A medical terminal based on a microcomputer

Herein are described purpose and field of application of the medical DVK-2M microcomputer based terminal. This system will be used to accumulate, preliminary process and feed the medico-physiological information to the consulting-diagnostic centre. Were studied the channel data feed control protocol and protective algorithm of the transferred information including error correction. Information on the medical network structure is proposed as well.     

The Bath metrology index as assessed by a trained and an untrained rater in patients with spondylarthropathy: a study of intra- and inter-rater agreements

The Bath ankylosing spondylitis metrology index (BASMI; range 0–10) has gained widespread use in daily clinical practice as an objective measure of spinal stiffness not only in patients with ankylosing spondylitis (AS) but also in patients with other spondylarthropathies (SpA ). We examined intra-rater and inter-rater reproducibility of BASMI scoring in 30 Danish patients with SpA (median age 40 years, range 22–56 years) fulfilling the European Spondylarthropathy Study Group criteria, 25 of them satisfying the modified New York Criteria for AS. Measurements were performed twice on two different days (median interval 7 days, range 4–11) by a trained physiotherapist (PT) and by an untrained nurse who had undergone a single 1-h training session with the PT. The median BASMI score obtained by the PT on the two test days was 3.5 (range 1–8) and 3.0 (range 1–8), respectively (NS). Test–retest BASMI scores from the PT were significantly correlated (r _s = 0.95, p < 0.0001). The 95% likely range for the difference between a patient’s BASMI scores from two tests was ±1.4 corresponding to a minimal detectable difference of ±2 in the individual patient as the scale consists of intervals of 1. Similar results were achieved by the nurse. BASMI scores obtained by the two raters were significantly inter-correlated (r _s = 0.95, p < 0.0001). The mean difference between paired BASMI scores obtained by the nurse and the PT on test day 1 was −0.2 with a minimal detectable difference of ±2. A similar result was found using data from test day 2. In conclusion, a change in BASMI less than 2 may be due solely to expected random measurement error. A single 1-h training session allowed an untrained nurse to obtain BASMI results almost identical to those of an experienced PT.     

Molecular Typing of N. gonorrhoeae Strains Prevalent in the Russian Federation

Genetic polymorphism of Russian population of N. gonorrhoeae was detected and a system for genotyping of its clinical strains was introduced into practice. Comparative analysis of the prevalence of N. gonorrhoeae genotypes in Russia and abroad was carried out. For adaptation of the methods of molecular typing of N. gonorrhoeae strains and its approbation on clinical strains isolated in Russia 41 clinical strains of N. gonorrhoeae were typed. The predominance of PIB serovar (83%) was demonstrated.     

Image analysis of chronic wounds for determining the surface area

Progress in wound healing is primarily quantified by the rate of change of the wound's surface area. The most recent guidelines of the Wound Healing Society suggest that a reduction in wound size of <40% within 4 weeks necessitates a reevaluation of the treatment. However, accurate measurement of wound size is challenging due to the complexity of a chronic wound, the variable lighting conditions of examination rooms, and the time constraints of a busy clinical practice. In this paper, we present our methodology to quantify a wound boundary and measure the enclosed wound area reproducibly. The method derives from a combination of color‐based image analysis algorithms, and our results are validated with wounds in animal models and human wounds of diverse patients. Images were taken by an inexpensive digital camera under variable lighting conditions. Approximately 100 patient images and 50 animal images were analyzed and a high overlap was achieved between the manual tracings and the calculated wound area by our method in both groups. The simplicity of our method combined with its robustness suggests that it can be a valuable tool in clinical wound evaluations. The basic challenge of our method is in deep wounds with very small surface areas where color‐based detection can lead to erroneous results and which could be overcome by texture‐based detection methods. The authors are willing to provide the developed MATLAB code for the work discussed in this paper.     

Prediction of wound healing in human diabetic foot ulcers by diffuse near‐infrared spectroscopy: A pilot study

A human study was conducted in which the efficacy of in vivo diffuse near‐infrared (NIR) spectroscopy was demonstrated in predicting wound healing in diabetic foot ulcers. Sixteen chronic diabetic wounds were followed and assessed for subsurface oxy‐hemoglobin concentration using the NIR device. Weekly measurements were conducted until there was wound closure, limb amputation, or 20 completed visits without healing. Digital photography measured wound size, and the degree of wound contraction was compared with the NIR results. In the 16 patients followed, seven wounds healed, six limbs were amputated, and three wounds remained opened after 20 visits. The initial values in subsurface hemoglobin concentration in all wounds were higher than the nonwound control sites. Healed wounds showed a consistent reduction of hemoglobin concentration several weeks before closure that approached control site values. In wounds that did not heal or resulted in amputation of the limb, the hemoglobin concentration remained elevated. In some cases, these nonhealing wounds appeared to be improving clinically. A negative slope for the rate of change of hemoglobin concentration was indicative of healing across all wounds. In conclusion, evaluation of wounds using NIR may provide an effective measurement of wound healing. NIR spectroscopy can determine wound healing earlier than that visibly assessed by current clinical approaches.     

The risk of PD-L1 expression misclassification in triple-negative breast cancer

Breast Cancer Research and Treatment - Stratification of patients with triple-negative breast cancer (TNBC) for anti-PD-L1 therapy is based on PD-L1 expression in tumor biopsies. This study sought...     

Inhibitory activity of xanthine oxidase by fractions Crateva adansonii

ObjectiveTo study the inhibitory effect of various extracts from Crateva adansonii (C. adansonii) used traditionally against several inflammatory diseases such as rheumatism, arthritis, and gout, was investigated on purified bovine milk xanthine oxidase (XO) activity.MethodsXanthine oxidase inhibitory activity was assayed spectrophotometrically and the degree of enzyme inhibition was determined by measuring the increase in absorbance at 295 nm associated with uric acid formation. Enzyme kinetics was carried out using Lineweaver-Burk plots using xanthine as the substrate.ResultsAmong the fractions tested, the chloroform fraction exhibited highest potency (IC₅₀ 20.2±1.6 μg/mL) followed by the petroleum ether (IC₅₀ 30.1±2.2 μg/mL), ethyl acetate (IC₅₀ 43.9±1.4 μg/mL) and residual (IC₅₀ 98.0±3.3 μg/mL) fractions. The IC₅₀ value of allopurinol used, as the standard was 5.7±0.3 μg/mL.ConclusionsEnzyme inhibition mechanism indicated that the mode of inhibition was of a mixed type. Our findings suggest that the therapeutic use of these plants may be due to the observed Xanthine oxidase inhibition, thereby supporting their use in traditional folk medicine against inflammatory-related diseases, in particular, gout.     

Validity of the FOUR Score Coma Scale in the Medical Intensive Care Unit

OBJECTIVE: To evaluate the validity of the FOUR (Full Outline of UnResponsiveness) score (ranging from 0 to 16), a new coma scale consisting of 4 components (eye response, motor response, brainstem reflexes, and respiration pattern), when used by the staff members of a medical intensive care unit (ICU).PATIENTS AND METHODS: This interobserver agreement study prospectively evaluated the use of the FOUR score to describe the condition of 100 critically ill patients from May 1, 2007, to April 30, 2008. We compared the FOUR score to the Glasgow Coma Scale (GCS) score. For each patient, the FOUR score and the GCS score were determined by a randomly selected staff pair (nurse/fellow, nurse/consultant, fellow/fellow, or fellow/consultant). Pair wise weighted κ values were calculated for both scores for each observer pair.RESULTS: The interrater agreement with the FOUR score was excellent (weighted κ: eye response, 0.96; motor response, 0.97; brainstem reflex, 0.98; respiration pattern, 1.00) and similar to that obtained with the GCS (weighted κ: eye response, 0.96; motor response, 0.97; verbal response, 0.98). In terms of the predictive power for poor neurologic outcome (Modified Rankin Scale score, 3-6), the area under the receiver operating characteristic curve was 0.75 for the FOUR score and 0.76 for the GCS score. The mortality rate for patients with the lowest FOUR score of 0 (89%) was higher than that for patients with the lowest GCS score of 3 (71%).CONCLUSION: The interrater agreement of FOUR score results was excellent among medical intensivists. In contrast to the GCS, all components of the FOUR score can be rated even when patients have undergone intubation. The FOUR score is a good predictor of the prognosis of critically ill patients and has important advantages over the GCS in the ICU setting.FOUR = Full Outline of UnResponsiveness; GCS = Glasgow Coma Scale; ICU = intensive care unitAssessing impaired consciousness in the medical and surgical intensive care unit (ICU) is very difficult. The complexity of such an assessment relates in part to the difficulty of finding usable terminology, as illustrated in an earlier study in which 3 observers variously described a single patient as “somnolent,” “difficult to arouse,” and “deeply comatose.”¹ In recognition of this problem, Teasdale and Jennett¹ devised the Glasgow Coma Scale (GCS) in 1974 in an attempt to bring uniformity to the clinical examination and to clinical communication about the level of consciousness.The GCS has become a fixture in the initial assessment of abnormal consciousness but is not designed to capture distinct details of the neurologic examination. The GCS has been routinely used in medical and surgical ICUs and is commonly used in the Acute Physiology and Chronic Health Evaluation (APACHE) scoring system. However, its reliability in predicting patient outcomes is unsatisfactory, particularly with regard to the verbal component.² Other investigators have found additional shortcomings of the GCS and have suggested that adding measures of brainstem reflexes to the GCS could provide better prognostic information.³ Rowley and Fielding⁴ found that the reliability of the GCS increases with the experience of its users and that user inexperience is associated with a high rate of errors.We have developed a new coma scale, the Full Outline of UnResponsiveness (FOUR) score. Although the FOUR score is based on the bare minimum of tests necessary for assessing a patient with altered consciousness, it includes much important information that is not assessed by the GCS, including measurement of brainstem reflexes; determination of eye opening, blinking, and tracking; a broad spectrum of motor responses; and the presence of abnormal breath rhythms and a respiratory drive. Because the FOUR score, unlike the GCS, does not include an assessment of verbal response, it is more useful for assessing critically ill patients who have undergone intubation.The FOUR score was originally tested with staff members of a neuroscience ICU⁵ and has been subsequently validated by tests with experienced and inexperienced neuroscience ICU nurses.⁶ To determine whether the FOUR score is equally suited for use by intensivists, fellows, residents, and nurses without a neuroscience background, we prospectively tested the validity of the FOUR score coma scale when used by staff members of a medical ICU.     

The effect of hair loss on quality of life

BACKGROUND: The aim of this study was to quantify the effect of hair loss on quality of life. Patients were recruited from an alopecia support group, and were assessed using the Dermatology Life Quality Index (DLQI) and an adapted version of the DLQI. Financial utility questions, an abbreviated version of the Center for Epidemiologic Studies Depression Scale and open-ended questions were also used. OBSERVATIONS: Seventy (90% response rate) questionnaires were returned. DLQI scores in responders with hair loss (mean score = 8.3, SD = 5.6, range 0-23, n = 70) were similar to those recorded in severe psoriasis. The hair loss continued to have a significant impact on life quality well after the initial event (median duration of hair loss = 138 months +/- 114; range 7-588, n = 70). Forty per cent of patients also felt dissatisfied with the way in which their doctor dealt with them. CONCLUSIONS: This study specifically identifies the feelings of loss of self-confidence, low self-esteem and heightened self-consciousness in people affected by hair loss.