ReportFlow: an application for EEG visualization and reporting using cloud platform.

BACKGROUND: The cloud is a promising resource for data sharing and computing. It can optimize several legacy processes involving different units of a company or more companies. Recently, cloud technology applications are spreading out in the healthcare setting as well, allowing to cut down costs for physical infrastructures and staff movements. In a public environment the main challenge is to guarantee the patients' data protection. We describe a cloud-based system, named ReportFlow, developed with the aim to improve the process of reporting and delivering electroencephalograms. METHODS: We illustrate the functioning of this application through a use-case scenario occurring in an Italian hospital, and describe the corresponding key encryption and key management used for data security guarantee. We used the X2 test or the unpaired Student t test to perform pre-post comparisons of some indexes, in order to evaluate significant changes after the application of ReportFlow. RESULTS: The results obtained through the use of ReportFlow show a reduction of the time for exam reporting (t = 19.94; p < 0.001) and for its delivering (t = 14.95; p < 0.001), as well as an increase of the number of neurophysiologic examinations performed (about 20%), guaranteeing data integrity and security. Moreover, 68% of exam reports were delivered completely digitally. CONCLUSIONS: The application resulted to be an optimal solution to optimize the legacy process adopted in this scenario. The comparative pre-post analysis showed promising preliminary results of performance. Future directions will be the creation and release of certificates automatically.

Alleles and haplotypes of tumor necrosis factor (TNF) alpha and beta genes in three ethnic populations of Sulawesi Indonesia.

Polymorphic variation in two cytokine genes, tumor necrosis factor (TNF) -alpha and -beta, was examined in three ethnic groups, the Bugis, the Makassans, and the Torajans, who inhabit Sulawesi, a large island in the Indonesian archipelago, and formerly a Dutch colony. TNF-alpha and -beta are key molecules in immune responses to infection, and both have been implicated in the pathogenesis and clinical manifestations of parasitic diseases. Several polymorphic variants with the potential to affect cytokine levels in autoimmune diseases and parasitic and bacterial infection have been reported. Two loci in the promoter region of TNF-alpha and two sites in the first intron of TNF-beta were scored in a maximum of 150 Bugis, 168 Makassans, and 58 Torajans. Genotypes at the two TNF-alpha loci are not in Hardy-Weinberg equilibrium because of a deficit of heterozygotes (p < 0.05). However, genotypes at the TNF-beta loci exhibit Hardy-Weinberg equilibrium. A comparison of allelic and genotypic frequencies at all TNF loci across the ethnic groups reveals that the differences are significant for TNFalpha(308) (p < 0.01) and for TNFbeta(NcoI) (p < 0.05). Overall, the distribution of the alleles differs from that seen in the few Asian populations for which data are available (p < 0.05). Construction of 4-locus haplotypes showed that, in addition to the five previously reported, four novel haplotypes were present in Sulawesi. These novel haplotypes were in low frequency, and two were seen only in Bugis (haplotypes F and J) and one (haplotype K) only in Makassans. The other, haplotype D, was present in Makassans and Torajans. Preliminary sampling of other ethnic groups suggests that three of these haplotypes (D, F, and J) may be restricted to Asian or Asian-derived populations. The frequency of the common TNF haplotypes differed between Dutch and Sulawesi populations, and these data also indicated that haplotype E, which has a relatively high frequency in the Dutch (25%), may be a useful marker of Dutch/European admixture in Indonesian populations, in which it is either rare (1%) or absent. The results suggest that unique allelic combinations with potential to influence cytokine secretion are present in Sulawesi, possibly as a consequence of parasite-driven selection, and argue for more extensive investigation of haplotype distribution in parasite-endemic areas.

Micellar electrokinetic chromatography of polyamines and monoacetylpolyamines.

A selective procedure for qualitative and quantitative analysis of ten polyamines by micellar electrokinetic chromatography (MEKC) was developed. Benzoylated polyamines and acetylpolyamines in micellar phase of SDS (10 mM) were separated at 25 degrees C by 20 mM borate buffer pH 8.5, containing 8% ethanol, with an applied voltage of 25 kV (5 microA) and then detected at 198 nm. The experimental factors and operational parameters were optimized by performing analysis at different surfactant concentrations, pH, voltage and temperature with and without ethanol. The repeatibility of migration times and peak heights is a peculiarity of the method here described.

Rapid and simultaneous high-performance liquid chromatography assay of polyamines and monoacetylpolyamines in biological specimens.

A rapid, resolutive and reproducible reversed-phase high-performance liquid chromatography (RP-HPLC) method was developed for polyamines and acetylpolyamines by adopting pre-column derivatization with benzoyl chloride. In a single run lasting less than 15 min ten polyamines were separated as well as traces of benzoic acid, methylbenzoate and benzoic anhydride. These contaminants, produced during the derivatization reaction, were almost all eliminated by washing steps envisaged in the same procedure. This simple and sensitive method can be applied to routine determination of polyamines in biological samples. A fine application of this procedure to the determination of endogenous content of polyamines in chick embryo retina was reported.

In vivo validation of distributed source solutions for the biomagnetic inverse problem.

Probabilistic modelling of continuous current sources is applied to the analysis of MEG signals generated by current dipoles implanted in the head of a living human subject. Estimates of the distribution of activity within a circular disk are obtained from signals generated by a single implanted dipole and by a pair of simultaneously active implanted dipoles. The orientation and depth of the disc is determined in advance from the experimental geometry and the measurements. The resulting reconstructions constitute the first in vivo validation of distributed source imaging; they provide a complementary test to earlier works using computer generated data and tests using point source analysis of signals generated by a single implanted dipole. In this work we provide a literal test of spatial resolution by resolving two nearby point-like sources. Temporal resolution is addressed in a de facto manner by imaging at one millisecond intervals. Computer simulations, with controlled amount of noise, are used to demonstrate the robustness of the results, and show the interplay between high spatial accuracy and noise insensitivity.

Prevalence of biliary lithiasis in the elderly people of a small town in Sicily.

The aim of the present study was to determine the prevalence of biliary lithiasis (BL) and its major associated factors in the elderly people of a small town in Sicily. All inhabitants over the age of 65 were interviewed and underwent a general physical examination, blood tests and ultrasonography of the gallbladder and biliary tracts. The final group included 328 subjects (162 men and 166 women), representing 63.1% of the population asked to participate, with a mean age of 74.3 +/- 6.8 years (range 65-95). The prevalence of BL (lithiasis in progress + subjects cholecystectomized for previous calculosis) was 18.6%. No male subject had been cholecystectomized. Prevalence was higher in women than in men, but there was no progressive increase with age. There was no significant correlation between number of pregnancies and BL and there was no statistically significant difference between subjects with and without lithiasis for total cholesterol, triglycerides, HDL-cholesterol, A-I and B apoprotein values; a significant difference was found only for body weight values (p less than 0.01). Stones were more often multiple and more radiopaque than in younger subjects; specific symptoms and positive family histories were found in 22% and 18% of the study group, respectively.

Principles of magnetoencephalography.

Magnetoencephalography (MEG) is a new, noninvasive functional test equivalent to EEG. It has been used to localize the sources of evoked responses and interictal and ictal epileptiform discharges and to study patients with psychiatric illnesses, cerebrovascular accidents, and migraine. In epilepsy research, it is hoped that MEG will provide information similar to that yielded by depth or subdural electrode recording, or that the combination of these methods will provide more information than either one alone. The application of MEG appears to be widening, although it is not yet a routine clinical diagnostic tool. The utility of MEG is limited by technological problems, but new and more efficient systems are becoming available. Within several years, advances in the technology and understanding of MEG may modify the course of its application.

[Giant cell immunoblastic malignant lymphoma following a myeloma]. / Lymphome malin à grandes cellules immunoblastiques succ édant à un myélome.

The possible development of giant-cell lymphoma in the course of a B cell monoclonal lymphopathy is well documented. This occurrence is however exceptional in the course of myeloma. We describe a case in which typing of cell populations established the immunologic identity between the myelomatous proliferation and the sarcomatous process.

[Richter's syndrome. A morphological study apropos of 3 cases]. / Le syndrome de Richter. Etude morphologique à propos de trois cas.

The occurrence of a large cell lymphoma in the course of chronic lymphocytic leukemia is rare and its evolution is fatal at short term. This is the definition of Richter's syndrome. The authors report three cases documented by cytology, histology. The immunological study was performed for one of these by typing on a suspension of fresh bone marrow and lymph node cells. It showed the immunological identity of the chronic phase and the transformation phase (Richter's syndrome). These findings are in line with recent studies showing the immunocellular filiation of the two hemopathies despite the morphological differences, the transformation phase showing the differentiation of the B clone of the chronic phase.

[Preleukemic erythroblastopenia]. / Erythroblastopénie préleucémique.

In adults, chronic aquired pure red cell aplasia (CAPRCA) with no thymic tumor may be idiopathic, fitting the description of Kaznelson syndrome, or a preleukemic disorder which will develop into a malignant hemopathy. Diagnosis of the second possibility is difficult to establish at onset. We report a case with a course suggestive of a possible relationship between CAPRCA and acute leukemia.

[Pinkus' lymphoma. Review of the literature apropos of a case]. / Le lymphome de Pinkus. Revue de la littérature à propos d'un cas.

We report one case of T cell type lymphoma with multilobated nuclei, a distinct variant described by G. Pinkus. The soft palate and subcutaneous tissues were the successive localisations. Despite an aggressive chemotherapy with autologous bone marrow transplantation, a fatal course happened in 18 months. This entity is different from cutaneous lymphomas, mantle zone lymphomas of Waldron, Japanese T lymphomas and from the cases described recently by Weisenburger. The link between these different anatomo-clinical and histological varieties is their belonging to the T cell line.

[Gastric pseudolymphomas. Apropos of 3 cases. Review of the literature]. / Pseudo-lymphomes gastriques. A propos de trois cas. Revue de la littérature.

The authors report three cases of gastric pseudolymphoma, before going on to review the literature on the subject. The pseudolymphoma has only recently been identified in relation to other primitive gastric lymphoid growths, on the basis of histological and evolutional criteria, which show it to be benign. It raises two problems. Firstly, a practical problem of diagnosis, as it often visualizes radiologically and endoscopically as a malignant tumor, and this diagnostic uncertainty persists, even after endoscopic biopsy. This necessarily implies surgical management of the case, normally leading to a clear diagnosis based on study of the gastrectomy specimen. Histologically, a growth of this nature consists of a very large lymphoid hyperplasia, often of an organoid type, strictly confined to the mucosa, which, incidentally, shows no real recent or ancient ulceration. Cytologically, this lymphoid infiltrate is benign and the neighbouring nodes are always normal. Point by point, therefore, these characteristics distinguish the pseudolymphoma from the real lymphoma and the lymphoid hyperplasia associated with ulcers. Fluorescence microscopic study of the intracytoplasmic immunoglobulin, which was carried out in the cases treated by the authors, and also in another recent case reported in the literature, shows a polyclonal type immunofluorescence. The pseudolymphoma is therefore, a benign form of lymphomatosis without ulceration. The second problem concerns the real nature of the lesion: a local immunosuppressive pathology? An atypical lymphoid presarcomatous hyperplasia? In order to support these hypotheses, fresh tissue lymphocyte typing tests covering the entire field of digestive lymph pathology should be carried out to complete the intracytoplasmic immunofluorescent study of the immunologically competent cells.

[Prolonged fever and latent tuberculous foci]. / Fièvres prolongées et foyers tuberculeux latents.

Two cases of prolonged fever are reported. In the first case a tuberculous abscess of the liver was considered after an ultrasonic examination of the periphery of an hepatic calcification discovered many years ago; a right hepatectomy confirmed the diagnosis. The second patient was treated twenty years ago for a tuberculous exsudative peritonitis. The pelvic examination showed a myoma. A computed body tomogram disclosed a picture of pyometritis. This was confirmed by laparotomy showing tuberculous salpingitis and pyometritis by praevia myoma.

[Automated hemogram and myeloperoxidase deficiency. Analysis of 33 cases]. / Hémogramme automatisé et déficit en myélopéroxydase. Analyse de trente-trois observations.

The daily use of the D Hemalog machine allowed us to recognize thirty-three cases of myeloperoxydase deficiency, on the basis of different "alarms", the most important of which is called LPX (Low Peroxydase). Some patients had a blood disease which was lacking among the other subjects. In no case the enzymatic defect has led to a clinical infection.

[Erythrocyte deformability in diabetics. Effects of insulin. Relation to platelet aggregation]. / Déformabilité des hématies chez les diabétiques. Effets de l'insuline. Relations avec l'agrégation plaquettaire.

Erythrocyte deformability is abnormal in diabetics and is closely related to the equilibrium of diabetes : in insulin dependent diabetics connected to an artificial pancreas, the alterations of erythrocyte deformability are quickly corrected after the administration of insulin. The study of platelet aggregation in whole blood, demonstrated that the impaired deformability of red cells was able to induce an hyperaggregability of platelets, phenomenon which vanished after correction of the erythrocyte abnormality. A good equilibrium of diabetes appears fundamental to avoid such abnormalities of erythrocytes and platelets and to prevent the microangiopathic disorders.

Acquired dyserythropoiesis with abnormal intercellular contacts between erythroblasts. Report of a patient with chronic myeloid leukaemia and hepatocarcinoma.

A case of acquired dyserythropoiesis with inter-erythroblastic connections is reported in a patient with chronic myeloid leukaemia, developing a terminal acute hepatic failure related to hepatocarcinoma. The erythroblastic series was abundant but only made of clusters grouping 10 to 20 closely adherent cells. The cellular membranes showed linear junctions or were interdigitated and the intercellular space was occupied with electron dense ferritin granules. This non specific aspect of dyserythropoiesis may be related to the hepatic carcinoma, which was probably induced by busulfan therapy.

[Thrombopenia and radial aplasia: 2 cases with platelet function and ultrastructural studies of megakaryocytes and platelets (author's transl)]. / Thrombopénie et aplasie radiale: deux cas avec étude ultrastructurale et fonctionnelle de la lignée mégacaryocytoplaquettaire.

The authors report on two cases of congenital thrombopenia with radial aplasia. Both children display several birth defects and a mild thrombopenia; hemorragic manifestations occured in the first case only. Megakaryoblastic to platelets series, as studied with electronic microscopy, show small-sized, "microcytic" and hypogranular megakaryocytes, displaying a maturative disorder (dysmegakaryocytopoiesis). In functional studies, platelets of the first patient show an imperfect nucleotidic release and do not agregate normally with ristocetin. The second case exhibits mostly a PF3 reduction. The variety of expression of the megakaryocytic-platelets disorders appears likewise in the skeletal and visceral malformations. The whole disorder could be ascribed to a pleiotropic abnormal gene with a variable expressivity.