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El avance de la tecnología permite realizar cambios en la rehabilitación y estética, reduce los tiempos de trabajo y disminuye los riesgos que se presentan al momento de utilizar materiales convencionales para la toma de impresiones. Existen dos técnicas que se pueden emplear, la analógica y la digital; la primera presenta mayores riesgos que el operador no puede controlar, así como tiempos más prolongados. Este reporte describe la rehabilitación bucal en dos pacientes con desgaste dental, se optó por usar ambas técnicas, la analógica y la digital, como tratamiento; en la primera se empleó el encerado convencional y en la segunda el software Exocad para el encerado digital. Finalmente en ambos casos se aplicó (AU)
The advance of technology has allowed changes in rehabilitation and esthetics, providing shorter working times and reducing the risks that occur when using conventional materials for taking impressions. There are two techniques that can be used, analog and digital, the first one presents greater risks that the operator cannot control, as well as more time. This report describes the oral rehabilitation in patients with dental wear. The treatment was carried out using the analogical and digital techniques, the former using conventional waxing and the latter using Exocad software for the digital waxing; finally, in both cases the injection technique with high-load Flow resin was used (AU)
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Humanos , Masculino , Feminino , Adulto , Estética Dentária , Desgaste dos Dentes/reabilitação , Planejamento de Assistência ao Paciente , Processamento de Imagem Assistida por Computador , InjeçõesRESUMO
Resumen Introducción : El Trastorno del Espectro Autista (TEA) es un trastorno del neurodesarrollo, y sus procedimien tos tradicionales de evaluación encuentran ciertas li mitaciones. El actual campo de investigación sobre TEA está explorando y respaldando métodos innovadores para evaluar el trastorno tempranamente, basándose en la detección automática de biomarcadores. Sin embargo, muchos de estos procedimientos carecen de validez ecológica en sus mediciones. En este contexto, la reali dad virtual (RV) presenta un prometedor potencial para registrar objetivamente bioseñales mientras los usuarios experimentan situaciones ecológicas. Métodos : Este estudio describe un novedoso y lúdi co procedimiento de RV para la evaluación temprana del TEA, basado en la grabación multimodal de bio señales. Durante una experiencia de RV con 12 esce nas virtuales, se midieron la mirada, las habilidades motoras, la actividad electrodermal y el rendimiento conductual en 39 niños con TEA y 42 compañeros de control. Se desarrollaron modelos de aprendizaje automático para identificar biomarcadores digitales y clasificar el autismo. Resultados : Las bioseñales reportaron un rendimien to variado en la detección del TEA, mientras que el modelo resultante de la combinación de los modelos de las bioseñales demostró la capacidad de identificar el TEA con una precisión del 83% (DE = 3%) y un AUC de 0.91 (DE = 0.04). Discusión : Esta herramienta de detección pue de respaldar el diagnóstico del TEA al reforzar los resultados de los procedimientos tradicionales de evaluación.
Abstract Introduction : Autism Spectrum Disorder (ASD) is a neurodevelopmental condition which traditional as sessment procedures encounter certain limitations. The current ASD research field is exploring and endorsing innovative methods to assess the disorder early on, based on the automatic detection of biomarkers. How ever, many of these procedures lack ecological validity in their measurements. In this context, virtual reality (VR) shows promise for objectively recording biosignals while users experience ecological situations. Methods : This study outlines a novel and playful VR procedure for the early assessment of ASD, relying on multimodal biosignal recording. During a VR experience featuring 12 virtual scenes, eye gaze, motor skills, elec trodermal activity and behavioural performance were measured in 39 children with ASD and 42 control peers. Machine learning models were developed to identify digital biomarkers and classify autism. Results : Biosignals reported varied performance in detecting ASD, while the combined model resulting from the combination of specific-biosignal models demon strated the ability to identify ASD with an accuracy of 83% (SD = 3%) and an AUC of 0.91 (SD = 0.04). Discussion : This screening tool may support ASD diagnosis by reinforcing the outcomes of traditional assessment procedures.
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Este artigo apresenta uma reflexão sobre os efeitos do contexto da cultura digital para a adolescência. Abordamos a adolescência na teoria psicanalítica desde as concepções freudianas até as elaborações contemporâneas. Retomamos a infância como fase constitutiva do sujeito e suas implicações para a adolescência para destacar os impasses experienciados pelos adolescentes na cultura digital. Destacamos os conceitos de saber, Outro e objeto como articulatórios para a compreensão da adolescência na contemporaneidade. Consideramos que o estatuto do saber sofreu transformações decorrentes da aliança entre o capitalismo e a digitalização e que essas transformações trazem implicações para o laço social, configurando o que chamamos de adormecimento psíquico. Por fim, apontamos a conversação de orientação psicanalítica como uma possibilidade no enfrentamento dos desafios que a cultura digital apresenta
Cet article présente une réflexion sur les effets du contexte de la culture numérique sur l'adolescence. Nous analysons l'adolescence dans la théorie psychanalytique à partir des conceptions freudiennes jusqu'aux élaborations contemporaines. Nous revenons sur l'enfance en tant que phase constitutive du sujet et ses implications pour l'adolescence afin de mettre en évidence les impasses vécues par les adolescents dans la culture numérique. Nous mettrons en évidence les concepts de connaissance, d'Autre et d'objet comme des articulations fondamentales pour la compréhension de l'adolescence à l'époque contemporaine. Nous considérons que le statut du savoir a subi des transformations résultant de l'alliance entre capitalisme et numérisation et que ces transformations ont des implications sur le lien social, configurant ce que nous appelons le sommeil psychique. Enfin, nous indiquons la conversation psychanalytique comme une possibilité pour faire face aux défis que présente la culture numérique.
This article presents a reflection on the effects of digital culture on adolescence. We analyze adolescence in psychoanalytic theory from Freudian conceptions to contemporary elaborations. We return to childhood as a constitutive phase of the subject and its implications for adolescence in order to highlight the impasses experienced by adolescents in the digital culture. We highlight the concepts of knowledge, Other and object as articulations for the understanding of adolescence nowadays. We consider that the status of knowledge has undergone transformations resulting from the alliance between capitalism and digitalization and that these transformations have implications for the social bond, configuring what we call psychic numbness. Finally, we point out the psychoanalytic conversation as a possibility in facing the challenges that digital culture presents.
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Adolescente , HipestesiaRESUMO
SUMMARY: The aim of this study was to compare the clinical value of vertebral artery ultrasound (VAU), Magnetic Resonance Angiography (MRA) and Digital Subtraction Angiography (DSA) on vertebral artery stenosis in patients with posterior circulation ischemia. Seventy-three patients with posterior circulation ischemia underwent vertebral artery ultrasound and magnetic resonance angiography as well as digital subtraction angiography, and the diagnosis of vertebral artery stenosis (VAS) and the degree of stenosis (normal, mild stenosis, moderate stenosis, severe stenosis, and occlusion) were recorded and compared between digital subtraction angiogram and vertebral artery ultrasound and magnetic resonance angiography. The vertebral artery stenosis rates on digital subtraction angiography and vertebral artery ultrasound were 87.30 % (55/63) and 49.20 % (31/63), respectively, and the difference was statistically significant. The rates of vertebral artery stenosis on digital subtraction angiography and, magnetic resonance angiography was 90.38 % (47/52) and 88.46 % (46/ 52), respectively, and the differences was not statistically significant. The sensitivity, accuracy, negative predictive value, and positive predictive value of vertebral artery ultrasound in diagnosing vertebral artery stenosis were 51.35 %, 54.76 %, 18.18 %, and 95.00 %, respectively, lower than those of magnetic resonance angiography, which were 91.89 %, 90.48 %, 57.14 %, and 97.14 %, respectively. Of the noninvasive imaging techniques, vertebral artery ultrasound does not accurately characterize vertebral artery stenosis and its degree of stenosis. Magnetic resonance angiography effectively screens for vertebral artery stenosis and its degree of stenosis, and can be used as a reliable tool for vertebral artery stenosis in posterior circulation cerebral infarction, and can be used in conjunction with digital subtraction angiogram in order to improve diagnostic convenience and accuracy.
El objetivo de este estudio fue comparar el valor clínico de la ecografía de la arteria vertebral (VAU), la angiografía por resonancia magnética (ARM) y la angiografía por sustracción digital (DSA) en la estenosis de la arteria vertebral en pacientes con isquemia de la circulación posterior. A 73 pacientes con isquemia de la circulación posterior se les realizó una ecografía de la arteria vertebral y una angiografía por resonancia magnética, así como una angiografía por sustracción digital, y se les diagnosticó estenosis de la arteria vertebral (EVA) y el grado de estenosis (normal, estenosis leve, estenosis moderada, estenosis grave, y oclusión) se registraron y compararon la angiografía por sustracción digital y la ecografía de la arteria vertebral y la angiografía por resonancia magnética. Las tasas de estenosis de la arteria vertebral en la angiografía por sustracción digital y la ecografía de la arteria vertebral fueron del 87,30 % (55/63) y del 49,20 % (31/63), respectivamente, y la diferencia fue estadísticamente significativa. Las tasas de estenosis de la arteria vertebral en la angiografía por sustracción digital y la angiografía por resonancia magnética fueron del 90,38 % (47/52) y del 88,46 % (46/52), respectivamente, y las diferencias no fueron estadísticamente significativas. La sensibilidad, precisión, valor predictivo negativo y valor predictivo positivo de la ecografía de la arteria vertebral en el diagnóstico de estenosis de la arteria vertebral fueron 51,35 %, 54,76 %, 18,18 % y 95,00 %, respectivamente, inferiores a los de la angiografía por resonancia magnética, que fueron 91,89 %, 90,48 %, 57,14 % y 97,14 %, respectivamente. De las técnicas de imagen no invasivas, la ecografía de la arteria vertebral no caracteriza con precisión la estenosis de la arteria vertebral y su grado de estenosis. La angiografía por resonancia magnética detecta eficazmente la estenosis de la arteria vertebral y su grado de estenosis, y puede usarse como una herramienta confiable para la estenosis de la arteria vertebral en el infarto cerebral de circulación posterior, y puede ser utilizada junto con la angiografía por sustracción digital para mejorar el diagnóstico y la exactitud.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Insuficiência Vertebrobasilar/diagnóstico por imagem , Angiografia Digital , Ultrassonografia , Angiografia por Ressonância Magnética , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
Resumen La mamografía contrastada (CEDM, contrast-enhanced digital mammography) es una herramienta nueva que ha ido implementándose de forma creciente. Aparece como alternativa a la resonancia magnética (RM), y al igual que esta, tiene como principio el uso de contraste endovenoso para explorar la angiogénesis tumoral. Combina la imagen de mamografía convencional (Mx) con la técnica de sustracción con energía dual poscontraste, lo que resulta en un incremento en la detección de cáncer de mama, en un tiempo corto de estudio y a un bajo costo. Es un método prometedor en casos seleccionados y de fácil lectura, siendo útil principalmente en pacientes con diagnóstico de cáncer de mama para detectar lesiones adicionales y determinar el tamaño tumoral, ayudando en la planificación quirúrgica, así como también en la evaluación de la respuesta a la neoadyuvancia. También en el seguimiento de pacientes operadas, para caracterizar lesiones dudosas en Mx y ecografía, o como alternativa ante contraindicación de la RM. El objetivo de este trabajo es valorar la utilidad de la mamografía contrastada en la práctica diaria y determinar sus principales indicaciones. Repasamos con casos propios las utilidades y características del método.
Abstract Contrast-enhanced digital mammography (CEDM) is an emerging tool that has been increasingly implemented. It appears as an alternative to magnetic resonance imaging (MRI), using intravenous contrast to explore tumor angiogenesis. It combines conventional mammography (Mx) with post-contrast dual energy subtraction technique, resulting in increased detection of breast cancer, in a short study time and at a low cost. It is a promising method in selected cases and easy to read, being useful mainly in patients with breast cancer to detect additional lesions and determine the tumor size, that helps surgical planning, as well as in the evaluation of post-neoadjuvant chemotherapy response in the follow-up of patients treated with surgery, to address inconclusive findings in screening mammogram, or as an alternative when MRI is contraindicated. The purpose of this article is to assess the usefulness of contrasted mammography in daily practice and to determine its main indications. We review with our own cases the applications and characteristics of this method.
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La utilización de herramientas tecnológicas en la docencia condiciona el desarrollo de nuevas destrezas intelectuales en los estudiantes, lo que les facilita la aplicación de estrategias de investigación, mejora sus capacidades de una forma integral, les ayuda a enfrentar las dificultades y exigencias del mundo y les permite adquirir un aprendizaje más significativo para poder desenvolverse en el ámbito socioeducativo. Con vistas a cumplir lo anterior, se desarrolló un repositorio institucional de recursos educativos abiertos para la Universidad Virtual de Salud, a partir del empleo de herramientas tecnológicas libres y de código abierto que permiten la estandarización e interoperabilidad entre cada uno de los repositorios establecidos en el Sistema Nacional de Salud, con lo cual se garantizará una lógica de organización académica.
The use of digital technologies in teaching determines the development of new intellectual skills in students, which facilitates the application of investigation strategies, improves their capabilities in an integral way, helps them face the difficulties and demands of the current world and allows them to acquire more significant learning to have a good performance in the socio-educational environment. With a view to fulfilling the above, an institutional repository of open educational resources was developed for the Virtual Health University, based on the use of free and open-source technology tools that allow the standardization and interoperability among each of the repositories established in the National Health System, which will guarantee logic of academic organization.
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La adolescencia constituye una etapa atravesada por cambios físicos, emocionales y sociales significativos, que incluyen la adquisición de múltiples habilidades. Aumentan los riesgos de sufrir alteraciones mentales, consumo de sustancias, embarazo no deseado, trastornos alimentarios, y se evidencian los efectos negativos del uso inapropiado de las redes sociales. El bienestar digital implica el uso saludable de la tecnología, la protección de la privacidad y la seguridad en línea. Los adolescentes utilizan las redes con la finalidad de identificarse, relacionarse, entretenerse y buscar información. La exposición no regulada conlleva riesgos: acceso a contenido inapropiado, ciberacoso, consumo problemático y fraudes. Desde el ámbito pediátrico, se debe acompañar a los adolescentes para que optimicen el uso de la tecnología y, para ello, es fundamental implementar estrategias multisectoriales para minimizar los riesgos y promover el bienestar de los adolescentes en línea, así como garantizar la alfabetización digital y el acceso equitativo a recursos tecnológicos de calidad y telesalud.
Adolescence is a period characterized by significant physical, emotional, and social changes, including the acquisition of multiple skills. It is also a time when the risks of mental disorders, substance use, unwanted pregnancy, eating disorders, and negative effects of inappropriate social media use manifest greatly. Digital well-being implies the healthy use of technology, the protection of privacy and security online. Adolescents use social media to identify themselves, interact with others, entertain themselves, and seek information. However, risks are present, including access to inappropriate content, cyberbullying, problematic consumption, and fraud. The pediatric field must support adolescents in optimizing their online use. Implementing multisectoral strategies can minimize risks, promote digital literacy, and ensure equitable access to quality technological resources and telehealth, thereby promoting adolescent online well-being.
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Humanos , Gravidez , Adolescente , Telemedicina , Transtornos Mentais , Nível de Saúde , Pessoal de Saúde , EmoçõesRESUMO
El cáncer causa millones de muertes a nivel mundial por lo que su registro es fundamental, existiendo registros clínicos, hospitalarios y poblacionales. Estos últimos son el estándar de oro para la información sobre incidencia y supervivencia de cáncer en una región definida. En Chile se cuenta con cinco registros poblacionales ubicados en ciertas zonas del país. El Registro Nacional del Cáncer chileno surge como un desafío para conformar una herramienta transversal a los tres tipos de registro con la finalidad de, al menos, conocer la cantidad de casos por tipo de cáncer. Su diseño implicó un despliegue de acciones orientadas a lograr consensos entre diversos actores respecto de la información, validación y eventos necesarios de registrar. Se identificaron cuatro etapas en el proceso de atención y el registro: sospecha de diagnóstico, confirmación morfológica (biopsia), resolución clínica (comité oncológico incluyendo la indicación de tratamiento), tratamiento y seguimiento oncológico. A su vez, el desarrollo de la plataforma (años 2018 a 2021) implicó levantamiento de información y acuerdos sobre los requerimientos para el co-diseño del registro, incluyendo un exitoso pilotaje con más de 20 establecimientos de salud del sector público y privado con registro de cerca de 7500 casos de cáncer. El despliegue y uso del Registro Nacional de Cáncer a nivel nacional depende de la autoridad sanitaria. Se trata de un sistema de información que recolecta, almacena, procesa y analiza de forma continua y sistemática datos sobre todos los casos y tipos de cánceres que ocurren en el país. En este trabajo se presenta el diseño y desarrollo de la herramienta, los desafíos abordados, sus fortalezas y debilidades.
Cancer causes millions of deaths worldwide, making its registration essential. There are clinical, hospital, and population-based registries in place. The latter is the gold standard for information on cancer incidence and survival in a defined region. Chile has five population-based registries located in specific areas of the country. The Chilean National Cancer Registry emerged with the challenge of creating a tool encompassing all three types of registries to identify the number of cancer cases by type. Its design involved a series of actions to achieve consensus among various actors regarding information, validation, and events to be registered. Four stages were identified in the care and registration process: suspected diagnosis, morphological confirmation (biopsy), clinical resolution (oncology committee, including treatment recommendations), treatment, and oncological follow-up. The platform's development (from 2018 to 2021) involved gathering information and agreements on the requirements for co-designing the registry, including a successful pilot program with over 20 public and private healthcare facilities that recorded nearly 7500 cancer cases. The deployment and use of the National Cancer Registry at a national level depends on the healthcare authority. It is an information system that continuously and systematically collects, stores, processes, and analyzes data on all cancer cases and types occurring in the country. This work presents the design and development of the tool, the challenges addressed, as well as its strengths and weaknesses.
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RESUMEN Objetivo: Describir y analizar, en varios niveles, los intercambios comunicativos sucedidos en un chat grupal de médicos intensivistas dentro de la aplicación de mensajería instantánea WhatsApp durante la primera etapa de la pandemia de la COVID-19, específicamente el día en que fue confirmado el primer caso en México. Se destaca una situación intensa donde se manifiestan los tres niveles analíticos del marco teórico. Materiales y métodos: Investigación cualitativa de la transcripción de los diálogos sostenidos en WhatsApp entre 239 médicos intensivistas al inicio de la pandemia, específicamente a lo largo del 27 de febrero del 2020. Se utilizó el análisis narrativo para interpretar el fragmento del chat. Se elaboró un esquema con tres dimensiones (análisis de la información compartida, estándares de acción social en la atención a pacientes COVID-19 y expresiones emocionales) para codificar y categorizar los diálogos. Resultados: Los intercambios comunicativos por WhatsApp permitieron dar sentido al conocimiento emergente sobre la COVID-19 expuesto en las tramas narrativas. También influyó en la orientación de acciones pertinentes en los contextos hospitalarios y ayudó a modular las emociones ante la pandemia. Además, fomentó lazos de solidaridad y empatía entre los médicos intensivistas para afrontar con resiliencia el sufrimiento personal y social. Conclusiones: Los diálogos del chat reflejaron las relaciones humanas y las profundas inquietudes de las personas en situaciones de crisis. El estudio permitió comprender las formas y los significados de los intercambios comunicativos con el uso de dispositivos tecnológicos en tiempos de crisis para orientar la implementación de acciones en situaciones emergentes como la pandemia de la COVID-19. El WhatsApp respondió a la necesidad de información, con datos científicos y verídicos, sobre la pandemia. Se apreció que los médicos intensivistas se beneficiaron de la mensajería instantánea al cooperar en situaciones y experiencias críticas en el marco de una crisis sanitaria en evolución.
ABSTRACT Objective: To describe and analyze, at various levels, the communication exchanges that took place in a group chat of intensivists using the instant messaging application WhatsApp during the first stage of the COVID-19 pandemic, specifically on the day the first case was confirmed in Mexico. An intense situation showing the three dimensions of the theoretical framework is stood out. Materials and methods: A qualitative research of WhatsApp messages shared between 239 intensivists at the beginning of the pandemic, specifically throughout February 27, 2020. A narrative analysis was used to interpret a fragment of a chat. A schema with three dimensions (analysis of shared information, standards of social action in COVID-19 patient care and emotional expressions) was developed to code and classify the messages. Results: The communication exchanges via WhatsApp made it possible to give meaning to the emerging knowledge about COVID-19 in the narrative plots. They also influenced the implementation of appropriate actions in hospital environments and helped modulate emotions in front of the pandemic. In addition, it fostered bonds of solidarity and empathy between intensivists to face personal and social suffering with resilience. Conclusions: The chat messages reflected human relationships and the deep concerns of people in crisis situations. The study provided insight into the forms and meanings of communication exchanges with the use of technological devices in times of crisis to guide the implementation of actions in emerging situations such as the COVID-19 pandemic. WhatsApp responded to the need for information, with scientific and truthful data, about the pandemic. It was noted that intensivists benefited from instant messaging by cooperating in critical situations and experiences within the context of an evolving health crisis.
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A Odontologia Estética baseia- se em princípios de estética com condutas e técnicas de procedência lógica, como também intuitiva, para planejar um sorriso harmônico. Com seu atual perfil mais conservador atrelado às inúmeras ferramentas disponíveis no mercado, é possível arquitetar procedimentos priorizando o sucesso do tratamento, restabelecendo a função e harmonia, com maior segurança e previsibilidade. O fluxo digital inclui Softwares e equipamentos automatizados que podem otimizar o tempo clínico, apresentando benefícios tanto para o Cirurgião Dentista como para o paciente. Atualmente, o DSD (digital smile design) tem sido utilizado como um recurso de grande destaque para a Odontologia reabilitadora, pois, possibilita um planejamento mais minucioso em cada estágio do tratamento reabilitador estético com o uso de desenhos e linhas de referência para comparações entre as imagens geradas do antes e depois, avaliando se concordam com o planejamento e anseios do profissional e do paciente, ou se serão necessárias modificações. Com isso, o objetivo do presente trabalho foi realizar uma revisão de literatura sobre os avanços do fluxo de trabalho digital em reabilitação oral estética, analisando-se a influência na qualidade do atendimento atrelado ao conforto dos pacientes. Foi realizada uma revisão de literatura nas bases de dados PubMed, Scielo e Wiley Library, utilizando os descritores "Digital Smile Design", "Dental Esthetic," EstheticTreatment". Foram buscados artigos entre 2009 até 2022. Com base na revisão de literatura, foi possível concluir que a técnica se apresenta como uma ferramenta valiosa para tratamentos restauradores, otimizando a compreensão das dificuldades estéticas e aumentando a aceitação do tratamento pelo paciente. E, por trás destes resultados, existem diversas variáveis influenciando-os, como a maior previsibilidade dos procedimentos, reduzindo o tempo para a finalização, além de trabalhos mais conservadores, com estrutura dental preservada.
Esthetic dentistry is based on aesthetic principles with logical, also intuitive procedures and techniques, in order to plan a harmonic smile. With its more consecutive current profile linked to the numerous tools available on the market, it is possible to design procedures prioritizing the success of the treatment restoring the function and harmony with greater safety and predictability. The digital flow includes software and automated equipment that can optimize clinical time, presenting benefits for both, the dental surgeon and the patient. Currently, the DSD (digital smile design) has been used as a resource of great prominence for Rehabilitative Dentistry, because it allows a more detailed planning in each stage of the aesthetic rehabilitation treatment with the use of drawings and reference lines, in order to compare between the images generated before and after the procedure, assessing whether they are in accordance with the planning and desires of the professional and the patient, or if modifications are necessary. With this, the objective of the present work was to carry out a literature review of the advances in the digital workflow in aesthetic oral rehabilitation. Analyzing the influence on the quality of care linked to the comfort of patients. A literature review was carried out in PubMed, Scielo and Wiley Library databases, using the descriptors "Digital Smile Design", "Dental Esthetic", "Esthetic Treatment". Articles were searched between 2009 and 2022. Based on the literature revie, it was possible to conclude that the technique presents itself as a valuable tool for restorative treatments, optimizing the understanding of aesthetic difficulties and increasing the acceptance of the treatment by the patient. And, behind these results, there are several variables influencing them, such as greater predictability of procedures, reducing the time for completion in addition to more conservative works, with preserved tooth structure.
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Software , Desenho Assistido por Computador , Estética Dentária , Planejamento , Reabilitação BucalRESUMO
Objective:To investigate the efficacy of transcatheter arterial embolization (TAE) in treating postoperative hemorrhage in the gallbladder-pancreas-duodenum(GPD) region.Methods:The clinical data of 39 patients with postoperative hemorrhage in the GPD region who underwent digital subtraction angiography (DSA) examination in Peking Union Medical College Hospital from July 2018 to August 2022 were analyzed retrospectively, clinical regression was compared between TAE-treated and non-TAE-treated patients, and the concordance between DSA and enhanced CT for bleeding indications was analyzed using the Kappa test.Results:Among 39 patients, DSA examination suggested bleeding in 26 patients (66.7%), which were gastroduodenal artery hemorrhage in 4 cases, common hepatic artery and branches in 6 categories, superior mesenteric artery and branches in 6 cases, pancreaticoduodenal artery and branches in 4 cases, pancreatic aorta in 3 cases, splenic artery in 2 cases, and gastric left artery in 1 case. Positive DSA signs manifested as contrast spillage alone in 18 cases (69.2%), pseudoaneurysm alone in 7 cases (26.9%), and pseudoaneurysm with contrast spillage in 1 case (3.8%). 26 patients underwent TAE with a technical success rate of 96.2% (25/26), a clinical success rate of 88.5% (23/26) and a rebleeding rate of 7.7% (2/26). 13 patients didn't undergo TAE and the rebleeding rate was 30.8%(4/13). 14 patients underwent enhanced CT in the same period of DSA, showed low concordance with DSA in determining the presence or absence of bleeding, with a Kappa value of 0.462.Conclusions:TAE is a safe and effective treatment for postoperative hemorrhage in the GPD region. Patients without TAE treated should be alert for rebleeding. When postoperative hemorrhage is suspected, the consistency between enhanced CT and DSA examination results is limited, and DSA examination should be preferred.
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Objective:To investigate the application of digital scanning combined with reverse engineering technology in the teaching of full crown preparation.Methods:A total of 30 undergraduate students in the fifth grade of stomatology were selected from Shantou University Medical College and were divided into experimental group and control group using a random number table. Two resin teeth were distributed to each student and were placed on dental head simulators to perform full crown preparation. The students in the control group received teaching with analogies of experience, and those in the experimental group received teaching with digital scanning, i.e., full crown preparation for the second time after digital scanning for the first time of full crown preparation. The score was determined based on China Stomatological Association Standards: Guideline for the tooth preparation of dental ceramic crowns (T/CHSA 008—2023), with a total score of 100 points. SAS9.4 software was used for the two-independent-samples t test and the paired t-test, and the Kendall W concordance coefficient was used to investigate the consistency of evaluators. Results:There were significant changes after teaching in the preparation scores of the right maxillary central incisor (76.27 pre-demonstration vs. 84.70 post-demonstration, P<0.001) and the right maxillary first molar (72.10 pre-demonstration vs. 82.37 post-demonstration, P<0.001). Compared with the control group, the experimental group had a significant increase in the mean preparation score of the right maxillary first molar (14.00 vs. 6.53, t=2.64, P=0.014). In the experimental group, there were significant increases in the preparation scores of the right maxillary first molar for the occlusal surface (15.40 pre-demonstration vs. 19.33 post-demonstration, P<0.001), the buccolingual surface (18.13 pre-demonstration vs. 20.87 post-demonstration, P=0.016), and the proximal surface (12.40 pre-demonstration vs. 14.07 post-demonstration, P=0.004), as well as significant increases in the scores of the convergence angles of the buccolingual surface (2.80 pre-demonstration vs. 4.07 post-demonstration, P=0.004) and the proximal surface (3.47 pre-demonstration vs. 4.47 post-demonstration, P=0.008). Conclusions:Application of digital teaching for difficult crown preparation of posterior teeth can effectively improve the quality of crown preparation among students, standardize the teaching process of crown preparation, and increase the precision of crown preparation, thereby laying a foundation for promoting uniformity in talent cultivation for dental prosthodontics.
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Purpose/Significance To explore the current situation and influencing factors of health digital hoarding behavior.Method/Process A total of 303 valid questionnaires are collected for users with different degrees of health digital hoarding behavior by using the ques-tionnaire survey method.SPSS 26 and AMOS 26 software are used for reliability and validity analysis and path analysis.Result/Conclusion In-formation quality and other factors have a significant impact on health digital hoarding behavior through mediating variables.
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Purpose/Significance To grasp the technological advantages of digitization empowerment,and to explore the effective path of digitization enabling medical education.Method/Process From the three aspects of experience enhancement,content enrichment and process coordination,the function mode of digitization enabling medical education is clarified.Result/Conclusion To achieve digitization enabling medical education,it's necessary to deepen digital sharing,promote the reconstruction of digital scenes of medical education,op-timize the presentation of digital content of medical education,and coordinate the operation of digital process of medical education.
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Objective A comprehensive evaluation of oral anticoagulants(OACs)was conducted using the A Quick Guideline for Drug Evaluation and Selection in Chinese Medical Institutions(the Second Edition),to provide a reference for drug selection and clinical medication decisions in medical institutions.Methods Evaluation evidence was collected,and the drugs included in the evaluation were quantified on four dimensions of clinical properties(efficiency and safety),pharmaceutical properties,economy and others.Results All oral anticoagulants included in the evaluation had a score of 70 or higher in the comprehensive evaluation,while warfarin had the highest overall score.Clinical properties and pharmacologic properties were identified as the core attributes for drug selection evaluation.When considering only these factors,edoxaban received the highest score.Conclusion OACs are the preferred option for patients requiring long-term anticoagulation therapy.Various OACs offer distinct clinical advantages.Utilizing the Guidelines(Second Edition)for oral anticoagulant selection and evaluation can offer visual evidence for drug selection and promote the scientific,rational,and safe use of drugs in clinical management.
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Objective To explore the value of droplet digital polymerase chain reaction(ddPCR)in the etiological diagnosis of severe acute pancreatitis(SAP)patients with suspected bloodstream infection(BSI).Methods SAP patients admitted to the department of critical care medicine in a hospital July to September 2022 were enrolled.When BSI was suspected,venous blood was collected for both ddPCR detection and blood culture(BC)with antimi-crobial susceptibility testing(AST)simultaneously.The time required for two detection methods was recorded,and the detection results of ddPCR and BC were compared.The etiological diagnostic efficacy of ddPCR was calculated,and the correlation between the value of pathogen load detected by ddPCR and the level of infection parameters was explored.Results A total of 22 patients were included in the analysis,and 52 venous blood specimens were collec-ted for detection.BC revealed 17 positive specimens(32.7％)and 29 pathogenic strains,while ddPCR showed 41 positive specimens(78.8％)and 73 pathogenic strains.Detection time required for ddPCR was significantly lower than that of BC([0.16±0.03]days vs[5.92±1.20]days,P＜0.001).Within the detection range of ddPCR and taking BC results as the gold standard,the sensitivity and specificity of ddPCR were 80.0％and 28.6％,respective-ly.With the combined assessment of BSI based on non-blood specimen microbial evidence within a week,the sensi-tivity and specificity of ddPCR detection increased to 91.9％and 76.9％,respectively.ddPCR detected resistance genes of blaKPC,blaNDM/IMP,VanA/VanM,and mecA from 19,9,6,and 5 specimens,respectively.Correlation analysis showed a positive correlation between pathogen load and levels of C-reactive protein as well as procalcitonin(r=0.347,0.414,P＜0.05).Conclusion As a supplementary detection method for BC in BSI diagnosis,ddPCR has the advantages of higher sensitivity and shorter detection time,and is worthy of further exploration in clinical application.
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Objective To improve the efficiency of hospital antimicrobial management and ensure rational clinical use of antimicrobial agents with the aid of antimicrobial stewardship(AMS)empowered by digital intelligence tech-nology in hospital.Methods Information systems such as early warning of antimicrobial indexes,closed-loop ma-nagement of microbial detection information,and decision-making system of antimicrobial resistance monitoring data were applied to the traditional AMS system.Through hospital information systems(HIS)to collect data about thera-peutic antimicrobial use and healthcare-associated infection(HAI)quality control indexes of hospitalized patients in a tertiary first-class public hospital in Shenzhen City before and after digital technology improvement,indexes of 2021 and 2022 were as control group(before improvement)and observation group(after improvement)respective-ly,improvement trend of antimicrobial management was compared.Results After upgrading and renovating the hospital information system,hospital antimicrobial management indexes improved significantly compared to before the renovation.The use rate of antimicrobial agents and the preventive use rate of antimicrobial agents in class Ⅰincision surgery in patients in the observation group were both lower than those in the control group(27.0％vs 38.8％,20.9％vs 23.8％,respectively,both P＜0.05).Antimicrobial use density in hospitalized patients in the observa-tion group was lower than that in the control group([33.27±3.03]DDDs vs[42.06±4.42]DDDs),difference was statistically significant(t=13.11,P＜0.001).The observation group had a higher qualified rate for evaluating antimicrobial medical orders compared to the control group(98.5％vs 96.8％).The pathogenic detection rate of hospitalized patients before therapeutic antimicrobial use and pathogen detection rate related to HAI diagnosis were both higher than those in the control group(87.1％vs 84.5％,99.0％vs 95.4％,respectively),differences were both statistically significant(both P＜0.05).Conclusion Empowering the hospital's AMS system with digital technology can promote more scientific,standardized,efficient,and rational antimicrobial management in hospitals.
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Objective To observe the value of a YOLOX target detection model for automatically identifying endovascular interventional instruments on images of digital subtract angiography(DSA).Methods DSA data of 37 patients who underwent abdominal endovascular interventional therapy were retrospectively analyzed.Totally 4 435 DSA images were captured and taken as data set,which were divided into training set(n=3 991)and verification set(n=444)at the ratio of 9∶1.Six kinds of endovascular interventional instruments were labeled.YOLOX algorithm was applied for deep learning of data in training set in order to build a target detection model,and the efficacy of the model for automatically identifying endovascular interventional instruments on DSA images was evaluated based on varification set.Results A total of 6 668 labels were put on 4 435 DSA images,aimed on Terumo 0.035in loach guide wire(n=587),Cook Lunderquist super hard guide wire(n=990),Optimed 5F with graduated pig tail catheter(n=1 680),Cordis MPA multi-functional catheter(n=667),Boston Scientific V-18 controllable guide wire(n=1 330)and Terumo 6F long sheath(n= 1 414),respectively.The training set contained 527,875,1 466,598,1 185 and 1 282,while the verification set contained 60,115,214,69,145 and 132 the above labels,respectively.The pixel accuracy of YOLOX target detection model for automatically identifying the above instruments in the verification set was 95.23%,97.32%,99.18%,98.97%,97.60%and 98.19%,respectively,with a mean pixel accuracy of 97.75%.Conclusion YOLOX target detection model could automatically identify endovascular interventional instruments on images of DSA.
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【Objective】 To establish a highly sensitive detection method of platelet HPA-3 and HPA-15 genotyping by droplet digital PCR (ddPCR), and to explore the feasibility of applying it to the detection of human platelet antigen (HPA) compatibility in maternal peripheral blood fetal free DNA. 【Methods】 For SNP mutation sites of HPA-3 and HPA-15, specific primers and MGB probes were designed, and amplification conditions such as annealing temperature and primer concentration of ddPCR were optimized to establish the optimal reaction system and clarify the test procedures. The methodological performance of the assay was evaluated, including specificity, sensitivity, repeatability and stability. ddPCR was used to detect 67 clinical blood samples, and the allele typing results were compared with the gene sequencing results. The fetal free DNA HPA antigen of 52 maternal peripheral blood samples was detected. 【Results】 The ddPCR method for detecting platelet HPA-3 and HPA-15 showed good specificity of primers and probes. The optimal annealing temperatures for HPA-3 and HPA-15 were 61.6℃ and 60.2℃, respectively. The optimal concentrations of primers were 900 nM and 700 nM respectively. The final concentration of the probe was 250 nM. The quantitative detection range of copy number was 2 to 20 000 copies, with lower limit of detection of 0.1 copies/μL, and the linearity is good. In low copy number samples, the intra - and inter batch coefficient of variation (CV) of actual detection values for HPA-3 and HPA-15 were both lower than 5%. The detection results of HPA-3 and HPA-15 genotypes of 67 blood samples were consistent with the gene sequencing results, and its application in fetomaternal platelet HPA-3, HPA-15 genotype detection met expectations. 【Conclusion】 The HPA-3 and HPA-15 ddPCR detection system constructed in this study has high accuracy, good repeatability, stability and sensitivity, and can be applied to the establishment of platelet HPA-3 and HPA-15 genotype donor pool, gene matching and fetomaternal platelet compatibility detection.
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The digital transformation of China's community health management is a key step in the high-quality development of medical and health services,and is of great significance in enhancing the health and well-being of all residents.Using literature analysis,logical analysis and other research methods,it analyzes the practical foundation and constraints of the digital transformation of China's community health management,and proposes optimization strategies.It concludes that national policy,infrastructure development and social demand provide a realistic foundation for the digital transformation of community health management in China,but it also faces the problems of insufficient transformation of thinking,the concept of digital management has not sufficiently replaced the traditional concepts;the technical foundation is weak,and the construction and operation of the digital application platform started late;the structural barriers are prominent,and the lack of sound system construction leads to insufficient cooperation among the main bodies;the lack of digital standards,and the lagging operation of digital standardization of community health management;and the lack of digital standards.Management digital standardized operation lagging behind the constraints.Accordingly,it is proposed to promote the identity of the digital transformation of community health management,to build an operational space for digital community health management,to improve the digital system to regulate the activation of synergistic governance of the main body,and to optimize the supervision and guarantee of technology in digital management.