RÉSUMÉ
BACKGROUND: Tumorous diseases of the jaw demand effective treatments, often involving continuity resection of the jaw. Reconstruction via microvascular bone flaps, like deep circumflex iliac artery flaps (DCIA), is standard. Computer aided planning (CAD) enhances accuracy in reconstruction using patient-specific CT images to create three-dimensional (3D) models. Data on the accuracy of CAD-planned DCIA flaps is scarce. Moreover, the data on accuracy should be combined with data on the exact positioning of the implants for well-fitting dental prosthetics. This study focuses on CAD-planned DCIA flaps accuracy and proper positioning for prosthetic rehabilitation. METHODS: Patients post-mandible resection with CAD-planned DCIA flap reconstruction were evaluated. Postoperative radiograph-derived 3D models were aligned with 3D models from the CAD plans for osteotomy position, angle, and flap volume comparison. To evaluate the DCIA flap's suitability for prosthetic dental rehabilitation, a plane was created in the support zone and crestal in the middle of the DCIA flap. The lower jaw was rotated to close the mouth and the distance between the two planes was measured. RESULTS: 20 patients (12 males, 8 females) were included. Mean defect size was 73.28 ± 4.87 mm; 11 L defects, 9 LC defects. Planned vs. actual DCIA transplant volume difference was 3.814 ± 3.856 cm³ (p = 0.2223). The deviation from the planned angle was significantly larger at the dorsal osteotomy than at the ventral (p = 0.035). Linear differences between the planned DCIA transplant and the actual DCIA transplant were 1.294 ± 1.197 mm for the ventral osteotomy and 2.680 ± 3.449 mm for the dorsal (p = 0.1078). The difference between the dental axis and the middle of the DCIA transplant ranged from 0.2 mm to 14.8 mm. The mean lateral difference was 2.695 ± 3.667 mm in the region of the first premolar. CONCLUSION: The CAD-planned DCIA flap is a solution for reconstructing the mandible. CAD planning results in an accurate reconstruction enabling dental implant placement and dental prosthetics.
Sujet(s)
Artère iliaque , Lambeaux chirurgicaux , Humains , Mâle , Femelle , Adulte d'âge moyen , Lambeaux chirurgicaux/vascularisation , Lambeaux chirurgicaux/transplantation , Artère iliaque/chirurgie , Artère iliaque/imagerie diagnostique , Sujet âgé , Adulte , Chirurgie assistée par ordinateur/méthodes , Imagerie tridimensionnelle , /méthodes , Tumeurs de la mandibule/chirurgie , Études rétrospectives , Reconstruction mandibulaire/méthodes , Mastication/physiologie , Résultat thérapeutiqueRÉSUMÉ
This Medical News story discusses the rise in ransomware cyberattacks on health care, as well as new cybersecurity initiatives.
Sujet(s)
Sécurité informatique , Prestations des soins de santé , Systèmes d'information sur la santé , Humains , Prestations des soins de santé/organisation et administration , Prestations des soins de santé/normes , États-Unis , Sécurité informatique/normes , Systèmes d'information sur la santé/organisation et administration , Systèmes d'information sur la santé/normes , Données personnellesRÉSUMÉ
BACKGROUND: Good communication between patients and practitioners is essential, especially during dental procedures, as these treatments are often associated with increased nervousness and anxiety. The aim of this study was to investigate, implement and evaluate a concept for communication skills training by using targeted training in combination with simulation patients in dental education. METHODS: Students (n = 34) were assigned to four small groups receiving targeted training consisting of two parts. A lecture about the theoretical basics of communication skills and two practical sessions with simulation patients. During this training, one of the students performed the conversation with the patient. Immediately after self-assessment was obtained, the simulation patient, the remaining students and the lecturer provided feedback. Additionally, anonymous surveys were administered to the students at the beginning of the semester, immediately after the training and at the end of the course. RESULTS: The students rated the learning of communication skills as important for later professional life at all times. After targeted training followed by subsequent use in simulated patients, there was a significant improvement in communication skills (p < 0.001). The number of open-ended questions asked to patients after attending the course significantly increased (p = 0.0245). The communication training was considered useful, especially in small groups. CONCLUSION: The implementation of targeted training with subsequent use in simulated patients significantly contributed to the students' improvement in communication skills. The concept offers a good opportunity to better prepare students for interaction with patients, both in their studies and in their upcoming professional lives.
Sujet(s)
Communication , Enseignement dentaire , Simulation sur patients standardisés , Étudiant dentisterie , Humains , Enseignement dentaire/méthodes , Études prospectives , Femelle , Mâle , Étudiant dentisterie/psychologie , Compétence clinique , Relations dentiste-patient , AdulteSujet(s)
Politique de santé , Disparités d'accès aux soins , Transplantation hépatique , Acquisition d'organes et de tissus , Humains , Politique de santé/économie , Politique de santé/législation et jurisprudence , Politique de santé/tendances , Disparités d'accès aux soins/ethnologie , Disparités d'accès aux soins/législation et jurisprudence , Disparités d'accès aux soins/statistiques et données numériques , Disparités d'accès aux soins/tendances , Transplantation hépatique/économie , Transplantation hépatique/législation et jurisprudence , Transplantation hépatique/statistiques et données numériques , Transplantation hépatique/tendances , Acquisition d'organes et de tissus/économie , Acquisition d'organes et de tissus/législation et jurisprudence , Acquisition d'organes et de tissus/statistiques et données numériques , Acquisition d'organes et de tissus/tendances , États-Unis/épidémiologieSujet(s)
Antihypertenseurs , Eczéma , Sujet âgé , Humains , Antihypertenseurs/effets indésirables , Antihypertenseurs/usage thérapeutique , Eczéma/induit chimiquement , Eczéma/étiologie , Hypertension artérielle/traitement médicamenteux , Adulte d'âge moyen , Diurétiques/effets indésirables , Diurétiques/usage thérapeutique , Inhibiteurs des canaux calciques/effets indésirables , Inhibiteurs des canaux calciques/usage thérapeutiqueSujet(s)
Virus de la dengue , Dengue , Prédisposition aux maladies , Infection par le virus Zika , Virus Zika , Femelle , Humains , Dengue/complications , Dengue/épidémiologie , Dengue/immunologie , Virus de la dengue/immunologie , Risque , Virus Zika/immunologie , Infection par le virus Zika/complications , Infection par le virus Zika/immunologie , Enfant d'âge préscolaire , Enfant , AdolescentSujet(s)
Peptides glucagon-like , Hypoglycémiants , Insuffisance rénale chronique , Humains , Maladies cardiovasculaires/prévention et contrôle , Diabète de type 2/traitement médicamenteux , Diabète de type 2/complications , Récepteur du peptide-1 similaire au glucagon/agonistes , Peptides glucagon-like/usage thérapeutique , Peptides glucagon-like/effets indésirables , Hypoglycémiants/usage thérapeutique , Hypoglycémiants/effets indésirables , Insuffisance rénale chronique/complications , RisqueRÉSUMÉ
BACKGROUND: Surgical correction of unicoronal craniosynostosis (UCS) is highly complex due to its asymmetric appearance. Although fronto-orbital advancement (FOA) is a versatile technique for craniosynostosis correction, harmonization of the orbital bandeau in UCS is difficult to predict. This study evaluates the biomechanics of the orbital bandeau using different patterns and varying characteristics of inner cortical bone layer osteotomies in a finite element (FE) analysis. METHOD: An FE model was created using the computed tomography (CT) scan of a 6.5-month-old male infant with a right-sided UCS. The unaffected side of the orbital bandeau was virtually mirrored, and anatomical correction of the orbital bandeau was simulated. Different combinations of osteotomy patterns, numbers, depths, and widths were examined (n = 48) and compared to an uncut model. RESULTS: Reaction forces and maximum stress values differed significantly (p < 0.01) among osteotomy patterns and between each osteotomy characteristic. Regardless of the osteotomy pattern, higher numbers of osteotomies significantly (p < 0.05) correlated with reductions in reaction force and maximum stress. An X-shaped configuration with three osteotomies deep and wide to the bone was biomechanically the most favorable model. CONCLUSION: Inner cortical bone layer osteotomy might be an effective modification to the conventional FOA approach in terms of predictable shaping of the orbital bandeau.
Sujet(s)
Craniosynostoses , Analyse des éléments finis , Orbite , Ostéotomie , Humains , Mâle , Craniosynostoses/chirurgie , Craniosynostoses/imagerie diagnostique , Nourrisson , Orbite/chirurgie , Orbite/imagerie diagnostique , Phénomènes biomécaniques , Contrainte mécanique , Phénomènes mécaniques , TomodensitométrieRÉSUMÉ
This Medical News article discusses the great resignation in health care and new efforts to create a sustainable medical workforce in the US.
Sujet(s)
Épuisement professionnel , COVID-19 , Prestations des soins de santé , Médecins , Résilience psychologique , Humains , Épuisement professionnel/prévention et contrôle , COVID-19/psychologie , Prestations des soins de santé/statistiques et données numériques , Personnel de santé/psychologie , Médecins/psychologie , Médecins/statistiques et données numériques , Médecins/ressources et distributionRÉSUMÉ
This Medical News story discusses an analysis of deaths by suicide among NCAA athletes over the past 20 years.
Sujet(s)
Athlètes , Étudiants , Suicide , Femelle , Humains , Mâle , Jeune adulte , Athlètes/psychologie , Athlètes/statistiques et données numériques , Étudiants/psychologie , Étudiants/statistiques et données numériques , Suicide/statistiques et données numériques , États-Unis/épidémiologie , Universités/statistiques et données numériquesRÉSUMÉ
This Medical News article is an interview with Saurabh Jha, a cardiothoracic radiologist and an associate professor of radiology at the University of Pennsylvania, and JAMA Editor in Chief Kirsten Bibbins-Domingo.
Sujet(s)
Intelligence artificielle , Imagerie diagnostique , Interprétation d'images radiographiques assistée par ordinateur , Humains , Imagerie diagnostique/méthodes , Interprétation d'images radiographiques assistée par ordinateur/méthodesRÉSUMÉ
BACKGROUND: The fundamental prerequisite for prognostically favorable postoperative results of peripheral nerve repair is stable neurorrhaphy without interruption and gap formation. METHODS: This study evaluates 60 neurorrhaphies on femoral chicken nerves in terms of the procedure and the biomechanical properties. Sutured neurorrhaphies (n = 15) served as control and three sutureless adhesive-based nerve repair techniques: Fibrin glue (n = 15), Histoacryl glue (n = 15), and the novel polyurethane adhesive VIVO (n = 15). Tensile and elongation tests of neurorrhaphies were performed on a tensile testing machine at a displacement rate of 20 mm/min until failure. The maximum tensile force and elongation were recorded. RESULTS: All adhesive-based neurorrhaphies were significant faster in preparation compared to sutured anastomoses (p < 0.001). Neurorrhaphies by sutured (102.8 [cN]; p < 0.001), Histoacryl (91.5 [cN]; p < 0.001) and VIVO (45.47 [cN]; p < 0.05) withstood significant higher longitudinal tensile forces compared to fibrin glue (10.55 [cN]). VIVO, with â³L/L0 of 6.96 [%], showed significantly higher elongation (p < 0.001) compared to neurorrhaphy using fibrin glue. CONCLUSION: Within the limitations of an in vitro study the adhesive-based neurorrhaphy technique with VIVO and Histoacryl have the biomechanical potential to offer alternatives to sutured neuroanastomosis because of their stability, and faster handling. Further in vivo studies are required to evaluate functional outcomes and confirm safety.
Sujet(s)
Anastomose chirurgicale , Poulets , Résistance à la traction , Animaux , Anastomose chirurgicale/méthodes , Phénomènes biomécaniques , Adhésifs tissulaires/pharmacologie , Colle de fibrine/pharmacologie , Nerfs périphériques/chirurgie , Nerfs périphériques/physiologie , Adhésifs , Procédures de neurochirurgie/méthodesRÉSUMÉ
PURPOSE: The deep circumflex iliac crest flap (DCIA) is used for the reconstruction of the jaw. For fitting of the transplant by computer-aided planning (CAD), a computerized tomography (CT) of the jaw and the pelvis is necessary. Ready-made cutting guides save a pelvic CT and healthcare resources while maintaining the advantages of the CAD planning. METHODS: A total of 2000 CTs of the pelvis were divided into groups of 500 by sex and age (≤ 45 and > 45 years). Three-dimensional (3D) pelvis models were aligned and averaged. Cutting guides were designed on the averaged pelvis for each group and an overall averaged pelvis. The cutting guides and 50 randomly selected iliac crests (10 from each group and 10 from the whole collective) were 3D printed. The appropriate cutting guide was mounted to the iliac crest and a cone beam CT was performed. The thickness of the space between the iliac crest and the cutting guide was evaluated. RESULTS: Overall the mean thickness of the space was 2.137 mm and the mean volume of the space was 4513 mm3. The measured values were significantly different between the different groups. The overall averaged group had not the greatest volume, maximum thickness and mean thickness of the space. CONCLUSION: Ready-made cutting guides for the DCIA flap fit to the iliac crest and make quick and accurate flap raising possible while radiation dose and resources can be saved. The cutting guides fit sufficient to the iliac crest and should keep the advantages of a standard CAD planning.
Sujet(s)
Artère iliaque , Ilium , Lambeaux chirurgicaux , Humains , Artère iliaque/chirurgie , Artère iliaque/imagerie diagnostique , Adulte d'âge moyen , Mâle , Femelle , Ilium/chirurgie , Lambeaux chirurgicaux/vascularisation , Tomodensitométrie/méthodes , Adulte , Impression tridimensionnelle , Sujet âgé , Tomodensitométrie à faisceau conique/méthodes , Imagerie tridimensionnelleRÉSUMÉ
This Medical News story discusses a clinical trial that tested symptom-guided exercise for patients with long COVID and postexertional malaise.
Sujet(s)
Traitement par les exercices physiques , Syndrome de post-COVID-19 , Humains , COVID-19/complications , COVID-19/rééducation et réadaptation , Traitement par les exercices physiques/méthodes , Syndrome de post-COVID-19/épidémiologie , Syndrome de post-COVID-19/étiologie , Syndrome de post-COVID-19/rééducation et réadaptation , Suède/épidémiologie , États-Unis/épidémiologie , Aggravation transitoire des symptômesRÉSUMÉ
Background: The high volume of the fasciomyocutaneous anterolateral thigh flaps (ALT) is suitable for the reconstruction of pronounced soft tissue defects. At the same time, harvesting ALT results in a drastic change in thigh shape. Here, we present an optical three-dimensional imaging method for thigh comparison, which can be an objective and reproducible method for evaluating donor sites after ALT harvesting. Methods: In total, 128 thighs were scanned with an optical three-dimensional scanner, Vectra XT ®. Sixty-eight non-operated right and left thighs were compared and served as a control. Sixty thighs were scanned in the ALT group. The average surface area deviations, thigh volume, thigh circumference, and flap ratio to thigh circumference were calculated. The results were correlated with Δthigh circumference and Δvolume of the unoperated thighs of the control group. Results: No significant difference between the thigh volumes of the right and left thighs was found in the control group. Removal of an ALT flap showed a significant (p < 0.007) volume reduction compared to unoperated thighs (2.7 ± 0.8 L and 3.3 ± 0.9 L, respectively). Flap area correlated strongly with the Δthigh circumference (r = 0.66, p < 0.001) and Δvolume (r = 0.68, p < 0.001). Strong correlations were observed between flap ratio and thigh circumference with Δhigh circumference (r = 0.57, p < 0.001) and Δvolume (r = 0.46, p < 0.05). Conclusions: Optical three-dimensional imaging provides an objective and reproducible tool for detecting changes in thigh morphology volume differences after ALT harvesting.