A searchable patient record database for decision support.

UNLABELLED: We describe a searchable patient record database for decision support. It contains medical histories of real but pseudonymous patients with patterns of diagnosis, chosen treatment, and outcome. To be searchable, the patterns contain a feature vector (for similarity search by calculating distances) and a globally unique "pattern name" which identifies the kind of data which are represented by the feature vector. Patterns with the same pattern name are directly comparable; they represent the same kind of data. For pattern selection the database provides a growing well-structured list of initial diagnoses with associated input masks. PROCEDURE: The doctor can assume that the database contains patients similar to the current patient if he finds his initial diagnosis in the list. Clicking on it opens an associated input mask which requests specific further data for finer differentiation. After input a searchable pattern group is built from the provided data, and used to search for histories of patients with similar fine diagnostics, and for the most successful treatment decisions at these patients. This information can be very valuable for deciding the treatment of the current patient. Because the database can collect patient histories from all countries, in the long run this could open access to a wealth of experience which by far exceeds the capacity of a today's doctor.

Microdamage in cortical bone due to the overtightening of orthodontic microscrews.

BACKGROUND AND AIM: The possibility of skeletal anchorage achieved with mini-implants has greatly broadened the spectrum of treatment modalities in orthodontics. Aim of this study was to investigate the microstructural alterations in cortical bone due to overtightening of orthodontic microscrews during the insertion procedure. MATERIAL AND METHODS: After having prepared three fresh pelvic porcine bone segments and removed the periosteum, we drilled 25 holes 1 mm in diameter into the segments. Using a screwdriver, we then manually inserted a total of 20 orthodontic microscrews from the Aarhus Anchorage System (1.5 mm x 7.7 mm) into the holes: ten screws were inserted about 6.7 mm deep, leaving the last 1 mm of the thread visible outside the bone. The other ten screws were initially inserted 7.7 mm (until the screw thread was no longer visible and the screw neck was slightly touching the cortex). Those last ten screws were then tightened by another quarter-turn. Five drill-holes were left empty, serving as a reference. The three pelvic bone segments were sawed into 25 smaller bone-specimens, 20 segments containing one screw and five with only the drill-hole. They were cortically cross-sectioned and processed for scanning electron microscope analysis. All the microcracks in the peri-implant bone tissue at least 50 microm long were documented for each sample. Statistical analysis was carried out according to the "number of cracks", "accumulated length of all cracks", "maximum radius of crack alteration", and "longest crack". The specimens were then divided into two subgroups according to cortical thickness. RESULTS: The group of overtightened implants showed higher values in the following categories: number of cracks, accumulated length of all cracks, maximum radius of crack alteration, and longest crack in comparison to the reference samples without screws and the group of less deeply-inserted implants. However, we identified no correlation between cortical thickness and the degree of microdamage. CONCLUSIONS: We demonstrate that there was more microstructural damage in cortical bone due to overtightening through deep insertion of orthodontic microscrews than occurred at the lower insertion depth. Extensive osseous microdamage may detract from the stability of immediately-loaded microscrews and implants due to the bone-remodeling processes initiated by microdamage. The subject of just how serious this potential risk is should be addressed in future studies.

Design of a Global Medical Database which is Searchable by Human Diagnostic Patterns.

UNLABELLED: We describe a global medical database which is designed for efficient evaluation. It allows language independent search for human diagnostic parameters. Core of the database is a fully automated electronic archive and distribution server for medical histories of real but anonymous patients which contain patterns of diagnosis, chosen treatment, and outcome. Every pattern is represented by a feature vector which is usually a sequence of numbers, and labeled by an unambiguous "pattern name" which identifies its meaning. Similarity search is always done only over patterns with the same pattern name, because these are directly comparable. Similarities of patterns are mapped to spatial similarities (small distances) of their feature vectors using an appropriate metric. This makes them searchable. Pattern names can be "owned" like today domain names. This facilitates unbureaucratic definition of patterns e.g. by manufacturers of diagnostic devices. APPLICATION: If there is a new patient with certain diagnostic patterns, it is possible to combine a part or all of them and to search in the database for completed histories of patients with similar patterns to find the best treatment. Confinement of the result by conventional language based search terms is possible, and immediate individual statistics or regression analyses can quantify probabilities of success in case of different treatment choices. CONCLUSIONS: Efficient searching with diagnostic patterns is technically feasible. Labeled feature vectors induce a systematic and expandable approach. The database also allows immediate calculation of individual up to date prediction models.

Telomerase-pulsed dendritic cells: preclinical results and outcome of a clinical phase I/II trial in patients with metastatic renal cell carcinoma.

OBJECTIVE: Therapeutic vaccination with dendritic cells (DC) showed promising results in first clinical trials in cases of metastatic renal cell carcinoma (RCC). Human telomerase reverse transcriptase (hTERT) could be a potential target because it is detectable in more than 85% of human tumors including RCC. DESIGN: 10 patients with progressive metastatic RCC were enrolled in a clinical phase I/II trial using DC pulsed with hTERT-peptide. Beside toxicity and feasibility aspects, a complex immune monitoring including in vitro data were evaluated. In addition to detection of tumor-specific effector cells we investigated their functionality like IFN-gamma secretion and cytotoxic activity against tumor cells. RESULTS: The vaccine was well tolerated. Two patients showed a mixed response (MR) and one patient a stable disease (SD). Interestingly, responders showed cytotoxic activity already before start of therapy and there was a significant increase in cytotoxic activity of effector cells from all responders (SD and MR patients) after the first vaccination. In contrast non-responders showed no cytotoxic activity before and during treatment. Therefore, cytotoxic activity might be used as a predictive marker in the future. Tetramer staining detected higher amounts of tumor-specific cytotoxic cells in responding patients compared to non-responders. Also, responders possessed increasing amounts of IFN-gamma producing immunological effector cells. CONCLUSION: Telomerase-pulsed DC could enhance a tumor-specific immune response against RCC.