Initial evaluation of a continuous speech recognition program for radiology

The aims of this work were to measure the accuracy of one continuous speech recognition product and dependence on the speaker's gender and status as a native or nonnative English speaker, and evaluate the product's potential for routine use in transcribing radiology reports. IBM MedSpeak/Radiology software, version 1.1 was evaluated by 6 speakers. Two were nonnative English speakers, and 3 were men. Each speaker dictated a set of 12 reports. The reports included neurologic and body imaging examinations performed with 6 different modalities. The dictated and original report texts were compared, and error rates for overall, significant, and subtle significant errors were computed. Error rate dependence on modality, native English speaker status, and gender were evaluated by performing ttests. The overall error rate was 10.3 +/- 3.3%. No difference in accuracy between men and women was found; however, significant differences were seen for overall and significant errors when comparing native and nonnative English speakers (P = .009 and P = .008, respectively). The speech recognition software is approximately 90% accurate, and while practical implementation issues (rather than accuracy) currently limit routine use of this product throughout a radiology practice, application in niche areas such as the emergency room currently is being pursued. This methodology provides a convenient way to compare the initial accuracy of different speech recognition products, and changes in accuracy over time, in a detailed and sensitive manner.     

Prostaglandin synthetase inhibition by alkaloids of Heimia salicifolia

Two alkaloids from Heimia salicifolia, cryogenine and nesodine, were respectively 2.48 and 2.24 times as potent as aspirin as inhibitors of prostaglandin synthetase prepared from bovine seminal vesicles. Reference compounds, indomethacin and phenylbutazone, were respectively 2800 and 8.75 times as potent while a synthetic analogue of cryogenine, JB-1-0, was 0.656 times the potency of aspirin. This activity may help to explain the traditional medicine use of H. salicifolia in the Americas.     

A clinical comparison of central and peripheral argon laser panretinal photocoagulation for proliferative diabetic retinopathy

Fifty eyes with three or four diabetic retinopathy risk factors received argon laser panretinal photocoagulation (PRP) with treatment randomly assigned to either central or peripheral distribution. Six months after treatment, two or more acuity lines had been lost by 24% of the central PRP, and by only 8% of the peripheral PRP eyes. Mean visual field constriction with the I-4e isopter was 39% for the central and 29% for the peripheral PRP eyes; for the IV-4e isopter, it was 12 and 7%. Pretreatment macular thickening increased in 19% of the central PRP eyes, but decreased in 19% of the peripheral PRP eyes (P less than 0.05). There was complete disc neovascular regression in 38% of the central and 47% of the peripheral PRP eyes. Partial regression was obtained in 31% centrally and 33% peripherally treated eyes.     

Management of vitreous cavity hemorrhage following pars plana vitrectomy for diabetic retinopathy

Vitreous cavity hemorrhage is a frequent problem following diabetic vitrectomy, and can be managed by either vitreous cavity lavage or outpatient fluid-air exchange procedures. Visual acuities of 6/60 or better and clear vitreous cavities were obtained in 18% of aphakic lavage cases, 47% of lavage cases combined with lens removal, 47% of phakic lavage cases, one of three aphakic exchange cases, and 68% of phakic exchange cases. Iris neovascularization was a major complication of the aphakic eyes occurring in 76% of aphakic lavage cases, 67% of lavage cases combined with lens removal, 14% of phakic lavage cases, all three of the aphakic exchange cases, but in only 25% of phakic exchange cases.     

Charlson Co‐morbidity Index and albumin significantly associated with fracture risk in peritoneal dialysis patients

Published literature on fracture in dialysis patients seldom addressed the effect of co‐morbidity and malnutrition. In this study, we reported the incidence and risk factors for fracture in peritoneal dialysis patients. Peritoneal dialysis patients who had fractures between 2006 and 2011 were recruited. Demographic data, details of fracture, Charlson Co‐morbidity Index (CCI) and biochemical parameters were also collected. Non‐fracture controls, matched for age, gender and duration of dialysis, were also recruited at ratio 1:1 for fracture risk analysis. The incidence of fracture was 1 in 37 patient‐years. The commonest site of fracture was neck of femur (n = 16, 55.2%). Twenty‐four patients (82.8%) developed fracture after slip and fall injury. Eight out of 17 self‐ambulatory patients (47.1%) became non‐ambulatory after fracture. Infection was the commonest complication during hospitalization. Univariant analysis demonstrated high CCI (P = 0.001), hypoalbuminaemia (P < 0.001), loss of self autonomy (P = 0.006) and non‐ambulatory state (P = 0.011) significantly associated with increased fracture risk. However, only CCI (odds ratio (OR) 1.373, P = 0.028) and albumin (OR 0.893, P = 0.025) increased fracture risk significantly on multivariant analysis. Bone profile and parathyroid hormone were not significant risk factors. To conclude, fracture associated with adverse outcome in peritoneal dialysis patients. High CCI score and hypoalbuminaemia significantly increase risk of fracture.     

Optimizing dose and scheduling of filgrastim (granulocyte colony- stimulating factor) for mobilization and collection of peripheral blood progenitor cells in normal volunteers [see comments]

To define an optimal regimen for mobilizing and collecting peripheral blood progenitor cells (PBPC) for use in allogeneic transplantation, we evaluated the kinetics of mobilization by filgrastim (recombinant met- human granulocyte colony-stimulating factor [r-metHuG-CSF]) in normal volunteers. Filgrastim was injected subcutaneously for up to 10 days at a dose of 3 (n = 10), 5 (n = 5), or 10 micrograms/kg/d (n = 15). A subset of volunteers from each dose cohort underwent a 7L leukapheresis on study day 6 (after 5 days of filgrastim). Granulocyte-macrophage colony-forming cell (GM-CFC) numbers in the blood were maximal after 5 days of filgrastim; a broader peak was evident for CD34+ cells between days 4 and 6. The 95% confidence intervals (CI) for mean number of PBPC per milliliter of blood in the three dose cohorts overlapped on each study day. However, on the peak day, CD34+ cells were significantly higher in the 10 micrograms/kg/d cohort than in a pool of the 3 and 5 micrograms/kg/d cohorts. Mobilization was not significantly influenced by volunteer age or sex. Leukapheresis products obtained at the 10 micrograms/kg/d dose level contained a median GM-CFC number of 93 x 10(4)/kg (range, 50 x 10(4)/kg to 172 x 10(4)/kg). Collections from volunteers receiving lower doses of filgrastim contained a median GM- CFC number of 36 x 10(4)/kg (range, 5 x 10(4)/kg to 204 x 10(4)/kg). The measurement of CD34+ cells per milliliter of blood on the day of leukapheresis predicted the total yield of PBPC in the leukapheresis product (r = .87, P < .0001). Assuming a minimum GM-CFC requirement of 50 x 10(4)/kg (based on our experience with autologous PBPC transplantation), all seven leukapheresis products obtained at the 10 micrograms/kg/d dose level were potentially sufficient for allogeneic transplantation purposes. We conclude that in normal donors, filgrastim 10 micrograms/kg/d for 5 days with a single leukapheresis on the following day is a highly effective regimen for PBPC mobilization and collection. Further studies are required to determine whether PBPC collected with this regimen reliably produce rapid and sustained engraftment in allogeneic recipients.