Objective To investigate the clinicalmanifestations, electroencephalogram (EEG) characteristics, surgical treatment and prognosis of epilepsy secondary to Sturge-Weber syndrome (SWS) in children.Methods The data of 7 children with epilepsysecondaryto Sturge-Weber syndrome who were treated by surgery from May 2015 to May 2020 in our Children's Epilepsy Center were retrospectively reviewed. Their demographic characteristics, seizure forms, results of EEG and cranial imaging investigations, surgical methods, postoperative pathological reports and prognosis during follow-upwere summarized and analyzed. The prognosis were evaluated byEngel classificationat the last time point during follow-up. Results Totally 7 pediatric patients were enrolled, including 1 male (16/25, 64.0%) and 6 females.All the 7 cases presented with focal seizures at the onset among whom 2 cases developed status epilepticus during the course of the disease(epilepsiapartialiscontinuain 1 case),one case had epileptic spasmsand 1 case was characterized by cluster seizures. The interictal EEG manifestations of the cases gradually deteriorated as the course of the disease prolonged, including the slow wave on the affected side gradually increases (7/7), the amplitude gradually decreases (7/7), and the physiological wave disappears (4/7). Besides, no epileptiform discharges/incidental or a few epileptiform dischargeswere found in their interictal EEGs. Four cases underwent hemispherotomy, 1 case underwent temporo-parieto-occipital disconnection and 2 cases underwent lesion resection. The cases were followed up for 6 months to 5 years, and the average follow-up duration was 79.29 months. Six cases were rated as Engel Ⅰa during the regularfollow-up. Only 1 case was rated asEngel Ⅱ and Engel Ⅲ at 3 month and 1 year after the operation. ConclusionChildren with epilepsy secondary to SWS usually present with focal seizures and have diverse seizure forms. The EEG show characteristic changes. For the caseswith drug refractory epilepsy, detailed preoperative evaluation and reasonable surgical methods can result in a better therapeutic effect.
Objective To reveal the worldwide research status and hot topics of sleep apnea syndrome ( SAS) . Methods Articles were searched from Web of Science ( SCI) , Essential Science Indicator ( 2000 to 2010) database using sleep apnea syndrome or apnea as keywords. Retrieved documents were analyzed using the database with its own statistical functions and histcite software ( version 8.12. 16) .Results Since 1992 the international scientific papers on the SAS study showed a gradual upward trend.The United States is a world leader in this field. Recent research has focused on vascular endothelial barrier function and repair, oxidative stress, inflammation, cognitive function, special populations such as the elderlyor children patients with SAS. Conclusion Clinical researchers have paid more attention to SAS than before, but there are still many important issues unresolved.
Objective To investigate the current status and development of electronic health records (EHR) at home and abroad to grasp the development trends of EHR, so as to point out the direction of the development and relevant research on EHR. Methods Based on the Web of Science citation database and the principle of bibliometrics, we analyzed the retrieved literature in aspects of publication date, language, country/region, institution, author, etc. Results A total of 1 262 eligible studies were identified. The number of articles on EHR increased rapidly from only 2 in 1995 to 218 in 2012. In terms of country/region, the United States ranked the top in all countries (763 articles, accounting for 60.46%). In terms of institution, Harvard University ranked the top (135 articles, accounting for 10.70%). In terms of journal, the Journal of the American Medical Informatics Association ranked the top (106 articles, accounting for 8.40%). In terms of authors, David W. Bates ranked the top (45 articles, accounting for 3.57%). In terms of subject type, health care sciences services and medical informatics were mainly focused on. Conclusion The research on EHR has become a global hot spot and relevant bibliometrics will contribute to the timely and correctly grasp the whole picture of its development trends and main research direction.
In order to satisfy demands of massive and heterogeneous tumor clinical data processing and the multi-center collaborative diagnosis and treatment for tumor diseases, a Tumor Data Interacted System (TDIS) was established based on grid platform, so that an implementing virtualization platform of tumor diagnosis service was realized, sharing tumor information in real time and carrying on standardized management. The system adopts Globus Toolkit 4.0 tools to build the open grid service framework and encapsulats data resources based on Web Services Resource Framework (WSRF). The system uses the middleware technology to provide unified access interface for heterogeneous data interaction, which could optimize interactive process with virtualized service to query and call tumor information resources flexibly. For massive amounts of heterogeneous tumor data, the federated stored and multiple authorized mode is selected as security services mechanism, real-time monitoring and balancing load. The system can cooperatively manage multi-center heterogeneous tumor data to realize the tumor patient data query, sharing and analysis, and compare and match resources in typical clinical database or clinical information database in other service node, thus it can assist doctors in consulting similar case and making up multidisciplinary treatment plan for tumors. Consequently, the system can improve efficiency of diagnosis and treatment for tumor, and promote the development of collaborative tumor diagnosis model.
Integrating visualization toolkit and the capability of interaction, bidirectional communication and graphics rendering which provided by HTML5, we explored and experimented on the feasibility of remote medical image reconstruction and interaction in pure Web. We prompted server-centric method which did not need to download the big medical data to local connections and avoided considering network transmission pressure and the three-dimensional (3D) rendering capability of client hardware. The method integrated remote medical image reconstruction and interaction into Web seamlessly, which was applicable to lower-end computers and mobile devices. Finally, we tested this method in the Internet and achieved real-time effects. This Web-based 3D reconstruction and interaction method, which crosses over internet terminals and performance limited devices, may be useful for remote medical assistant.
ObjectiveTo investigate the effectiveness of dorsal pentagonal flap for reconstruction of the web space in congenital toe syndactyly. MethodsBetween January 2009 and June 2014, 10 patients with congenital toe syndactyly were treated for web space reconstruction with dorsal pentagonal flap. There were 6 boys and 4 girls with the average age of 42 months (range, 8 months to 9 years). The congenital toe syndactyly located at the left foot in 5 cases, the right foot in 4 cases, and both feet in 1 case; 7 patients had polydactyly and 1 patient had brachydactylia. During followup, the toe function and web space appearance, web space depth, and web space gradient were observed to evaluate the effectiveness. ResultsAll 13 flaps survived and incisions healed by first intention. Ten patients were followed up 6-50 months (mean, 26 months). The skin color and texture in 13 reconstructed web spaces were close to normal web space. In 9 patients undergoing web spaces reconstruction of single foot, the abduction angle of toes was (42.879±3.703)° at the injured side, showing no significant difference when compared with the normal side [(45.922±2.657)°] (t=-2.004, P=0.062); the web space depth was (1.881±0.266) cm at the injured side and was (1.631±0.202) cm at the normal side, showing significant difference (t=2.248, P=0.039); and the web space gradient was (42.733±3.421)° at the injured side and was (41.189±5.593)° at the normal side, showing no significant difference (t=0.707, P=0.490). The web space appearance, web space depth, and web space gradient were close to those of the normal web space in 1 patient undergoing bilateral web spaces reconstruction. ConclusionWeb space reconstruction with dorsal pentagonal flap is easy to perform with reliable blood supply and low re-operated rate. The cosmetic and functional results are satisfactory.
With the trend of the development of "Internet +", some further requirements for the mobility of medical images have been required in the medical field. In view of this demand, this paper presents a web-based visual medical imaging platform. First, the feasibility of medical imaging is analyzed and technical points. CT (Computed Tomography) or MRI (Magnetic Resonance Imaging) images are reconstructed three-dimensionally by MeVisLab and packaged as X3D (Extensible 3D Graphics) files shown in the present paper. Then, the B/S (Browser/Server) system specially designed for 3D image is designed by using the HTML 5 and WebGL rendering engine library, and the X3D image file is parsed and rendered by the system. The results of this study showed that the platform was suitable for multiple operating systems to realize the platform-crossing and mobilization of medical image data. The development of medical imaging platform is also pointed out in this paper. It notes that web application technology will not only promote the sharing of medical image data, but also facilitate image-based medical remote consultations and distance learning.
Objective To summarize and compare the functional characteristics and technical parameters of the comprehensive global clinical practice guideline (CPG) databases, so as to provide references for the construction of CPG database of China. Methods CPG databases were collected worldwide by discussing with experts in the guideline and database fields. Studies on guideline databases were searched in PubMed and CNKI to additionally collect CPG databases mentioned in these studies. Representative comprehensive CPG databases were finally selected by consulting relevant guideline experts. The basic information, functional characteristics (including column settings, service contents, and related file types) and technical parameter data were extracted and summarized. A descriptive analysis was conducted to compare different CPG databases. Results Nine guideline databases which are distributed in eight countries of the Americas, Europe, Oceania and Asia were included. The number of included guidelines of the nine databases ranged from 31 to 15 410. The earliest database was established in 1993. Except that the MINDS database didn’t provide search function, eight databases provided basic search function, and six provided further advanced search function. PDF and HTML formats of guidelines were available in most databases, but the XML format was only available in National Guideline Clearinghouse (NGC). Responsive Web design was an important feature for most websites of databases and four databases developed mobile applications. Local mainstream social media sharing function was provided by six databases. All databases’ construction was professional in technical parameters including network transmission, Web server, programming language and the selection of server room. Conclusion This study compares the functional features and technical parameters of the comprehensive global CPG databases, which provides important information that should be considered in establishing a guideline database, to strengthen the top-level design or to help optimize the functionality of a guideline database. It also helps guideline databases users to find more proper resources.
ObjectiveTo evaluate the effectiveness of preputial pedicled flap phalloplasty for repair of severe webbed penis. MethodsBetween May 2011 and May 2015, 23 boys with severe webbed penis were treated. The age ranged from 2 years and 8 months to 8 years and 3 months (mean, 4 years and 8 months). According to El-Koutby & El Gohary classification, 14 cases were rated as grade 3 simple webbed penis and 9 cases as compound webbed penis (2 cases of type 1, 2 cases of type 2, and 5 cases of type 3). The penis length was 2.1-5.4 cm (mean, 3.4 cm), and the penoscrotal angle was 130-160° (mean, 144°). All the glans could not be exposed. No other urinary system diseases and no history of penile surgery were found in children. All cases underwent one stage preputial pedicled flap phalloplasty. ResultsAfter successful correction, the penis length was 3.6-6.4 cm (mean, 4.7 cm); the penoscrotal angle was 90-110° (mean, 97°). Clear skin boundaries were observed at penile and scrotal parts. No web skin or scrotal skin was left on the penis. Primary healing of incision was obtained, with no necrosis of the flap or infection. All cases were followed up 12 to 41 months (mean, 25 months). No penile curvature, abnormal sensation of glans, or recurrence of the penoscrotal angle occurred, and the patients had normal urination. ConclusionPreputial pedicled flap phalloplasty can be used as one stage repair for severe webbed penis. The penis is close to natural state and had satisfactory appearance, avoiding the possibility of long-term edema and penile curvature.