Citations

Background. Annual foot examinations (FE) constitute a critical component of care for diabetes. Documented evidence of FE is central to quality-of-care reporting; however, manual abstraction of electronic medical records (EMR) is slow, expensive, and subject to error. The objective of this study was to test the hypothesis that text mining of the EMR results in ascertaining FE evidence with accuracy comparable to manual abstraction. Methods. The text of inpatient and outpatient clinical reports was searched with natural-language (NL) queries for evidence of neurological, vascular, and structural components of FE. A manual medical records audit was used for validation. The reference standard consisted of 3 independent sets used for development (n=200 ), validation (n=118 ), and reliability (n=80 ). Results. The reliability of manual auditing was 91% (95% confidence interval [CI]= 85— 97) and was determined by comparing the results of an additional audit to the original audit using the records in the reliability set. The accuracy of the NL query requiring 1 of 3 FE components was 89% (95% CI= 83— 95). The accuracy of the query requiring any 2 of 3 components was 88% (95% CI= 82— 94). The accuracy of the query requiring all 3 components was 75% (95% CI= 68— 83). Conclusions. The free text of the EMR is a viable source of information necessary for quality of health care reporting on the evidence of FE for patients with diabetes. The low-cost methodology is scalable to monitoring large numbers of patients and can be used to streamline quality-of-care reporting.

PurposeA phase I first-in-human study was conducted to characterize the safety, tolerability, pharmacokinetic, and pharmacodynamic properties of the anti–insulinlike growth factor 1 receptor (IGF-IR) monoclonal antibody CP-751,871.Patients and MethodsAfter informed consent and screening, 47 patients with multiple myeloma in relapse or refractory phase were enrolled into 11 dose-escalation cohorts of CP-751,871 at doses from 0.025 to 20 mg/kg for 4 weeks. Patients with less than a partial response to CP-751,871 treatment were eligible to receive CP-751,871 in combination with oral dexamethasone at the discretion of the investigator. Treatment with CP-751,871 and rapamycin with or without dexamethasone was also offered to patients enrolled in the 10 and 20 mg/kg cohorts with less than a partial response to initial therapy with single-agent CP-751,871.ResultsNo CP-751,871-related dose-limiting toxicities were identified. Plasma CP-751,871 concentrations increased with dose and concentration-time profiles were consistent with those of antibodies with target-mediated disposition. Importantly, CP-751,871 administration led to a decrease in granulocyte IGF-IR expression and serum insulinlike growth factor 1 accumulation at high doses, suggesting systemic IGF-IR inhibition. Tumor response was assessed according to the European Group for Blood and Marrow Transplantation criteria. Nine responses were reported in 27 patients treated with CP-751,871 in combination with dexamethasone. Of interest, two of the patients with a partial response were progressing from dexamethasone treatment at study entry.ConclusionThese data indicate that CP-751,871 is well tolerated and may constitute a novel agent in the treatment of multiple myeloma.

Background— Obesity is a risk factor for atrial fibrillation and other cardiovascular conditions. Our objective was to determine whether catheter-based ablation effectively treated atrial fibrillation in obese patients. Methods and Results— Five hundred twenty-three consecutive patients with symptomatic, medication-refractory atrial fibrillation underwent catheter ablation. Patients were grouped by body mass index (lean, <25 kg/m 2 ; overweight, 25 to 29.9 kg/m 2 ; obese, ≥30 kg/m 2 ). Outcome and quality of life were measured with a general health survey (Medical Outcomes Study 36-item Short-Form General Health Survey [SF-36]); patients were assessed before ablation and at 3 and 12 months after the procedure. Two hundred twenty-eight study patients (44%) were overweight, and 201 (38%) were obese. Twelve months after curative ablation, 72% of patients were free of atrial fibrillation without the use of antiarrhythmic agents; 84% were arrhythmia free when those receiving medication were included. Atrial fibrillation was eliminated in 75%, 72%, and 70% of the lean, overweight, and obese patients, respectively, at 12 months ( P =0.41, trend test). SF-36 scores were lower for patients with higher body mass index ( P <0.05) at baseline. SF-36 scores improved in every functional domain for all body mass index groups after ablation. The mean SF-36 total physical score increased from 59±20 at baseline to 77±19 in 12 months ( P <0.001). The total mental health score improved from 66±18 to 79±16 in 12 months ( P <0.001). Conclusions— Catheter ablation of atrial fibrillation was effective in obese patients. Coexistence of atrial fibrillation and obesity indicated lower SF-36 scores, but the improvement in quality of life was consistent across all body mass index categories.

Background— Several echocardiographic dyssynchrony indexes have been proposed to identify responders to cardiac resynchronization therapy using tissue velocity and strain. The present study aimed to compare tissue velocity–derived and strain-derived dyssynchrony indexes in patients with or without systolic dysfunction and left bundle-branch block. Methods and Results— Tissue Doppler imaging was performed in 120 subjects divided into 4 groups: group 1 (n=40), normal subjects; group 2 (n=20), normal left ventricular ejection fraction and left bundle-branch block; group 3 (n=20), left ventricular ejection fraction <35% and normal conduction; and group 4 (n=40), left ventricular ejection fraction <35% and left bundle-branch block. Dyssynchrony indexes based on time to peak tissue velocity (septal-lateral delay, anteroseptal-posterior delay, and SD in time to peak systolic velocity in the 12 left ventricular segments) and strain (SD of time to peak strain in 12 segments) were measured. The SD in time to peak systolic velocity in the 12 left ventricular segments was greater in group 4 (54 ms; 25th and 75th percentiles, 46 to 64 ms) than group 1 (44 ms; 25th and 75th percentiles, 28 to 53 ms; P =0.006), but there was a considerable overlap of all tissue velocity–derived indexes among 4 groups, with 40% to 68% of group 1 having values proposed for predicting the responders of cardiac resynchronization therapy. The SD of time to peak strain in 12 segments distinguished these groups with much less overlap ( P <0.01 for all pairwise comparisons). Conclusions— A substantial proportion of normal subjects have tissue velocity–derived dyssynchrony indexes higher than the cutoff value proposed for predicting beneficial effect of cardiac resynchronization therapy. Strain-derived timing index appears to be more specific for dyssynchrony in patients with systolic dysfunction and left bundle-branch block. Identifying an optimal tissue velocity– or strain-derived dyssynchrony index requires a large prospective clinical trial.

Considerable interest in the elastic properties of soft tissue has increased in medicine due to their clinical relevance for monitoring various diseases as well as a biomarker for cancer. A recent emerging field is the use of acoustic radiation force for imaging and estimating the elastic properties of tissue. Newly developed imaging modalities include shear wave elasticity imaging, supersonic shear wave imaging, acoustic radiation force impulse imaging, and vibro-acoustography. In these new methods, the shear wave is used to estimate the elasticity of tissue. We have developed a novel surface wave method for noninvasively estimating the elasticity of tissue [X. Zhang et al., J. Acoust. Soc. Am., 122, 2522-2525 (2007)]. In this method, a localized ultrasound radiation force is remotely and noninvasively applied inside the tissue. The surface wave speed is used to estimate the elasticity of tissue. This method has been further developed and applied to estimate the viscoelasticity of animal myocardium tissue. In this abstract, we report our recent results of in vitro studies on animal myocardium tissue. Both the surface wave and shear wave are measured and analyzed. Noninvasive characterization of viscoelastic properties of myocardium tissue may be a very important tool for assessing heart function.

Vibro-acoustography (VA) is based on conversion of ultrasound energy from high frequency to a low frequency. This conversion, which results from the nonlinear nature of wave equation, gives VA some key advantages over linear ultrasound imaging such as B-mode. Two key features of VA are analyzed: lack of speckle noise, and angle-independency, which is the ability of imaging specular reflectors regardless of their orientation. Both the speckle noise and angle dependency are major artifacts in B-mode. Lack of speckle noise results from the fact that VA images are constructed from the low frequency acoustic signal. Using an acoustical model, it is shown that the random scatterers within soft tissue do not promote speckle noise in VA as they do in B-mode; thus VA generally produces high contrast images. Angle-independency results from the broad beam pattern of the low-frequency acoustic field. A model is constructed describing the amplitude of the acoustic signal versus object orientation angle. It is shown that the signal amplitude is relatively insensitive to object orientation; thus VA may be suitable for imaging specular objects such as implants. It is concluded that VA may be advantageous in applications where speckle noise and angle dependency are of concern.

Harmonic or pulsed radiation pressure and subsequent measurement of the tissue response can be used to accurately quantitatively measure fundamental material properties of tissue. The measurement of shear wave dispersion can be used to estimate elastic shear moduli of tissue using an appropriate model. Fundamental model free properties such as complex modulus can also be measured. Ultrasound radiation pressure is used to induce free propagating shear waves. The measurable properties of the shear waves such as speed are sensitive to only the local material properties of the tissue under certain circumstances. A model relating the shear wave speed as a function of frequency is related to the elastic and viscous moduli within small regions of tissue according to, for instance, the Voigt model. Shear and elastic moduli in tissue are measured with high accuracy and precision given appropriate models of wave propagation within the geometry of the tissue. Complex modulus in liver of live pig and other tissues have been made. Careful use of shear wave propagation and subsequent measurements can provide fundamental quantitative measurements of tissue mechanical properties if models are accurate. An application of this method is the noninvasive measurement of liver stiffness as a surrogate for fibrosis.