Using ontologies to integrate and share resuscitation data from diverse medical devices

ObjectiveTo propose a method for standardised data representation and demonstrate a technology that makes it possible to translate data from device dependent formats to this standard representation format.Methods and resultsOutcome statistics vary between emergency medical systems organising resuscitation services. Such differences indicate a potential for improvement by identifying factors affecting outcome, but data subject to analysis have to be comparable. Modern technology for communicating information makes it possible to structure, store and transfer data flexibly. Ontologies describe entities in the world and how they relate. Letting different computer systems refer to the same ontology results in a common understanding on data content. Information on therapy such as shock delivery, chest compressions and ventilation should be defined and described in a standardised ontology to enable comparison and combining data from diverse sources. By adding rules and logic data can be merged and combined in new ways to produce new information. An example ontology is designed to demonstrate the feasibility and value of such a standardised structure.ConclusionsThe proposed technology makes possible capturing and storing of data from different devices in a structured and standardised format. Data can easily be transformed to this standardised format, compared and combined independent of the original structure.     

Representing resuscitation data—Considerations on efficient analysis of quality of cardiopulmonary resuscitation

Objective

To discuss challenges in representing resuscitation data from Utstein style reports and devices like defibrillators with focus on unified and efficient handling of variety of resuscitation research objectives.

Methods and results

Information on therapy such as shock delivery, chest compressions and ventilation can be extracted from defibrillators. A method for merging this information with cardiac rhythm annotated from ECGs, yields a representation of the resuscitation episode with cardiac rhythm also giving information on response to therapy. These data should be synchronised to an electronic Utstein report. With modern technology for communicating information it is possible to structure, store and transport data flexibly so that data captured with devices from different manufacturers can be combined.

Conclusions

A scheme for representing resuscitation data should combine essential information stored in different locations after a resuscitation attempt. The resulting representation should enable data analysis to enable studies of the relationship between therapy and patient response. As the complexity and amount of data generated during resuscitation efforts are ever increasing, the time is mature for using modern information technology tools to provide infrastructure for efficient data management and analysis to identify and meet future challenges in resuscitation data analysis.     

Impact of second primary tumors on survival in head and neck cancer: an analysis of 2,063 cases

Objective/Hypothesis: To investigate the impact of second primary tumors on prognosis for patients with head and neck squamous cell carcinoma (HNSCC). Study Design: Prospectively recorded data on HNSCC patients treated at an academic tertiary referral center. Methods: An analysis of 2,063 patients treated over a 15 year period for tumors of the upper aerodigestive tract, with a minimum follow‐up of 10 years. Results: A total of 351 (17%) patients developed a second primary, mean time to diagnosis of the second tumor being more than 4 years from the date of the initial tumor. Median overall survival from the date of the first tumor among patients who later developed a second primary was 6 years versus 3 years among all other patients (P < .05). During the first 6 years after treatment of the initial tumor, cancer specific survival was better in the second primary group. After diagnosis of a second primary tumor, median survival was 12 months. A positive correlation was found between second primaries and stage I/II primary disease, low patient age, and initial tumors of the larynx and oral cavity. Conclusions: The group of patients with the highest risk of a second primary tumor was younger patients with limited initial tumors. A high proportion of patients who later developed a second primary were complete responders after treatment of the first tumor. However, prognosis was poor after the actual diagnosis of the second primary tumor.     

Pseudoaneurysm of the renal artery following partial nephrectomy: imaging findings and coil embolization

AIM: To present the imaging findings of five patients with renal artery pseudoaneurysm (RAP) after partial nephrectomy. METHODS: Five patients (four men and one woman) with RAP as a complication of partial nephrectomy were studied. The diagnosis of RAP was established using contrast-enhanced computed tomography (CT) in three patients and renal angiography in two patients. In two cases, the diagnosis was evident on ultrasound with colour Doppler. RESULTS: The indication for partial nephrectomy (open approach in four patients and laparoscopic in one patient) was a space-occupying lesion, which proved to be a renal cell carcinoma. All patients presented with macroscopic haematuria, 1-21 days (mean 12.2 days) after surgery. In three of patients the definitive diagnostic imaging method was contrast-enhanced CT. The arterial phase of CT showed a well-circumscribed dense collection of contrast material located within the renal parenchyma. In two other patients the initial and conclusive diagnostic imaging method was renal angiography. All patients underwent selective renal angiography with therapeutic coil embolization. The procedure failed in one patient, which necessitated nephrectomy. CONCLUSIONS: Pseudoaneurysm of the renal artery should be considered in patients presenting with macrohaematuria after nephron-sparing surgery. The diagnosis can be established using contrast-enhanced CT, ultrasound with colour Doppler, or angiography. Renal angiography with selective embolization is a safe and efficacious technique for managing the condition.     

Sound Propagation Properties of the Discrete-Velocity Boltzmann Equation

As the numerical resolution is increased and the discretization error decreases, the lattice Boltzmann method tends towards the discrete-velocity Boltzmann equation (DVBE). An expression for the propagation properties of plane sound waves is found for this equation. This expression is compared to similar ones from the Navier-Stokes and Burnett models, and is found to be closest to the latter. The anisotropy of sound propagation with the DVBE is examined using a two-dimensional velocity set. It is found that both the anisotropy and the deviation between the models is negligible if the Knudsen number is less than 1 by at least an order of magnitude.     

A 12-year National Study of Suicide by Jumping From Bridges in Norway

Studies from several countries suggest that erecting fences on bridges more commonly used for suicide by jumping may be an effective way of reducing the risk of suicide by jumping from these bridges. Distribution of suicides by jumping off bridges has not yet been studied on a national level in any country. This study included all suicides by jumping from high places registered in the Norwegian Cause of Death Registry (COD) in the period 1999–2010 (n = 319). Combining data from the COD registry and information from police records, 71 cases of suicide by jumping off a bridge were identified involving 36 bridges. This form of suicide constituted approximately 1% of all suicides in Norway in the period 1999–2010. Almost half of these suicides were registered at only 6 bridges. Three Norwegian bridges were secured during the observation period of this study. Two bridges had barriers installed on the full length of the bridge with 11 suicides registered before barriers were installed, and none after. On the 1 bridge that was only partially secured, no change in numbers of suicides was observed after barriers were installed. One-third of jumps from bridges occurred over land. We found that although suicide by jumping off bridges was a relatively rare event, there is a potential for saving lives by installing physical barriers on bridges that are more commonly used for suicide by jumping.     

NY-ESO-1 protein expression and humoral immune responses in prostate cancer

BACKGROUND: Due to restricted expression in normal tissues cancer/testis (C/T) antigens represent candidate molecules for immunotherapy of cancer. NY-ESO-1 is a well-studied C/T antigen with unknown expression and immunogenicity in prostate cancer (PC) patients. METHODS: NY-ESO-1 expression was determined by immunohistochemistry and humoral immune responses against NY-ESO-1 assessed by enzyme-linked immuno-sorbent assay (ELISA) and Western blotting. Protein expression and serological responses were correlated with clinical findings and survival. RESULTS: NY-ESO-1 expression was found in biopsies from 2 of 66 localized PC and 7/48 hormone refractory prostate cancer (HRPC) patients, respectively. Anti-NY-ESO-1 antibodies were detected in sera from 1 of 112 localized PC and 18 of 95 HRPC patients. Two of four HRPC patients with NY-ESO-1 positive biopsies had mounted a serological response. Positive anti-NY-ESO-1 titers were correlated with poor survival in HRPC patients. CONCLUSIONS: NY-ESO-1 is expressed in a subset of HRPC patients and, together with other C/T antigens, may serve as a target antigen for development of immunotherapy of PC. Spontaneous serological responses against NY-ESO-1 may be associated with poor survival.     

Intramolecular DNA coiling mediated by metallo-supramolecular cylinders: differential binding of P and M helical enantiomers

We have designed a synthetic tetracationic metallo-supramolecular cylinder that targets the major groove of DNA with a binding constant in excess of 10(7) M(-1) and induces DNA bending and intramolecular coiling. The two enantiomers of the helical molecule bind differently to DNA and have different structural effects. We report the characterization of the interactions by a range of biophysical techniques. The M helical cylinder binds to the major groove and induces dramatic intramolecular coiling. The DNA bending is less dramatic for the P enantiomer.     

The activation-associated antigen 4F2 predicts patient survival in low-grade B-cell lymphomas

Expression of the activation-associated 4F2 antigen, transferrin receptor and interleukin-2 (IL-2) receptor on suspended cells from 75 biopsied low-grade non-Hodgkin lymphomas (L-NHL) of B-cell origin was correlated to patient survival, clinical prognostic parameters and estimated DNA synthesis. 4F2 antigen expression correlated significantly with poor patient survival, high DNA synthesis and transferrin receptor expression. Transferrin receptor expression was associated with high DNA synthesis and treatment response, but not with patient survival. On the other hand, IL-2 receptor was correlated neither to patient survival nor to other studied markers for cell activation, but seemed to be expressed on certain subsets of lymphomas. We suggest that monoclonal antibody (MAb) against the activation-associated 4F2 antigen could be used to select patients with L-NHL for aggressive chemotherapy.