distributed processes
Dotaz
Zobrazit nápovědu
Această lucrare descrie conceptele, metodele şi instrumentele utilizate în proiectarea unui sistem informatic de monitorizare a glaucomului, practic şi având un cost potenţial scăzut, distribuit, cu capabilităţi de acces web (Internet). Experienţa noastră cu sistemele informaţionale existente acum în spitale (eng. Hospital Information System - HIS) a arătat că acestea sunt inadecvate pentru procese clinice cum este şi acela foarte important al monitorizării pacienţilor cu glaucom. Actualele scheme de înregistrare electronică a pacienţilor (eng. Electronic Patient Record - EPR) sunt mai adecvate aspectelor simple de management şi programare a consultaţiilor decât proceselor clinice şi de luare a deciziilor. Într-o relaţie şi mai strânsă cu specificul unei afecţiuni, bazele de date demografice pentru pacienţi, denumite uzual ca sisteme de administrare a pacienţilor (Patient Administration System - PAS), nu au fost proiectate pentru exploatarea partajată sau concurentă de către programe diferite sau chiar replici diferite ale aceluiaşi program. Multe dintre deficienţele timpurii în procesul de urmărire a pacienţilor cu glaucom de către zeci de oftalmologi diferiţi, în cabinete independente din clinici diferite (cu sisteme eterogene de înregistrare a informaţiilor, nu foarte bine administrate prin capabilităţile de birotică), pot fi rezolvate doar prin specificarea, proiectarea şi implementarea unor noi scheme EPR în medii distribuite mixte, bazate pe o bază de date distribuită ca un nucleu demografic (PAS) al pacienţilor cu glaucom. Un asemenea sistem specializat de management al înregistrărilor medicale, cu funcţionalitate centrată pe monitorizarea glaucomului, şi datele din nucleu organizate într-un sistem cu baze de date distribuite, a fost proiectat într-o manieră bottom-up pentru a răspunde unor necesităţi imediate. Implementarea pilot a sa a fost intenţionat menţinută flexibilă şi ţine cont de standardele în dezvoltare cu scopul acomodării oricăror cerinţe viitoare, anticipate. Printre multe alte beneficii, aceste noi scheme EPR permit oftalmologilor vizualizarea şi modificarea informaţiilor despre pacienţi şi a înregistrărilor într-o manieră deopotrivă sigură, flexibilă şi eficientă.
This paper describes, from a practitioner's point of view, the concepts, methods and tools involved in the design of a practical and potentially low cost distributed information system, with web-based capabilities, for monitoring glaucoma. Our experience with existing Hospital Information Systems (HISs) found them unsuitable in the very important monitoring process of patients with glaucoma. Actual Electronic Patient Record (EPR) schemes are more to do with management and appointment simple aspects than with clinical and decision-making processes. In a closer relationship to the specific of the affection, we found that demographic patient databases, usually known as Patient Administration Systems (PASs), have not been designed for being shared or concurrently exploited by different programs or even several replicas of the same program. Many of the early deficiencies in the process of following-up glaucoma patients by dozens of different ophthalmologists in many independent offices from different clinics (with heterogeneous information recording, not very well managed by the existing office capabilities) could only be solved by specifying, designing and implementing a new EPR scheme in a mixed distributed environment, based on a distributed database as a demographic core (or PAS) of patients with glaucoma. A specialized health record management system, with core functionality in monitoring glaucoma, and core data organized as a distributed database system, has been designed in a bottom-up manner to meet the immediate needs. Its pilot implementation was intentionally kept flexible, taking in account developing standards, to accommodate any anticipated future requirements. Among many other benefits, the new EPR allowed medical doctors (ophthalmologists) to view and modify patient information and records in a safe, flexible and efficient manner. Improvements in all the managerial and decisional aspects (regarding costs and time delays) could also be remarked rapidly.
Výskyt zlomenin kloubních výběžků dolní čelisti v posledních letech vzrůstá. V literatuře se uvádí, že kloubní výběžek bývá poraněn ve 25–30 % všech zlomenin dolní čelisti. V našem vyšetřovaném souboru je to 19,6 %. Sdělení se zabývá příčinami zlomenin kloubních výběžků dolní čelisti a jejich rozborem u dospělých pacientů, léčených od 1. 1. 1996 do 31. 12. 2000 na II. stomatologické klinice 1. LF UK a VFN Praha. Dále tato práce popisuje sdružená poranění, která se vyskytovala u zkoumaných pacientů z našeho souboru.
The incidence of fractures of articular processes of the mandible is rising in recent years. According to the literature the articular process is injured in 25–30% of all mandibular fractures. In our group it was in 19.6 %.The paper discusses the causes of fractures of articular processes of the mandible, their analysis in adult patients treated between Jan. 1 1996 and Dec. 31 2000 at the Second Stomatological Clinic of the First Medical Faculty Charles University and General Faculty Hospital. The paper describes also associated injuries found in the investigated group.
- MeSH
- fraktury mandibuly epidemiologie etiologie terapie MeSH
- lidé MeSH
- sexuální faktory MeSH
- věkové rozložení MeSH
- Check Tag
- lidé MeSH
Background: We have analyzed the aged population disability processes to establish specifics and regularities of the causal structure of disability among the working and nonworking aged population. Methods: In total, 1208 examination reports of the Medical & Social Expert Commission have been subjected to excerption in Almaty. Results: Persons having the second disability status prevail in the working aged contingent 4,4%, which is much higher than the ratios for the first and second disability statuses (0,4% and 0,6%, respectively). Among the nonworking population, persons having the second disability status largely prevail too 8,1% (3,1% and 1,1%, respectively). The casual structure of disability among the nonworking disabled persons includes as follows: blood circulatory system diseases (40%), malignant neoplasms (27,2%), and diseases of the eye and its appendages (10,2%). They are followed by endocrine diseases, nutritional and metabolic disturbances (7,6%), bodily injuries (3%), and urogenital system diseases with musculoskeletal system ones 2,3% each. The data collection for the working aged population contingent has found out blood circulatory system diseases (47%) and malignant neoplasms (34,4%). Alongside with that, the distinctive feature among the said aged population cohort is a substantial predominance of bodily injuries (7,4%), endocrine diseases, nutritional and metabolic disturbances (2,3%), and only 1,4% is accounted for diseases of the eye and its appendages.
- MeSH
- demografie MeSH
- lidé MeSH
- nemoc MeSH
- populace * MeSH
- posuzování pracovní neschopnosti MeSH
- práce * MeSH
- stárnutí MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Kazachstán MeSH
In this work, a novel force equilibrium method called distributed dielectrophoretic cytometry (2DEP cytometry) was developed. It uses a dielectrophoresis (DEP)-induced vertical translation of live cells in conjunction with particle image velocimetry (PIV) in order to measure probabilistic distribution of DEP forces acting on an entire cell population. The method is integrated in a microfluidic device. The bottom of the microfluidic channel is lined with an interdigitated electrode array. Cells passing through the micro-channel are acted on by sedimentation forces, while DEP forces either oppose sedimentation, support sedimentation, or neither, depending on the dielectric (DE) signatures of the cells. The heights at which cells stabilize correspond to their DE signature and are measured indirectly using PIV, which enables simultaneous and high-throughput collection of hundreds of single-cell responses in a single PIV frame. The system was validated using polystyrene micro-particles. Preliminary experimental data quantify the DE signatures of immortalized myelogenous leukemia cell lines K562 and KG1. We show DEP-induced cell translation along the parabolic velocity profile can be measured by PIV with sub-micron precision, enabling identification of individual cell DE signatures. DE signatures of the selected cell lines are distinguishable. Throughput of the method enables measurement of DE signatures at 10 different frequencies in almost real time.
- MeSH
- buňky K562 MeSH
- design vybavení MeSH
- elektrická stimulace MeSH
- elektroforéza přístrojové vybavení MeSH
- laboratoř na čipu MeSH
- lidé MeSH
- počítačová simulace MeSH
- průtoková cytometrie přístrojové vybavení metody MeSH
- stochastické procesy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Idiopatické zánětlivé myopatie (IZM) zahrnují dermatomyozitidu (DM), polymyozitidu (PM) a myozitidu s inkluzními tělísky (IBM) klinicky jsou charakterizovány symetrickou svalovou slabostí zejména proximálního svalstva. Etiologie a patogeneze není zatím dobře známa, ale je jisté, že na vývoji těchto onemocnění se podílejí imunologické mechanismy. Základním a společným histopatologickým kritériem IZM je infiltrace zánětlivými buňkami ve svalové tkáni. Tento zánět je často velmi fokální a heterogenní. Ne všechny svaly jsou postiženy ve stejný čas u stejného pacienta stejně. Existují případy, kdy přetrvává svalová slabost, přestože ve svalové tkáni již nenacházíme, anebo pouze v minimální míře, známky infiltrace svalovými buňkami. Přesná příčina svalové slabosti zůstává neznámá. Cílem této práce bylo pokusit se zmapovat mechanismy vedoucí k zánětlivé infiltraci svalů, ke tkáňovému poškození a následně ke klinickým projevům onemocnění u nemocných s PM a DM. V současné době nejsou dobře známy mechanismy přispívající k přetrvávání zánětlivých buněk a tvorbě edému ve svalové tkáni. Hledali jsme jakým způsobem enzymy COX-1, COX-2 a 5-LOX exprimované ve svalové tkáni podílejí na rozvoji a průběhu zánětlivého procesu, a jaká je tedy role COX, LOX a jejich produktů v patogenezi těchto onemocnění. Poprvé v této studii byla detekována exprese mRNA pro enzymy COX-1, COX-2 a 5-LOX na svalových vzorcích u pacientů s dermatomyozitidou a polymyozitidou. Tato exprese byla zvýšena v zánětem postižených svalových tkáních v porovnání s tkáněmi nepostiženými rozlišenými pomocí MRI, a zároveň byla vyšší i v porovnání tkáněmi odebranými po terapii, což naznačuje roli COX-1, COX-2, a 5-LOX a jejich produktů v patogenezi zánětu a tvorbě edému ve svalové tkáni u nemocných s DM/PM. Exprese systému IP-10 - CXCR3 ve svalových vzorcích svědčí pro významnou účast v patogenezi onemocnění. Současná nepřítomnost CCR5 na infiltrujících buňkách ukazuje na malé zastoupení Th1 buněk a přisuzuje reakci mezi IP-10 a CXCR3 roli spíše v aktivaci svalových buněk. Častá exprese IFN-β může být důvodem hyperexprese HLA molekul I. Akutní zánětlivé změny u IZM způsobují vznik edému, který může být vizualizován pomocí magnetické rezonance (MRI). Distribuce zánětlivých změn ve svalové tkáni je často velmi fokální. V rámci naší studie jsme sledovali vztah mezi MRI svalů stehen a klinickými a histopatologickým parametry u pacientů s IZM. Globální klinický stav a aktivita svalů pacientů hodnocené pomocí VAS nejlépe korelovaly s intenzitou MRI svalů. Pokud byla provedena biopsie cílená na základě MRI rozlišení postižených a nepostižených svalů detekovali jsme v takto odebraných MRI-postižených vzorcích signifikantně více zánětlivých buněk než ve vzorcích odebraných z MRI-nepostižených částí. Intenzita edému na MRI signifikantně poklesla při druhém vyšetření po léčbě, ačkoliv toto zlepšení na MRI nebylo provázeno poklesem počtu zánětlivých buněk ve svalových vzorcích odebraných po léčbě. Tyto výsledky naznačují, že neinvazivní vyšetření MRI by mohlo být užitečným a lepším parametrem k hodnocení klinického stavu a účinku léčby u pacientů s PM/DM než histologické hodnocení vzorků svalové tkáně. Cílem naší terapeutické části naší studie bylo zjistit, jaká je účinnost a tolerance léčby cyclosporinem A nebo methotrexatem v kombinaci s kortikosteroidy u pacientů s těžkou, aktivní polymyozitidou či dermatomyozitidou. Léčba pacientů pomocí methotrexatu nebo cyclosporinu A s kortikosteroidy byla v obou případech provázena zlepšením klinických i laboratorních parametrů. Naše výsledky prokázaly, že oba léčebné postupy byly v terapii PM/DM účinné, a že nebyl mezi oběma léky signifikantní rozdíl v jejich účinku. Změny hladin CK a IL-1Ra v této studii nebyly spojeny se zlepšením klinických parametrů nemoci. Pacienti léčeni MTX vykazovali statisticky nevýznamně lepší odpověď v některých parametrech, jako byl pokles CK, než pacienti léčeni CyA, což naznačuje, že MTX by mohl být lepším lékem pro léčbu PM/DM než CyA.
Idiopathic inflammatory myopathies (IIM) include dermatomyositis (DM), polymyositis (PM) and inclusion body myositis (IBM), which are clinically characterized by symmetrical proximal muscle weakness. The etiology and pathogenesis are unknown although immunological mechanisms appear to be involved. The hallmark and the basic histopathological criterion is an infiltrate with inflammatory cells. This muscle inflammation is often focal and heterogeneous. Not all of the muscles are affected at the same time with the same patient. Cases with persistent muscle weakness exist while at the same time the inflammatory infiltrate is only minimal or can no longer be found. The cause of the weakness appears to be largely unknown. The aim of our project was to find out and describe mechanisms that lead to the infiltration of inflammatory cells in the muscle tissue, muscle edema and the tissue damage, and subsequently to the clinical symptoms in patients with PM and DM. There is not much known about the factors that contribute to the persistence of inflammatory cells in muscle tissues and for the formation of edema in the muscle tissue. We searched for the contribution of COX and LOX enzymes production in the muscle during the evolution of myositis to understand the role that COX, LOX and their products might play in the pathogenesis of this disease.We observed for the first time the expression of COX-1, COX-2 and 5-LOX mRNA in muscle tissues from IIM patients. This expression of mRNA for these enzymes was increased in affected tissues and this was seen not only in inflammatory or vascular cells but also in muscle cells. The fact that COX and LOX enzymes are induced in myositis suggests their contribution to pathologic processes during the disease. The expression of IP-10-CXCR3 system in the muscle tissue samples points towards significant participation in the disease pathogenesis. The fact that CCR5 is not present in the infiltrating cells shows small representation of Th1 cells and it attributes the reaction between IP-10 and CXCR3 the role rather in activation of the muscle cells. The reason for hyperexpression of HLA class I molecules can be constituted by frequent expression of IFN-β. Acute inflammation in IIM causes edema that can be visualized by magnetic resonance imaging (MRI). The inflammatory infiltrate in IIM is thought to be frequent in a focal distribution. We tried to better evaluate the relationship of MR image of thigh muscles to clinical and histological parameters in patients with IIM. Assessment of the global and muscle disease activity correlated best with the intensity of MR image. Biopsies guided by positive MRI findings detect significantly more inflammatory infiltrate than the biopsies taken from MRI non-affected sites. The intensity of MRI oedema decreased significantly after the treatment, however, the improvement in the histologically detected inflammation has not been seen. This suggests that MRI could be a preferable parameter to histology in evaluation of clinical status and treatment effect in PM and DM patients. In our clinical study we attempted to determine the effectiveness and tolerance of treatment with cyclosporine A (CyA) or methotrexate (MTX) added to corticosteroids in patients with severe, active PM and DM. Significant improvement in muscle endurance and functional test (MEFT), clinical assessment (CA), global patient’s assessment (GPA) and muscle MRI was found in both groups MTX and CyA. Patients treated with MTX showed insignificantly better response than patients with CyA. CK levels in MTX group decreased significantly after 1, 3 and 6 months, whereas significant reduction in CyA group was first observed after 6 months. IL-1Ra serum levels significantly dropped in CyA group after two weeks, whereas in MTX group the significant decrease was first seen after 3 months of treatment. Good correlation was found between each of the clinical parameters (MEFT, CA and GPA), none of them showed any correlation with CK or IL-1Ra levels. Administration of MTX or CyA added to corticosteroids was associated with clinical and laboratory improvement. Changes in CK and IL-1Ra levels were not associated with parameters of clinical disease severity measured in this study.
- MeSH
- dermatomyozitida genetika patofyziologie terapie MeSH
- finanční podpora výzkumu jako téma MeSH
- imunosupresiva klasifikace terapeutické užití MeSH
- kreatinkinasa diagnostické užití MeSH
- lidé MeSH
- magnetická rezonanční tomografie využití MeSH
- polymyozitida genetika patofyziologie terapie MeSH
- Check Tag
- lidé MeSH
