Tool-supported Interactive Correction and Semantic Annotation of Narrative Clinical Reports.

Objectives: Our main objective is to design a method of, and supporting software for, interactive correction and semantic annotation of narrative clinical reports, which would allow for their easier and less erroneous processing outside their original context: first, by physicians unfamiliar with the original language (and possibly also the source specialty), and second, by tools requiring structured information, such as decision-support systems. Our additional goal is to gain insights into the process of narrative report creation, including the errors and ambiguities arising therein, and also into the process of report annotation by clinical terms. Finally, we also aim to provide a dataset of ground-truth transformations (specific for Czech as the source language), set up by expert physicians, which can be reused in the future for subsequent analytical studies and for training automated transformation procedures.

Medical knowledge representation system.

The aim of this article is to present a design of a Medical Knowledge Representation System (MEKRES). The system automatically offers relevant formalized knowledge by extended GLIF (Guidelines Interchange Format) models to participants (patient, physician, operator, ..

Formalization of clinical practice guidelines.

Clinical practice guidelines are textual recommendations based on the consensus of medical experts with the aim to solve diagnostic and therapeutic problems. For more advanced use in real medical applications it is necessary to find out mathematical models of physicians' decision-making processes. The acquisition of a formal model from text-based guidelines is a crucial point for development of decision support systems.

SAH gene variants revisited in the European Project On Genes in Hypertension.

Objective: Previous studies found significant association of hypertension and hypertension-related phenotypes with genetic variation in SAH (Spontaneously hypertensive rat-clone A-Hypertension-associated). We sought independent confirmation of these findings in the European Project On Genes in Hypertension.

Methods And Results: We randomly recruited 2603 relatives from 560 families and 31 unrelated subjects from six European populations (mean age 38.

Sympathetic activity, assessed by power spectral analysis of heart rate variability, in white-coat, masked and sustained hypertension versus true normotension.

Objective: To assess, in a population-based approach, sympathetic nervous system activity by the use of power spectral analysis of heart rate variability, in normotension, white-coat hypertension, masked hypertension and sustained hypertension.

Methods: The electrocardiographic RR interval was registered in the supine and standing positions and the low-frequency and high-frequency components of its variability were quantified. Cut-off values of 140/90 mmHg for conventional blood pressure and 135/85 mmHg for daytime ambulatory blood pressure were used to define the four blood pressure groups.

Sodium excretion as a modulator of genetic associations with cardiovascular phenotypes in the European Project on Genes in Hypertension.

Hypertension is a chronic age-related disorder, affecting nearly 20% of all adult Europeans. This disease entails debilitating cardiovascular complications and is the leading cause for drug prescriptions in Europeans older than 50 years. Intensive research over the past two decades has so far failed to identify common genetic polymorphisms with a major impact on blood pressure or associated cardiovascular phenotypes, suggesting that multiple genes each with a minor impact, along with gene-gene and gene-environment interactions, play a role.

Medical guidelines presentation and comparing with Electronic Health Record.

Electronic Health Record (EHR) systems are now being developed in many places. More advanced systems provide also reminder facilities, usually based on if-then rules. In this paper we propose a method how to build the reminder facility directly upon the guideline interchange format (GLIF) model of medical guidelines.

Method of GLIF Model Construction and Implementation.

Knowledge acquired in medicine is possible to represent by medical guidelines. The most important and nowadays mostly used for formalisation of guidelines is the GLIF (Guideline Interchange Format) model. Final model can be coded in XML (eXtensible Markup Language).

Presentation of medical guidelines on a computer.

Free-text forms of medical guidelines that are used in medical care are often cumbersome and difficult to memorize. Therefore a system that is able to present guidelines in a user-friendly manner has been designed. Guidelines are at first formalized by means of the popular GLIF3 model.

Analysis of guideline compliance--a data mining approach.

While guideline-based decision support is safety-critical and typically requires human interaction, offline analysis of guideline compliance can be performed to large extent automatically. We examine the possibility of automatic detection of potential non-compliance followed up with (statistical) association mining. Only frequent associations of non-compliance patterns with various patient data are submitted to medical expert for interpretation.

Development of electronic form of the 1999 WHO/ISH hypertension guidelines.

An electronic form of 1999 ISH/WHO Guidelines for Management of Hypertension was developed. It concentrates on two main problems--assessment of a patient's cardiovascular risk and selecting drug treatment. Moreover, it can remind the risk of unfilled items both for a cardiovascular risk calculation and drug contraindications.

Genetic variation in CYP11B2 and AT1R influences heart rate variability conditional on sodium excretion.

Sympathetic tone increases with stimulation of the renin-angiotensin system and is under the influence of salt intake. In the European Project On Genes in Hypertension (EPOGH), we investigated whether polymorphisms in the genes encoding aldosterone synthase (CYP11B2 C-344T) and the type-1 angiotensin II receptor (AT1R A1166C) affect the autonomic modulation of heart rate at varying levels of salt intake. We measured the low frequency (LF) and high frequency (HF) components of heart rate variability and their ratio (LF:HF) in the supine and standing positions in 1797 participants (401 families and 320 unrelated subjects) randomly selected from 6 European populations, whose average urinary sodium excretion ranged from 163 to 245 mmol/d.

Association of -344/T/C aldosterone synthase polymorphism (CYP11B2) with left ventricular structure and humoral parameters in young normotensive men.

Background: Aldosterone plays an important role in development of left ventricular (LV) hypertrophy and myocardial fibrosis. We assessed the influence of the T-344C polymorphism of aldosterone synthase - the rate-limiting enzyme in aldosterone biosynthesis - on the structure of the left ventricle in young normotensive men.

Design And Methods: The population included 113 normotensive mid-European Caucasian men aged 18-40 years (mean 27 +/- 5 years).

Enhanced care of hypertensive patients using the Internet.

Background: Medical guidelines provide recommendations that ought to help physicians in medical decision-making under different circumstances. To develop electronic medical guidelines and to make them available for physicians using the Internet can further enhance the quality and efficiency of health care, especially with the simultaneous use of electronic health records.

Objectives: This study aims to outline the needs for web-based systems that support the use of medical guidelines in practice; and to focus on the development of web-based electronic medical guidelines for treatment of arterial hypertension.

[Is mild essential hypertension without obvious organ complications and risk factors associated with increased levels of circulating markers of endothelial dysfunction? Effect of ACE inhibitor therapy].

The objective of the investigation was to assess whether circulating adhesion molecules, von Willebrand factor (vWf) and endothelin-1 are elevated in patients with mild uncomplicated essential hypertension without further risk factors of atherosclerosis and whether they could serve as indicators of endothelial dysfunction in this form of hypertension. Furthermore the authors investigated the effect of ACE inhibitor treatment (ACEI), quinapril, on the level of these markers of endothelial dysfunction. The level of adhesion molecules [intercellular cytoadhesion molecule-1 (ICAM-1), E-selectin, P-selectin], von Willebrand s factor (vWf) and endothelin-1 were assessed in patients with mild essential hypertension without further cardiovascular risk factors or clinical manifestations of atherosclerosis before and after quinapril treatment (n = 25) and compared with normotensive controls (n = 29).

Association analysis of Arg16Gly polymorphism of the beta2-adrenergic receptor gene in offspring from hypertensive and normotensive families.

Objective: Since beta2-adrenergic receptors (beta2AR) can influence blood pressure not only by vasodilation, but also participate in noradrenaline release from sympathetic nerve endings, we have studied whether Arg16Gly polymorphism of the beta2AR gene is associated with predisposition to essential hypertension and increased plasma noradrenaline concentration in offspring from normotensive (SN) and hypertensive parents (SH).

Design And Methods: The study population consisted of 105 young SN and 101 SH subjects matched for age and body mass index. Arg16Gly polymorphism of the beta2AR gene was determined by polymerase chain reaction (PCR) technique and subsequent incubation with NcoI restriction enzyme.

Quality control of the blood pressure phenotype in the European Project on Genes in Hypertension.

Objectives: In the European Project on Genes in Hypertension (EPOGH) standardized epidemiological methods were used to determine complex phenotypes consisting of blood pressure (BP) in combination with other traits. In this report, we present the quality control of one of the BP phenotypes.

Methods: In seven European countries eight different research groups recruited random samples of nuclear families.

Circulating intercellular cell adhesion molecule-1, endothelin-1 and von Willebrand factor-markers of endothelial dysfunction in uncomplicated essential hypertension: the effect of treatment with ACE inhibitors.

The aim of the study was to examine whether the circulating cell adhesion molecules, von Willebrand factor (vWf) and endothelin-1, are elevated in patients with essential hypertension with no other risk factors for atherosclerosis and thus may serve as a markers of endothelial dysfunction in uncomplicated hypertension. Furthermore, the effect of treatment with the ACE inhibitor, quinapril, on levels of endothelial dysfunction markers were studied. The levels of adhesion molecules (intercellular cell adhesion molecule-1 [ICAM-1], E-selectin, P-selectin), von Willebrand factor (vWf) and endothelin-1 were measured in patients with hypertension without any other risk factors of atherosclerosis before and after treatment with quinapril (n = 22) and in normotensive controls (n = 22).

Association between tyrosine hydroxylase polymorphisms and left ventricular structure in young normotensive men.

Tyrosine hydroxylase (TH) is a rate-limiting enzyme for catecholamine biosynthesis. Increased sympathetic activity is associated with an increased left ventricular (LV) mass. However, the influence of TH gene polymorphisms on LV structure and function has yet to be investigated.

Association of the Glu298Asp polymorphism in the endothelial nitric oxide synthase gene with essential hypertension resistant to conventional therapy.

Endothelial nitric oxide synthase (eNOS) produces nitric oxide (NO) which, after diffusing into vascular smooth muscle cells, activates guanylate cyclase leading to vasodilatation. A polymorphism (894G to T) in exon 7 of the eNOS gene causes the conversion of Glu to Asp in position 298. The recently described crystal structure of the heme domain of eNOS protein shows that Glu298 is fully solvent accessible and distant from regions integral to enzyme function.

Association analysis of two tyrosine hydroxylase gene polymorphisms in normotensive offspring from hypertensive families.

Objective: We have studied possible association between predisposition to essential hypertension, plasma noradrenaline level and two polymorphisms of the gene for tyrosine hydroxylase (TH), the rate-limiting enzyme of catecholamine biosynthesis.

Design And Methods: One hundred and one normotensive sons from normotensive parents (SN) and 107 normotensive sons of hypertensive families (SH) were studied. Tetranucleotide TCAT repeat and Va181Met polymorphisms of the TH gene were determined by polymerase chain reaction (PCR) technique.

Czech national data standards implementations in ORCA electronic patient record in cardiology.

In the paper we describe the situation concerning Czech data standards and requirements on health care providers. Further we compare the nowadays possibilities of the multimedia electronic patient record ORCA and its extension to fulfill Czech data standards and requirements.

Valsartan and atenolol in patients with severe essential hypertension.

The aim of this study was to evaluate the efficacy and tolerability of valsartan, a new angiotensin II receptor antagonist, versus atenolol in the treatment of severe primary hypertension. A total of 103 adult out-patients were randomised to receive either valsartan 160 mg or atenolol 100 mg once daily for 6 weeks. If necessary, additional blood pressure (BP) control could be provided as add-on therapy.

Computer supported decision making in therapy of arterial hypertension.

Therapy of hypertension is still more or less empirical. Several classes of antihypertensive medications are known, the effect of which is based on different mechanisms. The efficacy of the treatment is not always a reliable indication of the appropriate selection as a good therapeutical response can sometimes be achieved at the expense of humoral simulation.

Evaluation of data in cardiology by new software tools.

We describe an analysis of cardiology data using new software tools. First we use data of 1417 men aged 40 to 50 years living in the center of Prague gathered in the twenty years lasting longitudinal study. We show some results of application of the programs E.