for all of them. A system for automated notification of radiology results availability has been shown to be possible and practical. To do this automated interaction of 3 systems with a low-level or no electronic integration was required. Although not fully successful for this study, early physician response has been positive, and requests to expand this service hospitalwide now are common.

Prospective study of a PACS: information flow and clinical action in a medical intensive care unit.

PURPOSE: To prospectively compare efficiency and outcome of a standard film-only system with those of a digital picture archiving and communication system (PACS). MATERIALS AND METHODS: The film-only system, which used either analog film or computed radiography (CR) hard copy, was compared with a PACS, which used CR images displayed on a multiviewer in the radiology department and a workstation in the medical intensive care unit. A random sample of nonroutine, bedside chest radiographs was studied. RESULTS: Within 20 minutes of completion of radiography, 246 of 328 (75%) of the images were available at the workstations; it took 1.8 hours for 238 of 317 (75%) of the images to be displayed on the multiviewer. When the workstation was used, the staff did not access the image information earlier, but clinical actions were initiated more promptly in response to imaging findings. Consultation with radiologists decreased from 507 of 561 (90%) images with hard copies to 70 of 249 (28%) with the workstation. CONCLUSION: Use of a PACS improves the delivery of chest images, facilitates the initiation of clinical actions, and decreases input by radiologists.

Factors affecting the electronic communication of radiological information to an intensive-care unit.

In order to examine communication of radiological information under circumstances where rapid exchange of information was essential, we studied communication of non-routine portable chest radiographs to an intensive-care unit (ICU). Images and reports were available through the usual communication channels and through a PACS workstation in the ICU. Data were obtained to determine how quickly and by what means ICU physicians first viewed images and received radiologists' reports of chest radiographs. Peak information demand occurred within 4 h of the examination. The most rapid means of communication was for the physician to visit the radiology department. Image viewing and report receipt were tightly coupled, usually for images which were first viewed as hard copy. PACS performance suffered from unreliable film digitization and delayed report transcription. Integration of computed radiography and digital dictation into a PACS could markedly reduce the delays in ICU physicians' access to radiological information.

A methodology for the economic assessment of picture archiving and communication systems.

Most economic studies of picture archiving and communication systems (PACS) to date, including our own, have focused on the perspectives of the radiology department and its direct costs. However, many researchers have suggested additional cost savings that may accrue to the medical center as a whole through increased operational capacity, fewer lost images, rapid simultaneous access to images, and other decreases in resource utilization. We describe here an economic analysis framework we have developed to estimate these potential additional savings. Our framework is comprised of two parallel measurement methods. The first method estimates the cost of care actually delivered through online capture of charge entries from the hospital's billing computer and from the clinical practices' billing database. Multiple regression analyses will be used to model cost of care, length of stay, and other estimates of resource utilization. The second method is the observational measurement of actual resource utilization, such as technologist time, frequency and duration of film searches, and equipment utilization rates. The costs associated with changes in resource use will be estimated using wage rates and other standard economic methods. Our working hypothesis is that after controlling for the underlying clinical and demographic differences among patients, patients imaged using a PACS will have shorter lengths of stay, shorter exam performance times, and decreased costs of care. We expect the results of our analysis to explain and resolve some of the conflicting views of the cost-effectiveness of PACS.

Stimulation of penetrating corneal wound healing by exogenous fibronectin.

The paper describes the effect of exogenous fibronectin administered by instillation on the repair of the rabbit cornea after experimental mechanical injury. The effect was monitored by light microscopy and radioautography. Fibronectin had a beneficial effect on regenerating corneal epithelium, endothelium and keratocytes through a stimulatory effect on cell migration, proliferation and differentiation.

[Effects of fibronectin instillation on reparative regeneration of the corneal tissue (an experimental study)]. / Vliianie instilliatsii fibronektina na reparativnuiu regeneratsiiu rogovichnoi tkani (éksperimental'noe issledovanie).

Comprehensive morphologic studies (including light microscopy, morphometry, autoradiography) of experimental rabbits have revealed a stimulating effect of fibronectin instillations on healing of central penetrating wounds of the cornea. A polypotent mechanism of the stimulating effect of fibronectin instillations during all the stages of the reparative process in the corneal tissue was proved.

[A new enriched balanced irrigation solution for intraocular surgery (experimental study)]. / Novyi obogashchennyi sbalansirovannyi irrigatsionnyi rastvor dlia vnutriglaznoi khirurgii (éksperimental'noe issledovanie).

Experimental trials of a new intraocular irrigation solution, one of the enriched balanced salines, were carried out. A comprehensive morphologic study has revealed the protector characteristics of lactosol plus (lactosol + taurin) used in the management of irrigation injury to the posterior epithelium of the cornea in the course of experimental intrachamber perfusion. The protective properties of lactosol + taurin, a new enriched balanced saline, are explained by the similarity of its chemical composition to that of the intraocular fluid and by the presence of a stable polyfunctional bioprotector, taurin amino acid.

The diagnosis of pulmonary nodules: comparison between standard and inverse digitized images and conventional chest radiographs.

We compared plain chest radiographs, standard (bones white) digitized images, and inverse-intensity (bones black) images to determine their ability to identify pathologically confirmed malignant pulmonary nodules. The images were digitized by using a photo-optical laser scanner and were displayed on a 1024 x 1024 x 8 bit system capable of operator-controlled magnification (2x or 4x) and nonlinear (logarithmic/exponential) contrast transformation in both standard and inverse-intensity modes. Receiver-operator curve analysis was used to study the detection performance of six observers who viewed 40 images obtained in 15 normal subjects and 25 abnormal subjects. There was no statistically significant difference in the area under the ROC curve between the standard digital images and the plain chest radiographs. However, ROC areas were significantly greater (p less than or equal to .05) for inverse-intensity digital images when compared with either standard-intensity digital images or plain chest radiographs. These results suggest that inverse-intensity images may have some advantages in the detection of pulmonary nodules.

Portal radiographs: digital enhancement of contrast.

The quality of low-contrast portal radiographs for radiation therapy can be improved with electronic contrast enhancement. After the image is copied digitally with a laser scanner microdensitometer into 4,096 gray-scale levels (12 bits) and 1,686 X 2,048 pixels, a special software package permits linear, logarithmic, exponential, or sigmoid transformations of the optical density. The precise representation of the portal image can then be interactively adjusted to emphasize the desired anatomy. Clinical examples demonstrate the value of the digital enhancement approach.

Effect of a digital imaging network on physician behavior in an intensive care unit.

This study examined the effect of a medical image management network on the behavior of physicians working in a medial intensive care unit (MICU). For 1 year, 8-week periods during which chest radiographs were digitized and made available to MICU physicians on a digital display console were alternated with 8-week periods during which only film images were available. Clinical efficacy during the periods was compared by measuring the time between completion of imaging examinations and initiation of specific clinical actions such as placement and positioning of tubes. Results indicate that the time required to take some clinical actions decreased with the immediate availability of images on the digital display console. Established procedures for obtaining radiologic information were altered by the digital imaging network. The time at which physicians viewed images changed, and consultations between MICU staff and radiologists decreased. These results indicate that behavior patterns are altered when a new technology replaces an existing one. Optimal use of this technology may require changes in the logistics of clinical practice.

Design of a medical image management system: a practical cost-effective approach.

The impact of technology and economics is driving radiology departments into a digital era. There have been significant developments in the design of Medical Image Management System components. However, many important design criteria have been neglected, leading to an ineffective end product. This paper will discuss the more important design criteria. The design will be considered from the user's point of view. The implementation of a prototype Medical Image Management System (MIMS) serving a Medical Intensive Care Unit in our Institution will be presented. The structure and very preliminary results of a clinical evaluation will be discussed. Plans to expand the MIMS beyond the Department and the Hospital will also be briefly discussed. The role of the personal computer in the design of a MIMS will be reviewed.

[Cataract induction by products of lipid peroxidation]. / Induktsiia katarakty produktami perekisnogo okisleniia lipidov.

Liposome suspension prepared from the unsaturated phospholipids exposed to lipid peroxidation (LPO) induced posterior subcapsular cataracts after injection into the posterior vitreous of rabbit eyes. In the background of this model lies a type of lens opacity formed during retinal degeneration when toxic peroxide substances diffuse anteriorly through the vitreous body resulting in vitreous opacities and complicated cataracts. Saturated liposomes (prepared from beta-oleoyl-gamma-palmitoyl) L-alpha-lecithin) did not induce lens opacities, which is the evidence that a lipid peroxidation mechanism may be responsible for the posterior cataracts. Along with cataract formation accumulation of LPO fluorescent products in vitreous, aqueous humor and lens was observed. It was followed by a decreased level of reduced glutathione in the lens. The obtained results strongly support the hypothesis of LPO initial role in cataracts.