Возрастные особенности эффективности различных глюкокортикостероидов в терапии острого лимфобластного лейкоза
In the internal medicine wide spectrum the gastroenterology is one of the chapters, less enlightened by the scientific evidence. It does not mean that the practice of the grasntroenterology may ot be improved by the systematic use of the approaches of the evidence based medicine
A comparison of different treatment strategies does not always result in determining the best one for all patients, one needs to study subgroups of patients with significant difference in efficiency between treatment strategies. To solve this problem an approach to subgroups generation is proposed, where data are described in terms of a pattern structure and pattern concepts stay for patient subgroups and their descriptions. To find the most promising pattern concepts in terms of the difference of treatment strategies in efficiency a version of CbO algorithm is proposed. An application to the analysis of data on childhood acute lymphoblastic leukemia is considered.
Optimal choice of glucocorticoids (GC), like dexamethasone (DEXA) vs (methyl)prednisolone (MePRED) for remission induction in childhood acute lymphoblastic leukemia (ALL) remains controversial. The favorable antileukemic efficacy of DEXA is off-set by its dose-limiting toxicity. Hence, one objective of trial ALL-Moscow/Berlin (MB) 2002 was to evaluate whether an equiactive dose of MePRED leads to superior event-free survival (EFS) rates by reducing mortality, while maintaining the low relapse rates and central nervous system (CNS) protection obtained with DEXA previously. Of 1163 pediatric patients with newly diagnosed B-cell precursor or T-cell ALL, 1064 were randomized to induction with either 6 mg/m^2 DEXA (n=539) or 60mg/m^2 MePRED(n=525).
This prototype development explains the challenges encountered during the ISO/IEEE 11073 standard implementation process. The complexity of the standard and the consequent heavy requirements, which have not encouraged software engineers to adopt the standard. The developing complexity evaluation drives us to propose two possible implementation strategies that cover almost all possible use cases and eases handling the standard by non-expert users. The first one is focused on medical devices (MD) and proposes a low-memory and low-processor usage technique. It is based on message patterns that allow simple functions to generate ISO/IEEE 11073 messages and to process them easily. MD act as X73 agent. Second one is focused on more powerful device X73 manager, which do not have the MDs' memory and processor usage constraints. The protocol between Agent and Manager is point-to-point and we can distribute the functionality between devices.
Developed both implementation X73 Agent and Manager will cut developing time for applications based on ISO/EEE 11073.