[The Medical Informatics in Health Care of Russia].

The article considers medical informatics in relationship with medical cybernetics. The necessity of its development as an independent scientific discipline is emphasized. The input into development of public organizations is evaluated. The practical implementation is demonstrated on the example of the Unified State Information System in health care and telemedicine.

A phase I and pharmacokinetic study of oxaliplatin and bortezomib: activity, but dose-limiting neurotoxicity.

PURPOSE: The potential synergy of modulating platinum-induced DNA damage by combining the proteasome inhibitor bortezomib with oxaliplatin was studied in patients with solid tumors, with special attention to avoidance of cumulative neurotoxicity (NT). PATIENTS AND METHODS: In a 3 + 3 dose escalation design, patients received bortezomib at 1.0-1.5 mg/m² on days 1 and 4 and oxaliplatin at 60-85 mg/m² on day 1 of a 14-day cycle. NT assessments were performed at the start of every two cycles. Oxaliplatin pharmacokinetics (PK) were determined pre- and post-bortezomib. RESULTS: Thirty patients were enrolled with 25 (11 men, 14 women) fully evaluable for NT assessments at cycle 2. The median age was 56 years (range 35-74 years); median number of cycles received 2 (range 1-10). At dose levels 2-5 (B 1.3 mg/m²), patients manifested NT grades 3 and 4 at a median 3.4 cycles (range 2-9 cycles): 3 had ataxia (one also with sensory neuropathy or neurogenic hypotension, respectively) and 3 had just sensory neuropathy. A 6th dose-level reducing bortezomib to 1.0 mg/m² with oxaliplatin 85 mg/m²) was explored and no NT or dose limiting toxicities were noted among 7 evaluable patients (5 receiving two or more cycles). Four patients experienced a partial response--one with platinum-resistant ovarian cancer, another with gastroesophageal cancer, another with ampulla of Vater carcinoma, and a patient with cholangiocarcinoma. PK studies at dose levels 1 and 2 showed greater mean ultrafiltrable platinum when oxaliplatin was dosed after bortezomib. CONCLUSIONS: Bortezomib 1.0 mg/m² × 2 every 14 days combines safely with oxaliplatin. At higher doses, cumulative NT (i.e., cerebellar signs and sensory neuropathy) occurs at an accelerated pace perhaps from a PK interaction.

Telemedicine for a Children's Field Hospital in Chechnya.

In 2001, the Children's Field Hospital in the Gudermes area of the Chechen Republic was connected to a telemedical centre at the Scientific Institute of Pediatrics and Children's Surgery in Moscow, via the Russian SCA HeliosNet satellite system. An asymmetric satellite link, in which there was a high-speed downlink from the satellite to Gudermes and a low-speed uplink from Gudermes to the satellite was used. In total, 179 teleconsultations were carried out from October 2001 until February 2002, when the field hospital was closed. Of the 179 teleconsultations, 26 were real-time, by videoconference and the rest were asynchronous, by email. Almost half of consultations were carried out for emergency or urgent reasons, thus demonstrating the value of providing access to the necessary experts. The use of satellite communication allowed telemedical support for medical decisions in a wide range of disease and trauma in children and teenage in a conflict situation.

A multifunctional system of the national genetic register.

The National (Federal) Russian Genetic Register operates as a multifunctional system. It is designed for finding solution to the following key problems: 1. Information provision to watch families having children with hereditary and congenital diseases. 2. Follow up of the diagnostic process (including that associated with molecular-cytogenetic studies) and making predictive decisions concerning a risk of hereditary disease in the family. 3. Monitoring of new cases of congenital/hereditary disease under the effect of genotoxic and general toxic environmental factors. 4. Rendering consulting services to those concerned and reference information on the organizational/methodological problems. The relational database is composed of textual and graphical data. This enables the doctors to enter and review the pedigree in the form they have got accustomed to. Numerous built-in classification schemes help simplify and speed up the completion of the medical records. An additional information can be entered in the textual form. When requested by the user, the information about the patient and his (her) family, stored in the database, can be displayed as a summary document (a statement). To do so, a special algorithm based on the results of the logical information analysis, as well as medical history of the patients themselves and their families' members has been put forward. The document thus compiled is open for being edited by the doctor. The local computer network is operated in the "user-server" mode. For information protection purposes, an authorized access system has been devised to protect various data categories. The software tools operate in the Windows environment for IBM-compatible personal computers. Also, use is made of Microsoft SQL-Server, Visual Fox-Pro 3.0, Visual C+2 2.1, and FORTRAN 5.1. The doctor decision modules are activated with mathematical models, an expert system, and a self-learning recognizing system. The Windows NT system is a choice for the existing Federal and Regional Genetic Centers. For territorial consulting purposes other alternatives might be Windows for Workgroup 3.11 or Windows 95. The local computer networks in individual organizations will be integrated to form a Corporate Medical Genetics Service of Russia. The system is to be completed before the year 2000 in a number of phases. Up to now, program packages for family database management and recurrent risk calculations have been worked out and tested.