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Muehlmann M.,Ludwig Maximilians University of Munich | Koerte I.K.,Ludwig Maximilians University of Munich | Laubender R.P.,Institute of Medical Informatics | Steffinger D.,Ludwig Maximilians University of Munich | And 5 more authors.
Investigative Radiology | Year: 2013

Objectives: The aim of this study was to investigate the relationship between the pressure setting of the ventriculoperitoneal (VP) shunt valve and a magnetic resonance (MR)-based estimate of intracranial pressure (ICP) in children with shunt-treated hydrocephalus without clinical signs of shunt malfunction. Materials and Methods: Institutional review board approval was obtained before the study, and all subjects and/or their legal guardians provided written informed consent. In this prospective study, 15 consecutive patients (median age, 8.25 years; range, 2.2-18.4 years; 6 girls and 9 boys) with shunt-treated hydrocephalus without signs of shunt malfunction were examined with retrospectively gated phase contrast sequences to quantify arterial inflow, venous outflow, and cerebrospinal fluid (CSF) flow to and from the cranial vault. The ratio of the maximal intracranial volume change and the pulse pressure gradient change was used to derive MR-ICP. Spearman ρ was used to test for the association of setting of the shunt valve opening pressure and MR-ICP. Results: Shunt valve opening pressure settings and MR-ICP were positively correlated (Spearman ρ = 0.64, P < 0.01). Median MR-ICP was 8.67 mm Hg (interquartile range [IQR], 1.59 mm Hg) and median setting of the VP-shunt valve was 6.62 mm Hg (IQR, 1.47 mm Hg). The median MR-ICP was 1.9 mm Hg (IQR, 0.73 mm Hg) higher than the setting of the shunt valve. Conclusion: There is a positive correlation between MR-ICP and VP shunt valve opening pressure setting. The systematically higher assessment of MR-ICP is most likely a result of outflow resistance within the shunt tubing system and well within the known fluctuation rates of VP shunt systems. © 2013 by Lippincott Williams & Wilkins. Source


Zhao J.,Institute of Medical Informatics
Telemedicine journal and e-health : the official journal of the American Telemedicine Association | Year: 2010

The objective of this study was to share the experience of building an information security system for a regional collaborative medical platform (RCMP) and discuss the lessons learned from practical projects. Safety measures are analyzed from the perspective of system engineering. We present the essential requirements, critical architectures, and policies for system security of regional collaborative medical platforms. Source


Zhao J.,Institute of Medical Informatics
Telemedicine journal and e-health : the official journal of the American Telemedicine Association | Year: 2011

China has been implementing regional collaborative medical service (also known as e-health) for >5 years, but is still facing the challenges of bridging different community health information systems (CHISs). The fact that different communities have different systems makes it difficult to share information and data between different CHISs. To explore a solution for addressing this problem, we constructed a demonstration CHIS in Beijing's Dongcheng District. This system is based on the Software-as-a-Service model, in which a central data center is used to store users' health records and to provide different services. This system provides a comprehensive platform combining disease prevention, health protection, medical care, rehabilitation, health education, and family planning. In this article, we first show the challenge of implementing e-health-oriented CHIS in China, then we briefly introduce our solution, and finally we share our experience learned from the modern CHIS implementation practice. Source


Herbst A.,Ludwig Maximilians University of Munich | Rahmig K.,Ludwig Maximilians University of Munich | Stieber P.,Institute of Clinical Chemistry | Philipp A.,Ludwig Maximilians University of Munich | And 6 more authors.
American Journal of Gastroenterology | Year: 2011

Objectives: Colorectal cancer is the third most common cancer and a major cause of cancer-related deaths. Early detection of colonic lesions can reduce the incidence and mortality of colorectal cancer. Colonoscopy is the screening test for colorectal cancer with the highest efficacy, but its acceptance in the general public is rather low. To identify suitable tumor-derived markers that could detect colorectal cancer in blood samples, we analyzed the methylation status of a panel of genes in sera of affected patients. Methods: Using methylation-specific quantitative PCR, we analyzed the methylation of ten marker genes in sera of healthy individuals and patients with colorectal cancer. Results: Only HLTF, HPP1/TPEF, and NEUROG1 DNA methylation was detectable in at least 50% of patients with colorectal cancers. Whereas HLTF and HPP1/TPEF preferentially detected advanced and metastasized colorectal cancers, NEUROG1 methylation was detectable in UICC stages I-IV at a similar rate. Compared with other methylation markers, such as ALX4, SEPT9, and vimentin, NEUROG1 shows a higher sensitivity for colorectal cancer at UICC stages I and II. At a specificity of 91%, NEUROG1 reached a sensitivity of 61% (confidence interval, 50.4-70.6%) for the detection of colorectal cancers. Furthermore, detection of NEUROG1 methylation was independent of age and gender. Conclusions: Methylation of the NEUROG1 gene is frequently found in sera of patients with colorectal cancers independent of tumor stage. The quantitative detection of NEUROG1 DNA methylation in serum is a suitable approach for the non-invasive screening for asymptomatic colorectal cancer. © 2011 by the American College of Gastroenterology. Source


Zhao J.,Institute of Medical Informatics
Telemedicine journal and e-health : the official journal of the American Telemedicine Association | Year: 2010

Data sharing and information exchange among medical institutions is a requirement for convenient and effective data availability for both healthcare professionals and patients. In this paper, the characteristics of medical data are studied; two mainstream technologies of data storage for medical information are compared, and three strategies of medical documents storage are described with detailed advantages and disadvantages. Semi-structured storage technology is easier to deploy and much more promising to promote in a wider range than all-structured methods. The combination of central and distributed data storage is more practical for regional data sharing. This analysis suggests that semi-structural data storage technology and the combination of central and distributed data storage are efficient and fit well the current situation in China. Source

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