Effect of neurotrophic factor, MDP, on rats’ nerve regeneration

Our objective was to determine the immune-modulating effects of the neurotrophic factor N-acetylmuramyl-L-alanyl-D-isoglutamine (MDP) on median nerve regeneration in rats. We used male Wistar rats (120-140 days of age, weighing 250-332 g) and compared the results of three different techniques of nerve repair: 1) epineural neurorrhaphy using sutures alone (group S - 10 rats), 2) epineural neurorrhaphy using sutures plus fibrin tissue adhesive (FTA; group SF - 20 rats), and 3) sutures plus FTA, with MDP added to the FTA (group SFM - 20 rats). Functional assessments using the grasp test were performed weekly for 12 weeks to identify recovery of flexor muscle function in the fingers secondary to median nerve regeneration. Histological analysis was also utilized. The total number and diameter of myelinated fibers were determined in each proximal and distal nerve segment. Two indices, reported as percentage, were calculated from these parameters, namely, the regeneration index and the diameter change index. By the 8th week, superiority of group SFM over group S became apparent in the grasping test (P = 0.005). By the 12th week, rats that had received MDP were superior in the grasping test compared to both group S (P < 0.001) and group SF (P = 0.001). Moreover, group SF was better in the grasping test than group S (P = 0.014). However, no significant differences between groups were identified by histological analysis. In the present study, rats that had received MDP obtained better function, in the absence of any significant histological differences.

Effect of neurotrophic factor, MDP, on rats' nerve regeneration.

Our objective was to determine the immune-modulating effects of the neurotrophic factor N-acetylmuramyl-L-alanyl-D-isoglutamine (MDP) on median nerve regeneration in rats. We used male Wistar rats (120-140 days of age, weighing 250-332 g) and compared the results of three different techniques of nerve repair: 1) epineural neurorrhaphy using sutures alone (group S - 10 rats), 2) epineural neurorrhaphy using sutures plus fibrin tissue adhesive (FTA; group SF - 20 rats), and 3) sutures plus FTA, with MDP added to the FTA (group SFM - 20 rats). Functional assessments using the grasp test were performed weekly for 12 weeks to identify recovery of flexor muscle function in the fingers secondary to median nerve regeneration. Histological analysis was also utilized. The total number and diameter of myelinated fibers were determined in each proximal and distal nerve segment. Two indices, reported as percentage, were calculated from these parameters, namely, the regeneration index and the diameter change index. By the 8th week, superiority of group SFM over group S became apparent in the grasping test (P = 0.005). By the 12th week, rats that had received MDP were superior in the grasping test compared to both group S (P < 0.001) and group SF (P = 0.001). Moreover, group SF was better in the grasping test than group S (P = 0.014). However, no significant differences between groups were identified by histological analysis. In the present study, rats that had received MDP obtained better function, in the absence of any significant histological differences.

Image content extraction: application to MR images of the brain.

A system for automatically extracting image content features was developed that combines registration to a labeled atlas with natural language processing of free-text radiology reports. The system was then tested with T1-weighted, spoiled gradient-echo magnetic resonance (MR) imaging studies of the brain performed in nine patients. The locations of 599 structures were visually assessed by an experienced radiologist and compared with the locations indicated by automated output. The in-plane accuracy of the contours was subjectively evaluated as either good, moderate, or poor. The criterion for classifying a structure as correctly located was that 90% or more of all the images containing the structure had to be correctly identified. For 98% of the structures, the images identified by the automated algorithm agreed with those identified by the radiologist, and in 83% of cases, image contours showed a good in-plane overlap. The results of this validation study demonstrate that this combination of registration and natural language processing is accurate in identifying relevant images from brain MR imaging studies. However, the range of applicability of this technique has yet to be determined by applying the technique to a large number of studies.

Automatic structuring of radiology free-text reports.

A natural language processor was developed that automatically structures the important medical information (eg, the existence, properties, location, and diagnostic interpretation of findings) contained in a radiology free-text document as a formal information model that can be interpreted by a computer program. The input to the system is a free-text report from a radiologic study. The system requires no reporting style changes on the part of the radiologist. Statistical and machine learning methods are used extensively throughout the system. A graphical user interface has been developed that allows the creation of hand-tagged training examples. Various aspects of the difficult problem of implementing an automated structured reporting system have been addressed, and the relevant technology is progressing well. Extensible Markup Language is emerging as the preferred syntactic standard for representing and distributing these structured reports within a clinical environment. Early successes hold out hope that similar statistically based models of language will allow deep understanding of textual reports. The success of these statistical methods will depend on the availability of large numbers of high-quality training examples for each radiologic subdomain. The acceptability of automated structured reporting systems will ultimately depend on the results of comprehensive evaluations.

Fluctuations of Emax of the left ventricle: effect of atrial natriuretic polypeptide.

Recently the circadian rhythm of fluctuations in heart rate variability (HRV) has gained increasing attention, and the use of appropriate treatment corresponding to the circadian rhythm has become an important issue. However, the question has been raised as to whether the rhythm of fluctuation is only limited to HRV, and if a rhythm is also present in the contraction of the heart. The mathematical technique of electrical circuit simulation of the cardiovascular system was used to observe the Emax rhythm. In this study, the therapeutic effect of various drugs, including atrial natriuretic polypeptide (ANP), was confirmed. The effect of inotropic drugs including ANP on Emax was observed, and the results based on an old and a new method of determining Emax . were examined. Furthermore, the chaos analysis of Emax was also made. The time series of Emax showed an increased complexity due to the administration of ANP. In conclusion, it might be important to consider not only the fluctuation of HRV, but also an analysis of the fluctuation in the contraction of the heart.

Structure localization in brain images: application to relevant image selection.

Recent advances in imaging have lead to increases in the number of images/study. Automated methods to select relevant images are critical to effectively convey study results. The proposed method combines natural language processing (NLP) and automatic structure localization to identify relevant images of a MR brain study. NLP extracts relevant locations of findings. Two algorithms were implemented and evaluated for structure localization. The first method involves registration of patient dataset to a labeled atlas. The second method involves an eigenimage search using a training set of images. A prototype was developed and tested on MR brain studies of nine patients. With the registration method, slices containing the relevant structure agreed with expert selection in 98% of cases. Structure localization by eigenimage search was able to locate the lateral ventricles correctly in all the test cases. The proposed method provides an accurate method for identifying relevant slices of an imaging study.

Requirements of a Web-based experiment management system.

Recent advances in tools for scientific data acquisition, visualization, and analysis have lead to growing information management problems for medical research laboratories. An exponential increase in the volume of data, combined with a proliferation of heterogeneous formats and autonomous systems, has driven the need for flexible and powerful Experiment Management Systems (EMS). This paper provides a detailed analysis of the informatics requirements of an EMS, and proposes a new type of middleware called an EMS-Building Environment (EMSBE), which enables the rapid development of web-based systems for managing laboratory data and workflow. We describe the Web-Interfacing Respository Manager (WIRM), an open-source application server for building customizable experiment management systems. WIRM is being used to manage several ongoing experiments, including a natural language processor of radiological findings, and an interdisciplinary project for studying brain function.

Evaluation of SNOMED3.5 in representing concepts in chest radiology reports: integration of a SNOMED mapper with a radiology reporting workstation.

Standardized medical terminologies are gaining importance in the representation of medical data. In this paper, we present the evaluation of the SNOMED3.5 medical terminology to code concepts routinely used in chest radiology reports. Integration of this terminology mapper into a radiology reporting workstation that incorporates a speech recognition system and a natural language processor is also discussed. A total of 700 anatomical location terms (including synonyms) were tested and 72% of the terms had corresponding SNOMED terms. Of the 28% that did not result in a match, 16% were either morphological variants of SNOMED terms or could be found from a combination of terms from two or more SNOMED axes. Only 12% of the terms (primarily specialized radiology terms) were concepts not actually included in the SNOMED terminology.

Interactive software for generation and visualization of structured findings in radiology reports.

OBJECTIVE: Our objectives were to develop a user-friendly graphic interface for a module that integrates traditional radiology reporting, natural language processing, and editing capabilities; to facilitate the structuring of radiology reports as part of routine clinical practice; to use a commercial speech recognition module for online transcription; and to implement the module in a hardware-independent environment. CONCLUSION: After implementation, the module was tested with 150 chest radiology reports by two radiologists and assessed for ease of use and accuracy. Overall, accuracy was close to 90% and user satisfaction was high. When radiology reports are structured as a part of routine clinical practice, it is possible to accomplish intelligent indexing and retrieval to facilitate teaching and research.

Teleradiology as a foundation for an enterprise-wide health care delivery system.

An effective, integrated telemedicine system has been developed that allows (a) teleconsultation between local primary health care providers (primary care physicians and general radiologists) and remote imaging subspecialists and (b) active patient participation related to his or her medical condition and patient education. The initial stage of system development was a traditional teleradiology consultation service between general radiologists and specialists; this established system was expanded to include primary care physicians and patients. The system was developed by using a well-defined process model, resulting in three integrated modules: a patient module, a primary health care provider module, and a specialist module. A middle agent layer enables tailoring and customization of the modules for each specific user type. Implementation by using Java and the Common Object Request Broker Architecture standard facilitates platform independence and interoperability. The system supports (a) teleconsultation between a local primary health care provider and an imaging subspecialist regardless of geographic location and (b) patient education and online scheduling. The developed system can potentially form a foundation for an enterprise-wide health care delivery system. In such a system, the role of radiologist specialists is enhanced from that of a diagnostician to the management of a patient's process of care.

Improving the quality of care through routine teleradiology consultation.

RATIONALE AND OBJECTIVES: The hypotheses of this study were as follows: (a) University subspecialty radiologists can provide consultations effectively to general radiologists as part of routine clinical operations; (b) these consultations will improve the quality of the final radiologic report; and (c) the consultations will improve the care process and may save money, as well. MATERIALS AND METHODS: For 2,012 consecutive computed tomographic or magnetic resonance (MR) imaging studies, the initial interpretations provided by radiology generalists were subsequently reviewed by specialists, with a final consensus report available. "Truth" was established by final consensus reports. To control for potential bias, 150 adult MR imaging and 250 pediatric radiologic studies were interpreted initially by specialists and then by generalists. Again, truth was established by final consensus reports. RESULTS: There was disagreement between generalist and specialist radiologist interpretations in 427 (21.2%) of the cases reviewed. These disagreements were stratified further by independent specialists, who graded them as important, very important, or unimportant. Differences were considered important or very important in 99% of the cases reviewed. CONCLUSION: Consultations by subspecialty radiologists improved the quality of the radiology reports studied and, at least in some cases, improved the process of care by eliminating unnecessary procedures or suggesting more specific follow-up examinations. The consultation services can be provided cost-effectively from the payer's perspective and may save additional costs when unnecessary procedures can be eliminated.

Initial experiences with building a health care infrastructure based on Java and object-oriented database technology.

A multi-tiered telemedicine system based on Java and object-oriented database technology has yielded a number of practical insights and experiences on their effectiveness and suitability as implementation bases for a health care infrastructure. The advantages and drawbacks to their use, as seen within the context of the telemedicine system's development, are discussed. Overall, these technologies deliver on their early promise, with a few remaining issues that are due primarily to their relative newness.

Process models for telehealth: an industrial approach to quality management of distant medical practice.

Process modeling is explored as an approach for prospectively managing the quality of a telemedicine/telehealth service. This kind of prospective quality management is more appropriate for dynamic health care environments compared to traditional quality assurance programs. A vector model approach has also been developed to match a process model to the needs of a particular site.

Creating and indexing teaching files from free-text patient reports.

Teaching files based on real patient data can enhance the education of students, staff and other colleagues. Although information retrieval system can index free-text documents using keywords, these systems do not work well where content bearing terms (e.g., anatomy descriptions) frequently appears. This paper describes a system that uses multi-word indexing terms to provide access to free-text patient reports. The utilization of multi-word indexing allows better modeling of the content of medical reports, thus improving retrieval performance. The method used to select indexing terms as well as early evaluation of retrieval performance is discussed.

A statistical natural language processor for medical reports.

Statistical natural language processors have been the focus of much research during the past decade. The main advantage of such an approach over grammatical rule-based approaches is its scalability to new domains. We present a statistical NLP for the domain of radiology and report on methods of knowledge acquisition, parsing, semantic interpretation, and evaluation. Preliminary performance data are given. A discussion of the perceived benefit, limitations and future work is presented.

[Laboratory-based evaluation of DainaScreen TPAb to detect specific antibodies against Treponema pallidum].

A newly developed immunochromatography assay, DainaScreen TPAb (Dainabot, Tokyo), to detect antibodies specific to Treponema pallidum was evaluated. When we tested serum and plasma samples of Syphilis Mixed Titer Performance Panel PSS201 (Boston Biomedica, Inc. , Bridgewater, MA, U.S.A.), all the test results obtained by DainaScreen TPAb were comparable to those determined by fluorescent treponemal antibody absorption test (FTA-ABS). Both within-run and day-to-day variation tests were highly precise, and no discrepant interpretation was obtained by the different medical technicians performed. Also, the testings of whole blood and plasma for individual samples gave same interpretations. The minimum detectable antibody titer was equal to that of Mediace TPLA (Sekisui Chemicals, Osaka) determined by Behring Nephelometer Analyzer (Dade Behring, Marburg, Germany). All the test results by DainaScreen TPAb for clinical serum samples were comparable to those by Mediace TPLA. With these results, we can conclude that DainaScreen TPAb is a rapid, practical and easy-to-perform alternative to detect antibodies specific to Treponema pallidum, in particular as being a point-of-care testing.

Hyperad: augmenting and visualizing free text radiology reports.

Hyperad is an automated computer system designed to extract key concepts from thoracic radiology reports and give physicians access to a large database containing the reports and key concepts. The concepts are extracted from textual documents with natural language processing techniques, then stored with the original documents in the database, which can be queried in terms of findings or associated attributes from an intuitive and easily accessible interface. The extracted concepts are represented both textually in a coded hypertext format and graphically on a coronal cross-sectional anatomy atlas, an idealized graphical model of human anatomy. To facilitate implementation, the communication protocols and standards of the World Wide Web (Web) were adopted. The reports and associated forms are encoded in standard hypertext markup language, which makes it possible to use hypermedia links to navigate the Hyperad database with any graphical Web browser. In the future, Hyperad may prove useful for other applications.

A multimedia database system for thermal ablation therapy of brain tumors.

A prototype multimedia medical database is described for supporting thermal ablation therapy of brain tumors. Its design is motivated by the major need to manage and access multimedia information on the progress and reaction of tumors to various therapy protocols. The database links images to patient data in a way that permits the use to view and query medical information using alphanumeric, temporal, and feature-based predicates. Visualization programs permit the user to view or annotate the query results in various ways. These results support the wide variety of data types and presentation methods required by neuroradiologists to manage thermal ablation therapy data. The database satisfactorily meets the requirements defined by thermal ablation therapy. A similar approach is being undertaken for supporting different therapies of other types of tumors, thus showing the generality of our approach.

A unified timeline model and user interface for multimedia medical databases.

A multimedia medical database model and prototype is described for supporting a timeline-based presentation of information. The database links image and text data in a way that permits users to look at medical information in a single unified view. Various visualization programs permit the user to view data in various ways, including full image views, graphs, and tables. Our technology is applied for proof-of-concept to two areas: thoracic oncology and thermal tumor ablation therapy of the brain. This effort is part of the multidisciplinary KMeD project in collaboration with medical research and clinical treatment projects at UCLA.