前列腺癌患者调强放疗计划中不同算法计算结果分析

目的 分析前列腺癌患者调强放疗计划设计时PBC和AAA算法计算得到的剂量学参数差异。方法 对13例术后接受调强放射治疗的前列腺癌患者进行调强放疗计划设计时,分别用Eclipse Version 8.10治疗计划系统提供的PBC和AAA算法进行剂量计算并用二维电离室矩阵进行验证测量,比较两种算法获得的HI、CI、PTV_DP、PTV_mean、直肠和膀胱V₅₀等参数差异,并将二维电离室矩阵测量的剂量分布与两种算法的计算结果分别进行比较获得γ通过率、单次照射时的及DD_mean等参数差异。结果 两种算法得到的靶区HI、CI、PTV_DP、PTV_mean平均相差分别为0.003、0.004、2.2%、10 cGy,直肠和膀胱V₅₀值平均差异分别为0.3%和1.3%。γ通过率、DD_max及DD_mean平均差异分别为0.9%、1.2%(2.4 cGy)和0.85%(1.7 cGy)。两种算法所获得的剂量学参数差异不大。结论 对前列腺癌患者进行调强放疗计划设计时,PBC和AAA两种算法均可使用。     

French national consensus clinical guidelines for the management of Crohn’s disease

BackgroundCrohn’s disease (CD) is a chronic and disabling condition. There is no curative medical treatment but current treatments provide increasingly sustainable control of the disease and allow patients a better quality of life. There is limited evidence supporting CD management in specific clinical situations, thus precluding an evidence-based approach.AimsTo help clinicians in making informed treatment decisions, a group of 59 French gastroenterologists with experience in the management of CD met to develop straightforward and practical algorithms based on the European Crohn’s and Colitis Organisation (ECCO) recommendations.MethodsThis experts’ opinion was developed following a Nominal Group consensus methodology. Nine clinical situations were identified: mildly active CD; uncomplicated moderately active CD, with, and without poor prognostic factors; uncomplicated severely active CD; perianal CD with a single fistula; perianal CD with complex fistula with or without abscess; complicated CD with abscess; intestinal stricture; and post-operative CD. Two working groups were formed and proposed algorithms that were then approved by a two-thirds majority of the Nominal Group.ResultsThese algorithms represent the pragmatic consensus of a group of experts in gastroenterology on the modalities of therapeutic care in different clinical situations in CD. They are available via a web application at: www.algorithmici.com.     

An algorithm that administers adaptive speech-in-noise testing to a specified reliability at selectable points on the psychometric function

Abstract

Objective: To introduce and verify an algorithm designed to administer adaptive speech-in- noise testing to a specified reliability at selectable points on the psychometric function. Design: Speech-in-noise performances were measured using BKB sentences presented in diffuse babble-noise, using morphemic scoring. Target of the algorithm was a test-retest standard deviation of 1.13 dB within the presentation of 32 sentences. Normal-hearing participants completed repeated measures using manual administration targeting 50% correct, and the automated procedure targeting 25%, 50%, and 75% correct. Aided hearing-impaired participants completed testing with the automated procedure targeting 25%, 50%, and 75% correct, repeating measurements at the 50% point three times. Study sample: Twelve normal-hearing and 63 hearing-impaired people who had English as first language. Results: Relative to the manual procedure, the algorithm produced the same speech reception threshold in noise (p = 0.96) and lower test-retest reliability on normal-hearing listeners. Both groups obtained significantly different results at the three target points (p < 0.04) with observed reliability close to expected. Target accuracy was not reached within 32 sentences for 18% of measurements on hearing-impaired participants. Conclusions: The reliability of the algorithm was verified. A second test is recommended if the target variability is not reached during the first measurement.     

全口义齿在(牙合)架上前伸运动的计算机三维模拟

目的：探索建立能将三维模拟全口义齿在（牙合）架上进行前伸运动的算法模块。方法：应用激光三维扫描和重建技术，建立全口义齿人工牙列模型，采用Matlab6．5数学计算分析软件，并结合空间解析几何原理，对全口义齿在（牙合）架上的前伸运动进行数学建模和运动模拟。结果：建立了用于模拟全口义齿在（牙合）架上三维前伸运动的算法模块．并在实际病例进行验证。结论：该方法的设计思想可行，为定量研究义齿动态咬合情况奠定了基础。     

全口义齿在架上前伸运动的计算机三维模拟

目的:探索建立能将三维模拟全口义齿在架上进行前伸运动的算法模块。方法:应用激光三维扫描和重建技术,建立全口义齿人工牙列模型,采用Matlab6.5数学计算分析软件,并结合空间解析几何原理,对全口义齿在牙合架上的前伸运动进行数学建模和运动模拟。结果:建立了用于模拟全口义齿在牙合架上三维前伸运动的算法模块,并在实际病例进行验证。结论:该方法的设计思想可行,为定量研究义齿动态咬合情况奠定了基础。     

Appropriate hearing screening in the pediatric patient with head trauma

Purpose

To develop an algorithm for the appropriate audiologic screening of in children with head trauma.

Methods

Participants were the first consecutive 50 children admitted to a children's hospital trauma service after October 1, 2005, whose injuries resulted in a Glasgow Coma Scale (GCS) score ≤13 and/or loss of consciousness (LOC) but no history of hearing loss. Screening tympanometry, otoacoustic emissions testing, and/or routine audiometric evaluation were performed as soon as possible after admission. Age, GCS score, Pediatric Trauma Score, Injury Severity Score, presence of head and neck soft tissue injury, temporal bone fracture, skull fracture not involving the temporal bone, midface/mandible fractures, intracranial abnormality on computed tomography, and cervical fracture were analyzed as risk factors for hearing loss.

Results

Seventeen (34%) of the 50 children had abnormal hearing test results. Fischer's exact test showed abnormal test results were most strongly related to temporal bone fracture (p = 0.0041), non-temporal bone skull fracture (p = 0.0211) and younger age (p = 0.0638).

Conclusions

Any child with head trauma and clinical or radiologic evidence of temporal bone fracture should have early hearing evaluation. Using the proposed algorithm to test children with head trauma and GCS ≤13 and/or LOC and age <3 years or any type of skull fracture may help identify children with hearing loss in a more cost effective manner.     

Diagnostic value of tendon thickness and structure in the sonographic diagnosis of supraspinatus tendinopathy: room for a two-step approach

Objective

The aim of our study was to systematically compare different methodologies to establish an evidence-based approach based on tendon thickness and structure for sonographic diagnosis of supraspinatus tendinopathy when compared to MRI.

Methods

US was obtained from 164 symptomatic patients with supraspinatus tendinopathy detected at MRI and 42 asymptomatic controls with normal MRI. Diagnostic yield was calculated for either maximal supraspinatus tendon thickness (MSTT) and tendon structure as isolated criteria and using different combinations of parallel and sequential testing at US. Chi-squared tests were performed to assess sensitivity, specificity, and accuracy of different diagnostic approaches.

Results

Mean MSTT was 6.68 mm in symptomatic patients and 5.61 mm in asymptomatic controls (P < .05). When used as an isolated criterion, MSTT > 6.0 mm provided best results for accuracy (93.7%) when compared to other measurements of tendon thickness. Also as an isolated criterion, abnormal tendon structure (ATS) yielded 93.2% accuracy for diagnosis. The best overall yield was obtained by both parallel and sequential testing using either MSTT > 6.0 mm or ATS as diagnostic criteria at no particular order, which provided 99.0% accuracy, 100% sensitivity, and 95.2% specificity. Among these parallel and sequential tests that provided best overall yield, additional analysis revealed that sequential testing first evaluating tendon structure required assessment of 258 criteria (vs. 261 for sequential testing first evaluating tendon thickness and 412 for parallel testing) and demanded a mean of 16.1 s to assess diagnostic criteria and reach the diagnosis (vs. 43.3 s for sequential testing first evaluating tendon thickness and 47.4 s for parallel testing).

Conclusions

We found that using either MSTT > 6.0 mm or ATS as diagnostic criteria for both parallel and sequential testing provides the best overall yield for sonographic diagnosis of supraspinatus tendinopathy when compared to MRI. Among these strategies, a two-step sequential approach first assessing tendon structure was advantageous because it required a lower number of criteria to be assessed and demanded less time to assess diagnostic criteria and reach the diagnosis.     

Intensive insulin therapy: enhanced Model Predictive Control algorithm versus standard care

Objective  To investigate the effectiveness of an enhanced software Model Predictive Control (eMPC) algorithm for intravenous insulin infusion, targeted at tight glucose control in critically ill patients, over 72 h, in two intensive care units with different management protocols. Design  Comparison with standard care in a two center open randomized clinical trial. Setting  Two adult intensive care units in University Hospitals. Patients and participants  Thirty-four critically ill patients with hyperglycaemia (glucose >120 mg/dL) or already receiving insulin infusion. Interventions  Patients were randomized, within each ICU, to intravenous insulin infusion advised by eMPC algorithm or the ICU’s standard insulin infusion administration regimen. Measurements and results  Arterial glucose concentration was measured at study entry and when advised by eMPC or measured as part of standard care. Time-weighted average glucose concentrations in patients receiving eMPC advised insulin infusions were similar [104 mg/dL (5.8 mmol/L)] in both ICUs. eMPC advised glucose measurement interval was significantly different between ICUs (1.1 vs. 1.8 h, P < 0.01). The standard care insulin algorithms resulted in significantly different time-weighted average glucose concentrations between ICUs [128 vs. 99 mg/dL (7.1 vs. 5.5 mmol/L), P < 0.01]. Conclusions  In this feasibility study the eMPC algorithm provided similar, effective and safe tight glucose control over 72 h in critically ill patients in two different ICUs. Further development is required to reduce glucose sampling interval while maintaining a low risk of hypoglycaemia. An erratum to this article can be found at