The flexibility offered by an Enterprise Service Bus (ESB) in enabling various applications to exchange data makes it a very important middleware layer that is responsible for transporting data in a Service-Oriented A...The flexibility offered by an Enterprise Service Bus (ESB) in enabling various applications to exchange data makes it a very important middleware layer that is responsible for transporting data in a Service-Oriented Architecture (SOA). The popularity of the ESB has given rise to a number of commercial off the shelf (COTS) products as well as open source ESBs. In this study, we evaluated three open source ESBs and compared them both qualitatively and quantitatively. The empirical results were statistically tested to determine the statistical significance of the results.展开更多
Lack of investment for magnetic resonance(MR)fusion systems is an obstacle to deliver targeted prostate biopsies within the prostate cancer diagnostic pathway.We developed a coordinate-based method to support cognitiv...Lack of investment for magnetic resonance(MR)fusion systems is an obstacle to deliver targeted prostate biopsies within the prostate cancer diagnostic pathway.We developed a coordinate-based method to support cognitive targeted prostate biopsies and then performed an audit on cancer detection and the location of lesions.In each patient,the prostate is considered as two separate hemiprostates,and each hemiprostate is divided into 4×4×4 units.Each unit is therefore defined by a three-dimensional coordinate.We prospectively applied our coordinates approach to target 106 prostatic lesions in 93 men.Among 45(of 106;42.5%)lesions positive for cancer,27 lesions(60.0%)harbored clinically significant disease.PSA density was significantly higher in patients with proven cancer(median:0.264 ng ml^(-2))when compared to the noncancer group(median:0.145 ng ml-2;P=0.003,Wilcoxon ranksum test).Lesions with Prostate Imaging-Reporting and Data System(PIRADS)score of 5 were found to have a cancer incidence of 65.2%,while PI RADS 4 and 3 lesions have a lower risk of cancer detection,as expected,at 37.3%and 31.3%,respectively.The probability of a lesion being cancerous in our series significantly decreases as we go from the“apex-to-base”dimension(odds ratio[OR]:2.62,95%confidence interval[Cl]:1.55-4.44,P=0.00034).Our analysis also indicates that the probability of cancer decreases as the prostate volume increases(OR:1.03,95%Cl:1.01-1.05,P=0.00327).Based on this feasibility study,the use of coordinates to guide cognitive targeted prostate biopsies warrants future validation study in additional centers.展开更多
AIM To evaluate magnitude/direction of changes in peripheral lipid profiles in patients undergoing direct acting therapy for hepatitis C by genotype.METHODS Mono-infected patients with hepatitis C were treated with gu...AIM To evaluate magnitude/direction of changes in peripheral lipid profiles in patients undergoing direct acting therapy for hepatitis C by genotype.METHODS Mono-infected patients with hepatitis C were treated with guideline-based DAAs at a university-based liver clinic. Patient characteristics and laboratory values were collected before and after the treatment period. Baseline demographics included age, ethnicity, hypertension, diabetes, hyperlipidemia, treatment regimen, and fibrosis stage. Total cholesterol(TCHOL), high density lipoprotein(HDL), low density lipoprotein(LDL), triglycerides(TG), and liver function tests were measured prior to treatment and ETR. Changes in lipid and liver function were evaluated by subgroups with respect to genotype. Mean differences were calculated for each lipid profile and liver function component(direction/magnitude). The mean differences in lipid profiles were then compared between genotypes for differences in direction/magnitude. Lipid profile and liver function changes were evaluated with Levene's test and student's t test. Mean differences in lipid profiles were compared between genotypes using ANOVA, post hoc analysis via the Bonferroni correction or Dunnett T3.RESULTS Three hundred and seventy five patients enrolled with 321(85.6%) achieving sustained-viral response at 12 wk. 72.3% were genotype 1(GT1), 18.1% genotype 2(GT2), 9.7% genotype 3(GT3). Baseline demographics were similar. Significant change in lipid profiles were seen with GT1 and GT3(ΔGT1, p and ΔGT3, p), with TCHOL increasing(+5.3, P = 0.005 and +16.1, P < 0.001), HDL increasing(+12.5, P < 0.001 and +7.9, P = 0.038), LDL increasing(+7.4, P = 0.058 and +12.5, P < 0.001), and TG decreasing(-5.9, P = 0.044 and-9.80 P = 0.067). Among genotypes(ΔGT1 v. ΔGT2 v. ΔGT3, ANOVA), significant mean differences were seen with TCHOL(+5.3 v. +0.1 v. +16.1, P = 0.017) and HDL(+12.3 v. +2 v. +7.9, P = 0.040). Post-hoc, GT3 was associated with a greater increase in TCHOL than GT1 and GT2(P = 0.028 and P = 0.019).CONCLUSION Successful DAA therapy results in increases in TCHOL, LDL, and HDL and decrease in TG, particularly in GT1/GT3. Changes are most pronounced in GT3.展开更多
Musculoskeletal injuries following seizures have a high morbidity and mortality. These injuries are often missed and the diagnosis is delayed due to a lack of clinical suspicion and appropriate investigations. We repo...Musculoskeletal injuries following seizures have a high morbidity and mortality. These injuries are often missed and the diagnosis is delayed due to a lack of clinical suspicion and appropriate investigations. We report a case of 72 years old male with simultaneous bilateral central acetabular fracture dislocation and bilateral posterior shoulder fracture dislocation secondary to an epileptic seizure. Present study high- lights the significance of clinical suspicion and clinico-radiological evaluation for diagnosis of a rare injury following episode of seizures. Simultaneous fracture dislocation of all four limbs treated with a holistic approach can lead to a good functional recovery. Surgical management with open reduction and internal fixation is preferred and replacement arthroplasty should be reserved for cases with implant failure and elderly patients.展开更多
Background:To evaluate the predictive values of Prostate Imaging Reporting and Data System version 2(PI-RADS v2),prostate-specific antigen(PSA)level,PSA density(PSAD),digital rectal examination findings,and prostate v...Background:To evaluate the predictive values of Prostate Imaging Reporting and Data System version 2(PI-RADS v2),prostate-specific antigen(PSA)level,PSA density(PSAD),digital rectal examination findings,and prostate volume,individually and in combination,for the detection of prostate cancer(Pca)in biopsy-naïve patients.Methods:We retrospectively analyzed 630 patients who underwent transrectal systematic prostate biopsy following prostate multiparametric magnetic resonance imaging.A standard 12-core biopsy procedure was performed.Univariate and multivariate analyses were performed to determine the significant predictors of clinically significant cancer but not Pca.Results:The median age,PSA level,and PSAD were 70 years,8.6 ng/mL,and 0.18 ng/mL/mL,respectively.A total of 374(59.4%)of 630 patients were biopsy-positive for Pca,and 241(64.4%)of 374 were diagnosed with clinically significant Pca(csPCa).The PI-RADS v2 score and PSAD were independent predictors of Pca and csPCa.The PI-RADS v2 score of 5 regardless of the PSAD value,or PI-RADS v2 score of 4 plus a PSAD of<0.3 ng/mL/mL,was associated with the highest csPCa detection rate(36.1%-82.1%).Instead,the PI-RADS v2 score of<3 and PSAD of<0.3 ng/mL/mL yielded the lowest risk of csPCa.Conclusion:The combination of the PI-RADS v2 score and PSAD could prove to be a helpful and reliable diagnostic tool before performing prostate biopsies.Patients with a PI-RADS v2 score of<3 and PSAD of<0.3 ng/mL/mL could potentially avoid a prostate biopsy.展开更多
Urolithiasis is the most common cause of nonobstetric abdominal pain,resulting in 1.7 admissions per 1000 deliveries.Urolithiasis most commonly occurs in the second and third trimesters,with an incidence between 1∶12...Urolithiasis is the most common cause of nonobstetric abdominal pain,resulting in 1.7 admissions per 1000 deliveries.Urolithiasis most commonly occurs in the second and third trimesters,with an incidence between 1∶125 and 1∶2000.Acute urinary system obstructions are challenging to manage in obstetric patients because they contribute to physiological and anatomical changes that result in patho-logical outcomes.The restricted use of computed tomography in diagnosing and managing urolithiasis is particularly challenging.In ad-dition,a prompt diagnosis is required because the presence of renal calculi during pregnancy increases the risk of fulminating sepsis and preterm delivery.Affected pregnancies are conservatively managed;however,1 in 4 requires surgical intervention.Indications for surgi-cal interventions are complex and range from nephrostomy insertion to empirical stent placement or ureteroscopy.Therefore,a multi-disciplinary approach is required to optimize patient care.The diagnosis and management of urolithiasis in pregnancy are complex.We reviewed the role,safety,advantages and disadvantages of diagnostic tests and treatment used to manage acute urinary obstructions in pregnancy.展开更多
文摘The flexibility offered by an Enterprise Service Bus (ESB) in enabling various applications to exchange data makes it a very important middleware layer that is responsible for transporting data in a Service-Oriented Architecture (SOA). The popularity of the ESB has given rise to a number of commercial off the shelf (COTS) products as well as open source ESBs. In this study, we evaluated three open source ESBs and compared them both qualitatively and quantitatively. The empirical results were statistically tested to determine the statistical significance of the results.
文摘Lack of investment for magnetic resonance(MR)fusion systems is an obstacle to deliver targeted prostate biopsies within the prostate cancer diagnostic pathway.We developed a coordinate-based method to support cognitive targeted prostate biopsies and then performed an audit on cancer detection and the location of lesions.In each patient,the prostate is considered as two separate hemiprostates,and each hemiprostate is divided into 4×4×4 units.Each unit is therefore defined by a three-dimensional coordinate.We prospectively applied our coordinates approach to target 106 prostatic lesions in 93 men.Among 45(of 106;42.5%)lesions positive for cancer,27 lesions(60.0%)harbored clinically significant disease.PSA density was significantly higher in patients with proven cancer(median:0.264 ng ml^(-2))when compared to the noncancer group(median:0.145 ng ml-2;P=0.003,Wilcoxon ranksum test).Lesions with Prostate Imaging-Reporting and Data System(PIRADS)score of 5 were found to have a cancer incidence of 65.2%,while PI RADS 4 and 3 lesions have a lower risk of cancer detection,as expected,at 37.3%and 31.3%,respectively.The probability of a lesion being cancerous in our series significantly decreases as we go from the“apex-to-base”dimension(odds ratio[OR]:2.62,95%confidence interval[Cl]:1.55-4.44,P=0.00034).Our analysis also indicates that the probability of cancer decreases as the prostate volume increases(OR:1.03,95%Cl:1.01-1.05,P=0.00327).Based on this feasibility study,the use of coordinates to guide cognitive targeted prostate biopsies warrants future validation study in additional centers.
文摘AIM To evaluate magnitude/direction of changes in peripheral lipid profiles in patients undergoing direct acting therapy for hepatitis C by genotype.METHODS Mono-infected patients with hepatitis C were treated with guideline-based DAAs at a university-based liver clinic. Patient characteristics and laboratory values were collected before and after the treatment period. Baseline demographics included age, ethnicity, hypertension, diabetes, hyperlipidemia, treatment regimen, and fibrosis stage. Total cholesterol(TCHOL), high density lipoprotein(HDL), low density lipoprotein(LDL), triglycerides(TG), and liver function tests were measured prior to treatment and ETR. Changes in lipid and liver function were evaluated by subgroups with respect to genotype. Mean differences were calculated for each lipid profile and liver function component(direction/magnitude). The mean differences in lipid profiles were then compared between genotypes for differences in direction/magnitude. Lipid profile and liver function changes were evaluated with Levene's test and student's t test. Mean differences in lipid profiles were compared between genotypes using ANOVA, post hoc analysis via the Bonferroni correction or Dunnett T3.RESULTS Three hundred and seventy five patients enrolled with 321(85.6%) achieving sustained-viral response at 12 wk. 72.3% were genotype 1(GT1), 18.1% genotype 2(GT2), 9.7% genotype 3(GT3). Baseline demographics were similar. Significant change in lipid profiles were seen with GT1 and GT3(ΔGT1, p and ΔGT3, p), with TCHOL increasing(+5.3, P = 0.005 and +16.1, P < 0.001), HDL increasing(+12.5, P < 0.001 and +7.9, P = 0.038), LDL increasing(+7.4, P = 0.058 and +12.5, P < 0.001), and TG decreasing(-5.9, P = 0.044 and-9.80 P = 0.067). Among genotypes(ΔGT1 v. ΔGT2 v. ΔGT3, ANOVA), significant mean differences were seen with TCHOL(+5.3 v. +0.1 v. +16.1, P = 0.017) and HDL(+12.3 v. +2 v. +7.9, P = 0.040). Post-hoc, GT3 was associated with a greater increase in TCHOL than GT1 and GT2(P = 0.028 and P = 0.019).CONCLUSION Successful DAA therapy results in increases in TCHOL, LDL, and HDL and decrease in TG, particularly in GT1/GT3. Changes are most pronounced in GT3.
文摘Musculoskeletal injuries following seizures have a high morbidity and mortality. These injuries are often missed and the diagnosis is delayed due to a lack of clinical suspicion and appropriate investigations. We report a case of 72 years old male with simultaneous bilateral central acetabular fracture dislocation and bilateral posterior shoulder fracture dislocation secondary to an epileptic seizure. Present study high- lights the significance of clinical suspicion and clinico-radiological evaluation for diagnosis of a rare injury following episode of seizures. Simultaneous fracture dislocation of all four limbs treated with a holistic approach can lead to a good functional recovery. Surgical management with open reduction and internal fixation is preferred and replacement arthroplasty should be reserved for cases with implant failure and elderly patients.
文摘Background:To evaluate the predictive values of Prostate Imaging Reporting and Data System version 2(PI-RADS v2),prostate-specific antigen(PSA)level,PSA density(PSAD),digital rectal examination findings,and prostate volume,individually and in combination,for the detection of prostate cancer(Pca)in biopsy-naïve patients.Methods:We retrospectively analyzed 630 patients who underwent transrectal systematic prostate biopsy following prostate multiparametric magnetic resonance imaging.A standard 12-core biopsy procedure was performed.Univariate and multivariate analyses were performed to determine the significant predictors of clinically significant cancer but not Pca.Results:The median age,PSA level,and PSAD were 70 years,8.6 ng/mL,and 0.18 ng/mL/mL,respectively.A total of 374(59.4%)of 630 patients were biopsy-positive for Pca,and 241(64.4%)of 374 were diagnosed with clinically significant Pca(csPCa).The PI-RADS v2 score and PSAD were independent predictors of Pca and csPCa.The PI-RADS v2 score of 5 regardless of the PSAD value,or PI-RADS v2 score of 4 plus a PSAD of<0.3 ng/mL/mL,was associated with the highest csPCa detection rate(36.1%-82.1%).Instead,the PI-RADS v2 score of<3 and PSAD of<0.3 ng/mL/mL yielded the lowest risk of csPCa.Conclusion:The combination of the PI-RADS v2 score and PSAD could prove to be a helpful and reliable diagnostic tool before performing prostate biopsies.Patients with a PI-RADS v2 score of<3 and PSAD of<0.3 ng/mL/mL could potentially avoid a prostate biopsy.
文摘Urolithiasis is the most common cause of nonobstetric abdominal pain,resulting in 1.7 admissions per 1000 deliveries.Urolithiasis most commonly occurs in the second and third trimesters,with an incidence between 1∶125 and 1∶2000.Acute urinary system obstructions are challenging to manage in obstetric patients because they contribute to physiological and anatomical changes that result in patho-logical outcomes.The restricted use of computed tomography in diagnosing and managing urolithiasis is particularly challenging.In ad-dition,a prompt diagnosis is required because the presence of renal calculi during pregnancy increases the risk of fulminating sepsis and preterm delivery.Affected pregnancies are conservatively managed;however,1 in 4 requires surgical intervention.Indications for surgi-cal interventions are complex and range from nephrostomy insertion to empirical stent placement or ureteroscopy.Therefore,a multi-disciplinary approach is required to optimize patient care.The diagnosis and management of urolithiasis in pregnancy are complex.We reviewed the role,safety,advantages and disadvantages of diagnostic tests and treatment used to manage acute urinary obstructions in pregnancy.
