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A prescribing policy for SGLT2-inhibitors was implemented in a local public tertiary cardiology centre in Sabah to improve access for heart failure (HF) patients. The study evaluated 169 HF patients with reduced ejection fraction (HFrEF) who met the policy criteria. After starting SGLT2- inhibitors, a significant proportion of patients experienced decreased NTproBNP levels, indicating a positive response. HF hospitalisation rates within 1 year were lower compared to the previous year. No adverse events were reported, suggesting that the treatment is safe. Findings demonstrates the benefits of implementing prescribing policies to enhance treatment accessibility and generate valuable real-world data at the local healthcare level..
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Insuficiencia Cardíaca , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Humanos , Insuficiencia Cardíaca/tratamiento farmacológico , Volumen Sistólico/fisiología , Transportador 2 de Sodio-Glucosa , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , HospitalizaciónRESUMEN
Objective: To evaluate the long-term efficacy of percutaneous microwave ablation (MWA) therapy for hepatocellular carcinoma. Methods: 2054 cases with Barcelona Clinic Liver Cancer (BCLC) stage 0~B at the Fifth Medical Center of the Chinese People's Liberation Army General Hospital from January 2006 to September 2020 were retrospectively collected. All patients were followed up for at least 2 years. The primary endpoint of overall survival and secondary endpoints (tumor-related survival, disease-free survival, and postoperative complications) of patients treated with ultrasound-guided percutaneous MWA were analyzed. Kaplan-Meier method was used for stratified survival rate analysis. Fine-and-Gray competing risk model was used to analyze overall survival. Results: A total of 5 503 HCC nodules [mean tumor diameter (2.6±1.6) cm] underwent 3 908 MWAs between January 2006 and September 2020, with a median follow-up time of 45.6 (24.0 -79.2) months.The technical effectiveness rate of 5 375 tumor nodules was 97.5%. The overall survival rates at 5, 10, and 15-years were 61.6%, 38.8%, and 27.0%, respectively. The tumor-specific survival rates were 67.1%, 47.2%, and 37.7%, respectively. The free tumor survival rates were 25.8%, 15.7%, and 9.9%, respectively. The incidence rate of severe complications was 2.8% (108/3 908). Further analysis showed that the technical effectiveness and survival rate over the passing three time periods from January 2006-2010, 2011-2015, and 2016-September 2020 were significantly increased, with Pâ <â 0.001, especially for liver cancer 3.1~5.0 cm (Pâ <â 0.001). Conclusion: Microwave ablation therapy is a safe and effective method for BCLC stage 0-B, with significantly enhanced technical efficacy and survival rate over time.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Microondas , Humanos , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/cirugía , Microondas/uso terapéutico , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento , Supervivencia sin Enfermedad , Ablación por Catéter/métodos , Femenino , Complicaciones Posoperatorias/epidemiología , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: To provide an agreed upon definition of hyper-response for women undergoing ovarian stimulation (OS)? METHODS: A literature search was performed regarding hyper-response to ovarian stimulation for assisted reproductive technology. A scientific committee consisting of 5 experts discussed, amended, and selected the final statements in the questionnaire for the first round of the Delphi consensus. The questionnaire was distributed to 31 experts, 22 of whom responded (with representation selected for global coverage), each anonymous to the others. A priori, it was decided that consensus would be reached when ≥ 66% of the participants agreed and ≤ 3 rounds would be used to obtain this consensus. RESULTS: 17/18 statements reached consensus. The most relevant are summarized here. (I) Definition of a hyper-response: Collection of ≥ 15 oocytes is characterized as a hyper-response (72.7% agreement). OHSS is not relevant for the definition of hyper-response if the number of collected oocytes is above a threshold (≥ 15) (77.3% agreement). The most important factor in defining a hyper-response during stimulation is the number of follicles ≥ 10 mm in mean diameter (86.4% agreement). (II) Risk factors for hyper-response: AMH values (95.5% agreement), AFC (95.5% agreement), patient's age (77.3% agreement) but not ovarian volume (72.7% agreement). In a patient without previous ovarian stimulation, the most important risk factor for a hyper-response is the antral follicular count (AFC) (68.2% agreement). In a patient without previous ovarian stimulation, when AMH and AFC are discordant, one suggesting a hyper-response and the other not, AFC is the more reliable marker (68.2% agreement). The lowest serum AMH value that would place one at risk for a hyper-response is ≥ 2 ng/ml (14.3 pmol/L) (72.7% agreement). The lowest AFC that would place one at risk for a hyper-response is ≥ 18 (81.8% agreement). Women with polycystic ovarian syndrome (PCOS) as per Rotterdam criteria are at a higher risk of hyper-response than women without PCOS with equivalent follicle counts and gonadotropin doses during ovarian stimulation for IVF (86.4% agreement). No consensus was reached regarding the number of growing follicles ≥ 10 mm that would define a hyper-response. CONCLUSION: The definition of hyper-response and its risk factors can be useful for harmonizing research, improving understanding of the subject, and tailoring patient care.
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Hormona Folículo Estimulante , Síndrome del Ovario Poliquístico , Humanos , Femenino , Técnica Delphi , Fertilización In Vitro , Inducción de la Ovulación , Medición de Riesgo , Fertilización , Hormona AntimüllerianaRESUMEN
PURPOSE: To provide agreed-upon guidelines on the management of a hyper-responsive patient undergoing ovarian stimulation (OS) METHODS: A literature search was performed regarding the management of hyper-response to OS for assisted reproductive technology. A scientific committee consisting of 4 experts discussed, amended, and selected the final statements. A priori, it was decided that consensus would be reached when ≥66% of the participants agreed, and ≤3 rounds would be used to obtain this consensus. A total of 28/31 experts responded (selected for global coverage), anonymous to each other. RESULTS: A total of 26/28 statements reached consensus. The most relevant are summarized here. The target number of oocytes to be collected in a stimulation cycle for IVF in an anticipated hyper-responder is 15-19 (89.3% consensus). For a potential hyper-responder, it is preferable to achieve a hyper-response and freeze all than aim for a fresh transfer (71.4% consensus). GnRH agonists should be avoided for pituitary suppression in anticipated hyper-responders performing IVF (96.4% consensus). The preferred starting dose in the first IVF stimulation cycle of an anticipated hyper-responder of average weight is 150 IU/day (82.1% consensus). ICoasting in order to decrease the risk of OHSS should not be used (89.7% consensus). Metformin should be added before/during ovarian stimulation to anticipated hyper-responders only if the patient has PCOS and is insulin resistant (82.1% consensus). In the case of a hyper-response, a dopaminergic agent should be used only if hCG will be used as a trigger (including dual/double trigger) with or without a fresh transfer (67.9% consensus). After using a GnRH agonist trigger due to a perceived risk of OHSS, luteal phase rescue with hCG and an attempt of a fresh transfer is discouraged regardless of the number of oocytes collected (72.4% consensus). The choice of the FET protocol is not influenced by the fact that the patient is a hyper-responder (82.8% consensus). In the cases of freeze all due to OHSS risk, a FET cycle can be performed in the immediate first menstrual cycle (92.9% consensus). CONCLUSION: These guidelines for the management of hyper-response can be useful for tailoring patient care and for harmonizing future research.
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Síndrome de Hiperestimulación Ovárica , Femenino , Humanos , Embarazo , Consenso , Técnica Delphi , Hormona Liberadora de Gonadotropina , Gonadotropina Coriónica , Fertilización In Vitro/métodos , Inducción de la Ovulación/métodos , Medición de Riesgo , Índice de EmbarazoRESUMEN
INTRODUCTION: The COVID-19 pandemic has reached a phase where many have been infected at least once. Healthcare workers were not spared from being infected. This study aimed to determine the period prevalence of COVID-19 among the paediatric healthcare workers in Negeri Sembilan as the country transitioned into an endemic phase of the pandemic. Additionally, we investigate potential sociodemographic and occupational characteristics associated with SARS-CoV-2 infection among healthcare workers. MATERIALS AND METHODS: A cross-sectional study was conducted among the healthcare workers in the paediatric department at three public specialist hospitals in Negeri Sembilan between 15 and 21 April 2022. Data were collected through a self-administered questionnaire. RESULTS: Out of the 504 eligible healthcare workers, 493 participated in this study (response rate 97.8%). The overall prevalence of COVID-19 (11 March 2020-15 April 2022) among healthcare workers was 50.9%. The majority (80.1%) were infected during the Omicron wave two months before the survey. Household contacts accounted for 35.9% of infection sources. The proportion of non-doctors in the COVID-19-infected group was significantly higher compared to the non-infected group (74.1% vs 64.0%, p=0.016). The COVID-19-infected group had a higher proportion of schoolgoing children (44.6% vs 30.6%, p=0.001) and children who attended pre-school/sent to the babysitter (49.0% vs 24.4%, p<0.001). There were no significant differences between infection rates among the healthcare workers working in the tertiary hospital and the district hospitals. There were also no significant differences in the proportion of COVID-19- infected doctors and nurses when analysed by seniority. CONCLUSION: Our study provided an estimate on the prevalence of COVID-19 among paediatric healthcare workers in Negeri Sembilan and the factors associated with infection, which captures the extent and magnitude of this pandemic on the state's paediatric department. Most infections resulted from household contact, with a higher proportion of infected healthcare workers having young children.
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COVID-19 , Humanos , Niño , Preescolar , COVID-19/epidemiología , Estudios Transversales , Prevalencia , SARS-CoV-2 , Pandemias , Personal de SaludRESUMEN
BACKGROUND: The use of smartphones and multimedia messaging service (MMS) continues to increase in day to day orthopaedic clinical practice. However, there is limited evidence to support the safe utilisation of MMS. OBJECTIVES: The aim of this study was to correlate the performance of MMS imaging to picture archiving and communication systems (PACS) imaging within the setting of diagnosis and management of ankle fractures. METHODS: The ankle fracture radiograph series of 82 consecutive patients were evaluated by five orthopaedic consultant specialists. A questionnaire regarding diagnosis and preferred management was completed separately for each patient using smartphone and PACS images. Statistical analysis was performed using Intraclass Correlation Coefficient (ICC). RESULTS: Ankle fracture diagnosis showed strong to excellent correlation both inter- and intraobserver MMS vs PACS when using the Weber (0.815, 0.988), Anatomical (0.858, 0.988), and AO classification systems (0.855, 0.985). MMS was less reliable than PACS in determining many management options. CONCLUSION: The reliability of ankle fracture classification using MMS image viewing was not significantly different to interpretation on PACS workstations. Smartphone use in ankle fracture classification is supported by this study. Smartphone use was less accurate than PACS in devising management plans and future use should be limited to making only initial plans that must be corroberated with PACS and intraoperative findings prior to definitive fixation.
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Fracturas de Tobillo , Teléfono Inteligente , Fracturas de Tobillo/diagnóstico por imagen , Fracturas de Tobillo/cirugía , Humanos , Multimedia , Radiografía , Reproducibilidad de los ResultadosRESUMEN
Intracranial haemorrhage (ICH) in a patient with relapse of idiopathic thrombocytopaenic purpura (ITP) can be lethal. The site of haemorrhage, compounded by low platelets in this disease, makes its management extremely challenging, especially when a neurosurgical procedure is warranted. We report a case report of an unconventional way of increasing platelet counts in ITP rapidly in an emergency setting.
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Hemorragias Intracraneales/fisiopatología , Hemorragias Intracraneales/cirugía , Laparoscopía , Arteria Esplénica/fisiopatología , Arteria Esplénica/cirugía , Trombocitopenia/fisiopatología , Adulto , Humanos , Masculino , Resultado del TratamientoRESUMEN
ABSTRACT: Objective To explore a kind of visual evoked potential test equipment and method that is more suitable for the application of forensic clinical visual acuity evaluation. Methods Thirty-four volunteers ï¼68 eyesï¼ were selected, including 15 males and 19 females, aged between 20 and 40 years. Test lenses were placed before the tested eyes of volunteers to induce refractive myopia with insert method, and the diopter lenses were adjusted so that the visual acuity level of one eye of volunteers was above 0.8, and the visual acuity of the other eye was at moderate damage level ï¼<0.3 and ≥0.1ï¼. The tests were carried out under the binocular simultaneous asynchronous stimulation mode ï¼hereinafter referred to as "binocular mode"ï¼ and monocular separate stimulation mode ï¼hereinafter referred to as "monocular mode"ï¼ of virtual reality-pattern visual evoked potential ï¼VR-PVEPï¼, and the amplitude of PVEP of volunteers under the two modes was compared at four spatial frequencies of 8×8, 16×16, 24×24 and 32×32. Results The differences in the amplitude of P100 wave between monocular and binocular modes at 8×8 spatial frequency had no statistical significance and the differences in amplitude of P100 wave between monocular and binocular modes at 16×16, 24×24, and 32×32 spatial frequencies had statistical significance ï¼P<0.05ï¼. The amplitude of the same eye in monocular mode was higher than that in binocular mode. Through correlation analysis, it was found that the amplitude of P100 wave in monocular mode was moderately correlated with amplitude of P100 wave in binocular mode. Conclusion In forensic identification practice, VR-PVEP is helpful for overcoming the disturbance of poor fixation, and to increase the reliability of PVEP evaluation results. It can greatly shorten the detection time of PVEP and improve work efficiency.
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Potenciales Evocados Visuales , Realidad Virtual , Adulto , Ojo , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Agudeza Visual , Adulto JovenRESUMEN
ABSTRACT: Objective To research the correlation between the visual acuity ratio and pattern reversal visual evoked potential ï¼PRVEPï¼ P100 waveform amplitude ratio of both eyes. Methods Forty-seven volunteers were selected, and the visual chart visual acuity of both eyes was measured. The visual acuity ratio of the eye with poor vision to the eye with better vision was calculated by five grade notation method. The amplitudes of P100 waveforms of both eyes were recorded respectively by using black-and-white checkerboard PRVEP and chosing 1°, 15' stimulating visual angle, and the ratio of amplitudes between the two eyes was also calculated. SPSS 20.0 software was used to analyze the correlation between the visual acuity ratio and the ratio of P100 waveform amplitudes between the two eyes. Return test and linear regression analysis with the binocular ratio of P100 waveform amplitudes as the independent variable ï¼xï¼ and the binocular visual acuity ratio as the dependent variable ï¼yï¼ were made. Results There was a positive correlation between the binocular visual acuity ratio and the ratio of P100 waveform amplitudes under 15' stimulating visual angle ï¼Pearson correlation coefficient was 0.62, P=0.000ï¼. The fitting linear regression equation was y=0.090 x+0.846 ï¼F=20.954, P=0.000ï¼. There was no significant correlation between the binocular ratio of visual acuity and the binocular ratio of P100 waveform amplitudes under 1° stimulating visual angle ï¼P>0.05ï¼. Results of return test showed that there was no statistical significance in the difference between visual acuity estimated by equation and actual detected visual acuity. Conclusion In forensic appraisal of monocular injury, fitting linear regression equation of binocular visual acuity ratio and the binocular ratio of P100 waveform amplitudes under 15' stimulating visual angle, is helpful for visual acuity level estimation of the injured eye to some extent.
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Potenciales Evocados Visuales , Ojo/fisiopatología , Visión Ocular , Agudeza Visual , Humanos , Análisis de RegresiónRESUMEN
BACKGROUND: The deltopectoral approach for reverse shoulder arthroplasty (RSA) requires subscapularis tenotomy or lesser tuberosity osteotomy. Whether the subscapularis should be repaired at the conclusion of the procedure remains controversial. The present study sonographically assessed the subscapularis after RSA and evaluated the effect of tendon integrity on functional outcome. METHODS: All patients who had undergone RSA in the Gold Coast University Hospital between 2005 and 2016 were included. Sonography was performed by a blinded examiner. Function was assessed using the Disabilities of the Arm, Shoulder and Hand, the Constant-Murley, and Oxford Shoulder scores. Internal rotation ability was recorded on a 6-point scale. RESULTS: The study included 43 patients (48 shoulders). Median length of follow-up was 19 months (range, 4-132 months). On sonography, the subscapularis was graded intact in 6 shoulders (13%), intact with mild attenuation in 16 (33%), severely attenuated in 15 (31%), and not intact or absent in 11 (23%). Differences in Disabilities of the Arm, Shoulder and Hand, Constant-Murley, or Oxford Shoulder scores between intact and attenuated or absent subscapularis shoulders were not significant. Internal rotation scores were significantly higher in the intact and mildly attenuated tendon group than in the absent tendon group (U = 1.0, P = .001 and U = 28.5, P = .007, respectively). CONCLUSIONS: The present work is the first long-term outcome study of RSA using sonography to assess the subscapularis. Subscapularis integrity did not appear to have a measurable effect on patient outcome as measured by standard scores but was important for internal rotation ability after RSA.
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Artroplastía de Reemplazo de Hombro , Manguito de los Rotadores/diagnóstico por imagen , Articulación del Hombro/fisiopatología , Adulto , Anciano , Femenino , Humanos , Húmero/cirugía , Masculino , Persona de Mediana Edad , Osteotomía , Rango del Movimiento Articular , Reoperación , Manguito de los Rotadores/cirugía , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/cirugía , Tendones/cirugía , Tenotomía , Resultado del Tratamiento , UltrasonografíaRESUMEN
Binocular vision refers to a progress of analysing and integrating the binocular visual signals into a whole and three-dimensional sensory perception by higher nerve centre. In this process, the interac- tion between the two eyes results in the changes of output signal, which is called binocular interaction. Through a series of subjective and objective experiments, it can be concluded that binocular interaction can be divided into three typesï¼ facilitation, summation and suppression, and the forms of binocular interaction in different visual states are different. In general, the visual signal is processed by binocular interaction, so that there are some differences between binocular vision and monocular vision. The extent of the difference can be affected by the damage of monocular vision and then affects the binocular vision. Thus, it is necessary for forensic scientists to further study the effects of the monocular visual impairment on visual function. Based on relevant data, this paper reviews the mechanism of the monocular visual impairment in binocular vision, the research methods and the application prospect in forensic science.
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Trastornos de la Visión , Visión Binocular , Visión Monocular , Agudeza Visual , Adulto , Humanos , Visión OcularRESUMEN
Accurate evaluation of muscle function helps to understand the recovery of muscle, bone, nervous system diseases or injuries, especially for muscle dysfunction caused by peripheral nerve injury. Therefore, the methods of muscle function evaluation have been the focus of researchers, with new methods having been constantly proposed. Muscle strength testing is an important part of muscle function evaluation. Besides hand muscle strength assessment, currently used muscle function assessments include simple instrumental test, isokinetic muscle test, electrophysiological test, etc. In addition, the application of needle electromyography, motor unit number estimation, motion unit index in muscle function evaluation has also been reported for several times. This paper reviews the research progress and practical application of these methods.
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Enfermedades del Sistema Nervioso , Traumatismos de los Nervios Periféricos , Electromiografía , Humanos , Fuerza Muscular , Músculo Esquelético , Enfermedades del Sistema Nervioso/diagnóstico , Traumatismos de los Nervios Periféricos/diagnósticoRESUMEN
OBJECTIVES: To explore the assessment method of original height of L1-2 after vertebral compression fracture and its application value in forensic clinical practice. METHODS: A total of 154 normal thoracic and lumbar X-ray films were collected, and 140 cases were used as experimental group while 14 cases as validation group. The heights of anterior ï¼Haï¼ and posterior ï¼Hpï¼ vertebral body of T12-L3 vertebrae in each X-ray image were measured. In the experimental group, the correlation analysis between HaL1 and HaT12, HpT12, HpL1, HaL2 and HpL2 was carried out, and regression equation was established via fitting. The correlation analysis between HaL2 and HaL1, HpL1, HpL2, HaL3, HpL3 was performed, and the regression equation was also established via fitting. The difference between the predicted and measured values of HaL1 and HaL2 in validation group was compared. RESULTS: In the 140 normal subjects, HaL1 ï¼y1ï¼ was well correlated with HaT12 ï¼x1ï¼ and HaL2ï¼x2ï¼, and the multiple linear regression equation was y1=2.545+0.423 x1+0.486 x2 ï¼determining coefficient R²=0.712, P<0.05; F=169.206, P<0.05ï¼. There was no significant difference between the predicted and actual measured values of HaL1 in the validation group ï¼ P>0.05ï¼. HaL2 ï¼y2ï¼ was well correlated with HaL1 ï¼x3ï¼ and HaL3 ï¼x4ï¼, and the multiple linear regression equation was y2=4.354+0.530 x3+0.349 x4 ï¼determining coefficient R²=0.689, P<0.05; F=151.575, P<0.05ï¼. There was no significant difference between the predicted and actual measured values of HaL2 in the validation group ï¼ P>0.05ï¼. CONCLUSIONS: It is more appropriate to evaluate the original height of L1 or L2 single vertebrae by comparing with the height of the anterior edge of the upper and lower adjacent vertebral bodies.
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Fracturas por Compresión , Vértebras Lumbares/diagnóstico por imagen , Fracturas de la Columna Vertebral/cirugía , Vértebras Torácicas/diagnóstico por imagen , Anciano , Humanos , Persona de Mediana EdadRESUMEN
WHAT IS KNOWN AND OBJECTIVE: Warfarin is a widely used anticoagulant with a narrow therapeutic index. Polymorphisms in the VKORC1, CYP2C9 and CYP4F2 genes have been verified to correlate with warfarin stable dosage (WSD). Whether any other genes or variants affect the dosage is unknown. The aim of our study was to investigate the relationship between GGCX, miR-133 variants and the WSD in Han Chinese patients with mechanical heart valve replacement (MHVR). METHODS: A total of 231 patients were enrolled in the study. Blood samples were collected for genotyping. The average WSD among subjects with different GGCX or miR-133 genotypes was compared. Regression analyses were performed to test for any association of genetic polymorphisms with WSD. RESULTS AND DISCUSSION: The warfarin dosage in patients with the GGCX rs699664 TT and rs12714145 TT genotypes was 3.77±0.93 (95% CI: 3.35-4.19) mg/d and 3.70±1.00 (95% CI: 3.32-4.09) mg/d, respectively. The GGCX rs699664 and rs12714145 genotypes were significantly associated with WSD (P<.05). But they were ruled out in the multivariate regression analysis. There were no significant differences in the average warfarin stable dosage between subjects with MIR133B rs142410335 wild-type and variant genotypes (P>.05). WHAT IS NEW AND CONCLUSION: The genotypes of GGCX rs699644 and rs12714145 were significantly associated with WSD (P<.05), but their contributions were not significant after accounting for other factors. MIR133B rs142410335 makes no significant contributions to warfarin stable dosage in Han Chinese patients with MHVR neither in univariate regression nor in multivariate regression analyses.
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Ligasas de Carbono-Carbono/genética , Implantación de Prótesis de Válvulas Cardíacas , MicroARNs/genética , Warfarina/administración & dosificación , Adolescente , Adulto , Anciano , Anticoagulantes/administración & dosificación , Pueblo Asiatico/genética , China , Relación Dosis-Respuesta a Droga , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Polimorfismo Genético , Análisis de Regresión , Adulto JovenRESUMEN
OBJECTIVES: To compare the differences between Hertel exophthalmometry and CT on exophthalmos measurement, and explore its practical application value in forensic medicine. METHODS: Fifty-six normal individuals without eye injuries or diseases were selected as the control group. The absolute values of exophthalmos were measured in the standardized CT image workstation. The difference of binocular exophthalmos was compared in normal group. Forty-seven cases with unilateral orbital fracture were divided into injured eye group and normal eye group according to the presence of binocular orbital fractures. The differences of the absolute values of eophthalmos from the same eye and the relative values of eophthalmos between two eyes for same person measured by Hertel exophthalmometry and CT were analyzed. RESULTS: There was no statistical difference of exophthalmos between the normal eyes measured by CT method. In the normal eye group, the absolute value of exophthalmos measured by CT method was ï¼16.66±5.41ï¼ mm, which was ï¼16.16±4.45ï¼ mm when measured by the Hertel exophthalmometry method. There was no statistical difference between two groups ï¼P>0.05ï¼. In the injured eye group, there was statistical difference between the absolute values of exophthalmos measured by two measurement methods ï¼ P<0.05ï¼. There was no statistical difference of the relative values of exophthalmos between the injured eyes and the normal eyes by two measurement methods ï¼P>0.05ï¼. CONCLUSIONS: CT method has a good consistency with Hertel exophthalmometry, which can be applied into the practice of medicolegal expertise.
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Técnicas de Diagnóstico Oftalmológico/instrumentación , Exoftalmia/diagnóstico por imagen , Lesiones Oculares/diagnóstico por imagen , Ojo/diagnóstico por imagen , Fracturas Orbitales/diagnóstico por imagen , Adulto , Estudios de Casos y Controles , Ojo/patología , Medicina Legal , Humanos , Masculino , Órbita/diagnóstico por imagen , Órbita/patología , Estándares de Referencia , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: The aim of distal radial fracture treatment is to achieve optimal function through the restoration of normal anatomy, including volar tilt. The accuracy of assessing volar tilt on standard lateral radiographs compared with anatomic tilt lateral (ATL) radiographs is uncertain. This study aimed to investigate the anatomy of the articular surface of the distal radius, in particular measuring the angle between the dorsal and volar rims at several points from radial to ulnar, to ascertain whether volar tilt is uniform between the scaphoid and lunate facet and to explore consistency between standard lateral and ATL views. METHODS: We studied 38 dry cadaveric specimens of radii. The distal articular surface of each specimen was marked at 5 intervals and placed in a customized jig. A 1.5-mm stylus was placed at each marker to represent the articular surface angle, and was photographed in standard lateral and ATL projections. An on-screen protractor was used to measure each angle from the digital photographs. RESULTS: The volar tilt measurements at the lunate facet demonstrated a significantly shallower angle than those at the scaphoid facet. The measurements between the standard lateral and ATL were found to have no significant difference. CONCLUSIONS: Adjusting the projection angle between a simulated standard lateral and ATL view did not significantly change the volar tilt measurements in this anatomic study. The lunate facet was found to have a significantly shallower volar tilt than the scaphoid facet. Variance in radiographic volar tilt may relate to different anatomic sagittal planes, reflecting the anatomic variation between the scaphoid and lunate facets. CLINICAL RELEVANCE: A detailed understanding of distal radius anatomy is required by the surgeon for accurate radiologic interpretation and anatomic fracture reduction and fixation.
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Variación Anatómica , Radio (Anatomía)/anatomía & histología , Cadáver , Humanos , Radiografía , Radio (Anatomía)/diagnóstico por imagen , Radio (Anatomía)/lesiones , Fracturas del Radio/cirugíaRESUMEN
The purpose of this review is to synthesize the current knowledge on the international movement of patients and biopsied embryo cells for pre-implantation genetic diagnosis and its different applications. Thus far, few attempts have been made to identify the specific nature of this phenomenon called 'cross-border reprogenetic services'. There is scattered evidence, both empirical and speculative, suggesting that these services raise major issues in terms of service provision, risks for patients and the children-to-come, the legal liabilities of physicians, as well as social justice. To compile this evidence, this review uses the narrative overview protocol combined with thematic analysis. Five major themes have emerged from the literature at the conjunction of cross-border treatments and reprogenetics: 'scope', 'scale', 'motivations', 'concerns', and 'governance'. Similar themes have already been observed in the case of other medical tourism activities, but this review highlights their singularity with reprogenetic services. It emphasizes the diagnostic and autologous feature of reprogenetics, the constant risk of misdiagnosis, the restriction on certain tests for medically controversial conditions, and the uncertain accessibility of genetic counseling in cross-border settings.
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Biopsia/métodos , Embrión de Mamíferos , Internacionalidad/legislación & jurisprudencia , Diagnóstico Preimplantación/métodos , Técnicas Reproductivas Asistidas , Viaje/tendencias , Humanos , Viaje/legislación & jurisprudenciaRESUMEN
AIM: To investigate the capability and diagnostic accuracy of diffusion-weighted imaging (DWI) in differentiating benign from malignant breast lesions using 3 T magnetic resonance imaging (MRI). MATERIALS AND METHODS: Women with suspicious or indeterminate breast lesions detected at MRI, mammogram and/or ultrasound were recruited for dynamic contrast-enhanced (DCE)-MRI and DWI prior to their biopsy. Image fusion of DCE-MRI with apparent diffusion coefficient (ADC) map was utilized to select the region of interest (ROI) for ADC calculation in the area that showed the most avid enhancement. DWI was performed using two sets of b-values at 500 and 1000 s/mm(2), respectively. RESULTS: Fifty women were recruited and the final analysis comprised 44 breast lesions, 31 of which were malignant and 13 were benign. Significant results were obtained between ADC values of benign and malignant lesions (p < 0.001). The cut-off ADC values for benign and malignant lesions were 1.21 × 10(-3) mm(2)/s for b = 500 s/mm(2) and 1.22 × 10(-3) mm(2)/s for b = 1000 s/mm(2), respectively. The sensitivity of DCE-MRI alone was 100% with a specificity of 66.7%. When DCE-MRI was combined with b = 1000 s/mm(2), the specificity rose to 100%, while only mildly affecting sensitivity (90.6%). No significant correlation was found between ADC values and prognostic factors, such as lymph node metastasis, tumour size, oestrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status, and tumour grades. CONCLUSION: The present study provides consistent evidence to support DWI as a diagnostic tool for breast lesion characterization. A combination of DCE-MRI with DWI is suggested to improve the sensitivity and specificity of lesion characterization.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Imagen de Difusión por Resonancia Magnética/métodos , Adulto , Anciano , Medios de Contraste , Diagnóstico Diferencial , Femenino , Gadolinio DTPA , Humanos , Metástasis Linfática , Mamografía , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Sensibilidad y Especificidad , Ultrasonografía MamariaRESUMEN
Hand, foot, and mouth disease (HFMD) is a contagious childhood disease caused by enteroviruses including enterovirus A71 (EV-A71), coxsackievirus A6 (CV-A6) and CV-A16 transmitted via direct and indirect contact. Different types of toy surfaces can affect the stability of viruses. Understanding the stability of enteroviruses on toys provides insightful data for effective disinfection in kindergartens or homes. Porous (ethylene-vinyl acetate mat foam, paper, pinewood, polyester fabric, and squishy polyurethane foam) and non-porous (acrylonitrile butadiene styrene plastic and stainless-steel coin) surfaces were inoculated with EV-A71 at 4, 24, and 35°C, and coxsackieviruses at 24°C. Infectious enteroviruses were recovered and titred in median tissue culture infectious dose assay (TCID50). Atomic force microscopy (AFM) images were taken from surfaces to examine association of surface roughness with virus stability. Overall, infectious enteroviruses were persistent on all non-porous and porous surfaces. Virus persistence was longest at 4°C followed by 24°C and 35°C. EV-A71 half-lives ranged between 6.4-12.8 hours at 4°C, 2.4-6.7 hours at 24°C, and 0.13-2.7 hours at 35°C. At lower virus titres exposed to 24°C, half-lives of enteroviruses ranged from 0.1-1.4 hours. Surface roughness values from AFM suggested smooth surfaces of non-porous surfaces were associated with better virus stability. Temperature, enterovirus concentration, and type of surface affected persistence and stability of enteroviruses. Our findings suggest both porous and non-porous surfaces in kindergartens allow enterovirus persistence and should be frequently disinfected to curb HFMD outbreaks in kindergartens.