Transcervical uterine flushing and embryo transfer in sheep: Morphophysiological basis for approaches currently used, major challenges, potential improvements, and new directions (alas, including some old ideas).

At present, the success of non-surgical embryo recovery (NSER) and transfer (NSET) hinges upon the cervical passage of catheters, but penetration of the uterine cervix in ewes is problematic due to its anatomical structure (i.e., long and narrow cervical lumen with misaligned folds and rings). It is a major obstacle limiting the widespread application of NSER and NSET in sheep. While initial attempts to traverse the uterine cervix focused on adapting or re-designing insemination catheters, more recent studies demonstrated that cervical relaxation protocols were instrumental for transcervical penetration in the ewe. An application of such protocols more than tripled cervical penetration rates (currently at 90-95 %) in sheep of different breeds (e.g., Dorper, Lacaune, Santa Inês, crossbred, and indigenous Brazilian breeds) and ages/parity. There is now sufficient evidence to suggest that even repeatedly performed cervical passages do not adversely affect overall health and reproductive function of ewes. Despite these improvements, appropriate selection of donors and recipients remains one of the most important requirements for maintaining high success rates of NSER and NSET, respectively. Non-surgical ovine embryo recovery has gradually become a commercially viable method as even though the procedure still cannot be performed by untrained individuals, it is inexpensive, yields satisfactory results, and complies with current public expectations of animal welfare standards. This article reviews critical morphophysiological aspects of transcervical embryo flushing and transfer, and the prospect of both techniques to replace surgical methods for multiple ovulation and embryo transfer (MOET) programs in sheep. We have also discussed some potential pharmacological and technical developments in the field of non-invasive embryo recovery and deposition.

Implementing a challenge-based learning experience in a bioinstrumentation blended course.

BACKGROUND: Bioinstrumentation is essential to biomedical engineering (BME) undergraduate education and professional practice. Several strategies have been suggested to provide BME students with hands-on experiences throughout the curriculum, promoting their preparedness to pursue careers in industry and academia while increasing their learning and engagement. This paper describes the implementation of challenge-based learning (CBL) in an undergraduate bioinstrumentation blended course over the COVID-19 pandemic. METHODS: The CBL experience was implemented in a third-year bioinstrumentation course from the BME program at Tecnologico de Monterrey. Thirty-nine students enrolled in two sections formed fourteen teams that tackled blended learning activities, including online communication, lab experiments, and in-person CBL activities. Regarding the latter, students were challenged to design, prototype, and test a respiratory or cardiac gating device for radiotherapy. An institutional student opinion survey was used to assess the success of our CBL implementation. RESULTS: Student responses to the end-of-term survey showed that they strongly agreed that this course challenged them to learn new concepts and develop new skills. Furthermore, they rated the student-lecturer interaction very positively despite the blended format. Overall, students assessed their learning experience positively. However, implementing this CBL experience required a substantial time increase in planning, student tutoring, and constant communication between lecturers and the industry partner. CONCLUSION: This work provides an effective instance of CBL for BME education to improve students' learning experience despite decreased resource efficiency. Our claim is supported by the student's performance and the positive feedback from our industrial partner.

Use of Biomedical Engineering for Rehabilitation of Patients with Disability Caused by Guillain-Barré Syndrome: a Systematic Review / Uso de la Ingeniería Biomédica para Rehabilitación de Pacientes con Discapacidad Causada por el Síndrome de Guillain-Barré: Una Revisión Sistemática

Abstract This systematic review aims to assess the extent to which biomedical engineering has been applied in the rehabilitation of patients suffering from Guillain-Barré Syndrome (GBS), given the scarcity of information on this topic. We conducted a thorough analysis of research articles, conference abstracts, and case reports published between 2000 and 2023, specifically from ScienceDirect, PubMed, IEEE Xplore, Springer, and Dimensions. 19 articles were extensively discussed, complemented by an additional 40 information sources providing supplementary information. Each paper underwent a meticulous review process by the four authors, where each separately examined the title and abstract of the papers and subsequently provided a thorough examination of the full text; when conflicts arose, a clear consensus was reached through discussion. The analysis of the articles revealed a notable improvement in upper and lower limb function of GBS patients that was facilitated by both custom-made and commercial devices. Likewise, a small handful of other devices have been used (e.g., to improve urinary retention issues). There is a clear opportunity for new research, innovation and applications.

Resumen Esta revisión sistemática tiene como objetivo evaluar hasta qué punto se ha aplicado la ingeniería biomédica en la rehabilitación de pacientes que padecen el Síndrome de Guillain-Barré (SGB), dada la escasez de información sobre este tema. Realizamos un análisis exhaustivo de artículos de investigación, resúmenes de conferencias e informes de casos publicados entre 2000 y 2023, específicamente de ScienceDirect, PubMed, IEEE Xplore, Springer y Dimensions. Se discutieron ampliamente 19 artículos, complementados con 40 fuentes de información adicionales. Cada artículo pasó por un meticuloso proceso de revisión por parte de los cuatro autores, donde cada uno examinó por separado el título y el resumen de los artículos y posteriormente proporcionó un examen exhaustivo del texto completo; cuando surgieron conflictos, se alcanzó un consenso mediante la discusión. El análisis de los artículos reveló una mejora notable en la función de las extremidades superiores e inferiores de los pacientes con SGB que fue facilitada por dispositivos tanto hechos a medida como comerciales. Asimismo, se han creado un pequeño puñado de otros dispositivos, (por ejemplo, para mejorar los problemas de retención urinaria). Existe una clara oportunidad para nueva investigación, innovación y aplicaciones.

Utilidad de la tecnología CAD/CAM en la fabricación de prótesis dentales

La tecnología CAD/CAM es una forma innovadora relacionada con la implementación de técnicas digitales para mejorar las restauraciones prostéticas en un paciente, entre ellas, las destinadas a la estética dental. El presente estudio tiene el objetivo de describir la utilidad de la tecnología CAD/CAM en la fabricación de prótesis dentales. Para ello se realizó una revisión de la literatura médica disponible en las bases de datos PubMed/Medline, Scopus y SciELO, mediante fórmulas de búsqueda avanzada; se seleccionaron artículos en idioma español e inglés. En la actualidad, con esta tecnología se ha logrado combinar estética, resistencia y precisión en la restauración directa, además de garantizarse una mayor duración y años de funcionalidad para cada una de las prótesis, coronas e implantes. La calidad de vida y satisfacción referidas por los pacientes portadores de piezas producidas con esta tecnología, es superior a las manifestadas por aquellos tratados con piezas de fabricación tradicional. El uso de técnicas de inteligencia artificial y biomateriales representará un cambio cualitativo y cuantitativo en el uso de los sistemas CAD/CAM.

CAD/CAM technology is an innovative way related to the implementation of digital techniques to improve prosthetic restorations in a patient, including those intended for dental aesthetics. The objective of this study is to describe the usefulness of CAD/CAM technology in the dental prostheses manufacture. A review of the medical literature available in the PubMed/Medline, Scopus and SciELO databases was carried out, using advanced search formulas; Articles in Spanish and English were selected. Currently, with this technology it has been possible to combine aesthetics, resistance and precision in direct restoration, in addition to guaranteeing greater duration and years of functionality for each of the prostheses, crowns and implants. The quality of life and satisfaction reported by patients wearing parts produced with this technology is higher than those reported by those treated with traditionally manufactured parts. The use of artificial intelligence and biomaterials techniques will represent a qualitative and quantitative change in the use of CAD/CAM systems.

A New Generative Model for Textual Descriptions of Medical Images Using Transformers Enhanced with Convolutional Neural Networks.

The automatic generation of descriptions for medical images has sparked increasing interest in the healthcare field due to its potential to assist professionals in the interpretation and analysis of clinical exams. This study explores the development and evaluation of a generalist generative model for medical images. Gaps were identified in the literature, such as the lack of studies that explore the performance of specific models for medical description generation and the need for objective evaluation of the quality of generated descriptions. Additionally, there is a lack of model generalization to different image modalities and medical conditions. To address these issues, a methodological strategy was adopted, combining natural language processing and features extraction from medical images and feeding them into a generative model based on neural networks. The goal was to achieve model generalization across various image modalities and medical conditions. The results showed promising outcomes in the generation of descriptions, with an accuracy of 0.7628 and a BLEU-1 score of 0.5387. However, the quality of the generated descriptions may still be limited, exhibiting semantic errors or lacking relevant details. These limitations could be attributed to the availability and representativeness of the data, as well as the techniques used.

Transdisciplinary experiential learning in biomedical engineering education for healthcare systems improvement.

BACKGROUND: The growing demand for more efficient, timely, and safer health services, together with insufficient resources, put unprecedented pressure on health systems worldwide. This challenge has motivated the application of principles and tools of operations management and lean systems to healthcare processes to maximize value while reducing waste. Consequently, there is an increasing need for professionals with the appropriate clinical experience and skills in systems and process engineering. Given their multidisciplinary education and training, biomedical engineering professionals are likely among the most suitable to assume this role. In this context, biomedical engineering education must prepare students for a transdisciplinary professional role by including concepts, methods, and tools that commonly belong to industrial engineering. This work aims to create relevant learning experiences for biomedical engineering education to expand transdisciplinary knowledge and skills in students to improve and optimize hospital and healthcare care processes. METHODS: Healthcare processes were translated into specific learning experiences using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model. This model allowed us to systematically identify the context where learning experiences were expected to occur, the new concepts and skills to be developed through these experiences, the stages of the student's learning journey, the resources required to implement the learning experiences, and the assessment and evaluation methods. The learning journey was structured around Kolb's experiential learning cycle, which considers four stages: concrete experience, reflective observation, abstract conceptualization, and active experimentation. Data on the student's learning and experience were collected through formative and summative assessments and a student opinion survey. RESULTS: The proposed learning experiences were implemented in a 16-week elective course on hospital management for last-year biomedical engineering undergraduate students. Students engaged in analyzing and redesigning healthcare operations for improvement and optimization. Namely, students observed a relevant healthcare process, identified a problem, and defined an improvement and deployment plan. These activities were carried out using tools drawn from industrial engineering, which expanded their traditional professional role. The fieldwork occurred in two large hospitals and a university medical service in Mexico. A transdisciplinary teaching team designed and implemented these learning experiences. CONCLUSIONS: This teaching-learning experience benefited students and faculty concerning public participation, transdisciplinarity, and situated learning. However, the time devoted to the proposed learning experience represented a challenge.

Processo de construção de um ventilador pulmonar mecânico para situação de pandemia da covid-19 / Construction process of a mechanical lung ventilator for a covid-19 pandemic situation

Em dezembro de 2019 o mundo foi surpreendido pela pandemia da COVID-19, que, devido à alta transmissibilidade, rapidamente se espalhou pelo planeta, causando milhares de vítimas. Durante a pandemia muitas vidas foram ceifadas, houve superlotação hospitalar e esgotamento dos recursos. Objetivo: Descrever o processo de construção e equivalência de um ventilador pulmonar mecânico, durante a situação de pandemia. Materiais e Métodos: No processo seguiram-se as recomendações da Associação Brasileira de Normas Técnicas (ABNT), Agência Nacional de Vigilância Sanitária (ANVISA) e Associação de Medicina Intensiva Brasileira (AMIB). Foram utilizados materiais encontrados no mercado brasileiro, dispensando importações para agilizar a construção, a fim de suprir demandas locais. O equipamento foi desenvolvido no Laboratório de Mecânica Aplicada da Universidade Federal de Goiás (UFG) em proposição feita pela Escola de Engenharia Elétrica, Mecânica e de Computação da UFG. O Ensaio pré-clínico foi realizado em suínos in vivo, instrumentados e ventilados mecanicamente no Centro Cirúrgico do Hospital Veterinário da UFG, após aprovação da Comissão de Ética no Uso de Animais (CEUA/UFG), sob o número de protocolo: 049/20. Foram analisados indicadores respiratórios e hemodinâmicos de forma comparativa, utilizando o protótipo de ventilação mecânica versus ventilador pulmonar já consagrado no mercado. Ambos os ventiladores foram igualmente programados. Resultados: O processo de elaboração, construção e funcionamento do protótipo seguiu recomendações da ABNT e mostrou-se seguro, medido pelos indicadores respiratórios e hemodinâmicos. As variáveis analisadas, em sua grande maioria apresentaram comportamento semelhante entre os ventiladores, independentemente do animal ventilado. Durante o ensaio pré-clínico não houve instabilidade hemodinâmica incontrolável. Conclusões: A construção e utilização do protótipo de ventilação pulmonar mecânica deve ser considerada uma alternativa para situações de pandemia, desde que a construção do equipamento cumpra os requisitos mínimos exigidos pela ABNT

In December 2019, the world was surprised by the COVID-19 pandemic, which, due to its high transmissibility, quickly spread across the planet, causing thousands of victims. During the pandemic, many lives were lost, there was hospital overcrowding and an exhaustion of resources. Objective: To describe the construction process and equivalence of a mechanical lung ventilator, during the pandemic situation. Materials and Methods: The process followed the recommendations of the Brazilian Association of Technical Standards (ABNT), the National Health Surveillance Agency (ANVISA) and the Brazilian Intensive Care Medicine Association (AMIB). Materials found on the Brazilian market were used, eliminating imports to speed up construction, in order to meet local demands. The equipment was developed at the Applied Mechanics Laboratory at the Federal University of Goiás (UFG) on a proposal made by the School of Electrical, Mechanical and Computer Engineering at UFG. The pre-clinical trial was carried out in pigs in vivo, instrumented and mechanically ventilated in the Surgical Center of the UFG Veterinary Hospital, after approval by the Ethics Committee on the Use of Animals (CEUA/UFG), under protocol number: 049/20. Respiratory and hemodynamic indicators were analyzed in a comparative way, using the prototype of mechanical ventilation versus pulmonary ventilator already established on the market. Both ventilators were programmed equally. Results: The process of elaboration, construction and operation of the prototype followed ABNT recommendations and proved to be safe, measured by respiratory and hemodynamic indicators. The vast majority of the variables analyzed showed similar behavior between ventilators, regardless of the ventilated animal. During the preclinical trial there was no uncontrollable hemodynamic instability. Conclusions: The construction and use of the mechanical lung ventilation prototype should be considered an alternative for pandemic situations, as long as the construction of the equipment meets the minimum requirements required by ABNT

Evaluación de la Calidad de los Agentes Conversacionales para la Creación de Instrumentos de Evaluación en Medición de Señales Bioeléctricas / Evaluation of the Quality of Conversational Agents for the Creation of Evaluation Instruments in Bioelectric Signals Measurement

Resumen El objetivo de esta investigación es evaluar la calidad de agentes conversacionales basados en Modelos de Lenguaje Grandes, para la evaluación de aplicación de conocimiento en Ingeniería Biomédica. Se desarrolló un instrumento de evaluación sobre seis temas de medición de señales bioeléctricas elaborado por un agente humano y los agentes conversacionales Chat-GPT y Bard. Se evaluó la calidad del instrumento en términos de nivel de pensamiento, validez, relevancia, claridad, dificultad y capacidad de discriminación, mediante índice kappa (k) del acuerdo de dos expertos y análisis Rasch de resultados de treinta y ocho estudiantes. Tras eliminar siete preguntas de los agentes conversacionales por problemas de validez y originalidad se integró un instrumento de seis preguntas. Las preguntas fueron válidas y relevantes, claras (>0.95, k=1.0), con dificultad baja a alta (0.61-0.87, k=0.83), índice de discriminación adecuado (0.11-0.47), a nivel de pensamiento de análisis (k=0.22). El promedio de los estudiantes fue de 7.24±2.40. Este es el primer análisis crítico de la calidad de los agentes conversacionales a un nivel de pensamiento superior al de comprensión. Los agentes conversacionales presentaron limitaciones en términos de validez, originalidad, dificultad y discriminación en comparación con el experto humano lo que resalta la necesidad aún de su supervisión.

Abstract This research aims to evaluate the quality of conversational agents based on Large Language Models for evaluating the application of knowledge in Biomedical Engineering. An evaluation instrument was developed on six topics for measuring bioelectrical signals prepared by a human agent and the conversational agents Chat-GPT and Bard. The quality of the instrument was evaluated in terms of level of thinking, validity, relevance, clarity, difficulty, and discrimination capacity, using the kappa (k) index of the agreement of two experts and Rasch analysis of results from thirty-eight students. After eliminating seven questions from the conversational agents due to validity and originality problems, a 6-question instrument was integrated. The questions were valid and relevant, clear (>0.95, k=1.0), with low to high difficulty (0.61-0.87, k=0.83), adequate discrimination index (0.11-0.47), at the analysis level of thinking (k =0.22). The average score of the students was 7.24±2.40. This is the first critical analysis of the quality of conversational agents at a level of thinking higher than comprehension. The conversational agents presented limitations in terms of validity, originality, difficulty, and discrimination compared to the human expert, which highlights the need for their supervision.

Challenges of design, implementation, acceptability, and potential for, biomedical technologies in the Peruvian Amazon.

BACKGROUND: Biomedical technologies have the potential to be advantageous in remote communities. However, information about barriers faced by users of technology in general and in remote Indigenous communities is scarce. The purpose of this study was to characterize the leading challenges faced by researchers who have used biomedical technologies in the Peruvian Amazon. METHODS: This exploratory, qualitative study with a phenomenological approach depicts the lived experience of participants who were researchers with experience working with biomedical technologies in the Peruvian Amazon in the past five years. Analysis was based on three core themes: design, implementation, and acceptability. Sub-themes included environment, community, and culture. Of the 24 potential participants identified and contacted, 14 agreed to participate, and 13 met inclusion criteria and completed semi-structured interviews. Results were sent to each participant with the opportunity to provide feedback and partake in a 30-minute validation meeting. Five participants consented to a follow-up meeting to validate the results and provide further understanding. RESULTS: Participants recognized significant challenges, including technologies designed out-of-context, difficulty transporting the technologies through the Amazon, the impact of the physical environment (e.g., humidity, flooding), and limited existing infrastructure, such as electricity and appropriately trained health personnel. Participants also identified cultural factors, including the need to address past experiences with technology and health interventions, understand and appropriately communicate community benefits, and understand the effect of demographics (e.g., age, education) on the acceptance and uptake of technology. Complementary challenges, such as corruption in authority and waste disposal, and recommendations for technological and health interventions such as co-design were also identified. CONCLUSIONS: This study proposes that technological and health interventions without efforts to respect local cultures and health priorities, or understand and anticipate contextual challenges, will not meet its goal of improving access to healthcare in remote Amazon communities. Furthermore, the implications of corruption on health services, and improper waste disposal on the environment may lead to more detrimental health inequities.

Multi-Sensing Techniques with Ultrasound for Musculoskeletal Assessment: A Review.

The study of muscle contractions generated by the muscle-tendon unit (MTU) plays a critical role in medical diagnoses, monitoring, rehabilitation, and functional assessments, including the potential for movement prediction modeling used for prosthetic control. Over the last decade, the use of combined traditional techniques to quantify information about the muscle condition that is correlated to neuromuscular electrical activation and the generation of muscle force and vibration has grown. The purpose of this review is to guide the reader to relevant works in different applications of ultrasound imaging in combination with other techniques for the characterization of biological signals. Several research groups have been using multi-sensing systems to carry out specific studies in the health area. We can divide these studies into two categories: human-machine interface (HMI), in which sensors are used to capture critical information to control computerized prostheses and/or robotic actuators, and physiological study, where sensors are used to investigate a hypothesis and/or a clinical diagnosis. In addition, the relevance, challenges, and expectations for future work are discussed.

Reseña del Libro: "Medicine-Based Informatics and Engineering" Lecture Notes in Bioengineering, Springer, 2022 / Book Review: "Medicine-Based Informatics and Engineering" Lecture Notes in Bioengineering, Springer, 2022

RESUMEN El presente trabajo es una reseña original sobre el libro "Medicine-Based Informatics and Engineering" publicado en la colección Lecture Notes in Bioengineering de Springer, en 2022, cuyos editores son los investigadores Franco Simini y Pedro Bertemes-Filho. La reseña busca sintetizar el contenido de los trabajos presentados en los capítulos centrándose en las soluciones desarrolladas. Los editores, a partir de la diversidad de los aportes, vislumbran la integración de visiones, en lo que denominan "Ingeniería Médica".

ABSTRACT This paper is an original review of the book "Medicine-Based Informatics and Engineering" published in Springer's Lecture Notes in Bioengineering collection, in 2022, whose editors are Franco Simini and Pedro Bertemes-Filho. The review aims to synthesize the content of the papers presented in the chapters focusing on the solutions developed. The editors, from the diversity of the contributions, envision the integration of visions, in what they call "Medical Engineering".

Mammogram Image Enhancement Techniques for Online Breast Cancer Detection and Diagnosis.

Breast cancer is the type of cancer with the highest incidence and global mortality of female cancers. Thus, the adaptation of modern technologies that assist in medical diagnosis in order to accelerate, automate and reduce the subjectivity of this process are of paramount importance for an efficient treatment. Therefore, this work aims to propose a robust platform to compare and evaluate the proposed strategies for improving breast ultrasound images and compare them with state-of-the-art techniques by classifying them as benign, malignant and normal. Investigations were performed on a dataset containing a total of 780 images of tumor-affected persons, divided into benign, malignant and normal. A data augmentation technique was used to scale up the corpus of images available in the chosen dataset. For this, novel image enhancement techniques were used and the Multilayer Perceptrons, k-Nearest Neighbor and Support Vector Machines algorithms were used for classification. From the promising outcomes of the conducted experiments, it was observed that the bilateral algorithm together with the SVM classifier achieved the best result for the classification of breast cancer, with an overall accuracy of 96.69% and an accuracy for the detection of malignant nodules of 95.11%. Therefore, it was found that the application of image enhancement methods can help in the detection of breast cancer at a much earlier stage with better accuracy in detection.

Las normas técnicas para la formación en ingeniería biomédica, tecnología y administración en salud / Technical standards for the training in biomedical engineering, health technology and health management

Introducción: Los documentos normativos establecen el estado del arte relacionado con determinado campo del conocimiento. Existe una gran cantidad de normas relacionadas con los servicios de salud y su gestión, cuya aplicación es relevante en este sector. Objetivo: Exponer la importancia de las normas técnicas en la formación de los profesionales en ingeniería biomédica, tecnología y administración en salud. Desarrollo: Diferentes aspectos relacionados con el desempeño y las funciones de los profesionales en ingeniería biomédica, tecnología de la salud y administración en salud están recogidos en normas técnicas internacionales y en otras de carácter nacional, que resultan pertinentes y de gran utilidad para su formación en el nivel de grado y el posgrado. Conclusiones: Las profesiones abordadas requieren emplear los documentos normativos relacionados con sus funciones para contribuir con la calidad de los servicios de salud; de ahí la pertinencia de su incorporación en los planes de estudio de estas carreras(AU)

Introduction: Normative documents establish the state of the art related to a certain field of knowledge. There is a large number of standards related to health services and their management, whose application is relevant in this sector. Objective: To show the importance of technical standards in the training of professionals from the fields of biomedical engineering, health technology and health management. Development: Different aspects related to the performance and functions of professionals from the fields of biomedical engineering, health technology and health management are gathered in international and other national technical standards, relevant and useful for their training at the undergraduate and postgraduate levels. Conclusions: The addressed professions require the use of normative documents related to their functions in order to contribute to the quality of health services, hence the relevance of their incorporation into the curriculums of these major(AU)

Las normas técnicas para la formación en ingeniería biomédica, tecnología y administración en salud / Technical standards for the training in biomedical engineering, health technology and health management

Introducción: Los documentos normativos establecen el estado del arte relacionado con determinado campo del conocimiento. Existe una gran cantidad de normas relacionadas con los servicios de salud y su gestión, cuya aplicación es relevante en este sector. Objetivo: Exponer la importancia de las normas técnicas en la formación de los profesionales en ingeniería biomédica, tecnología y administración en salud. Desarrollo: Diferentes aspectos relacionados con el desempeño y las funciones de los profesionales en ingeniería biomédica, tecnología de la salud y administración en salud están recogidos en normas técnicas internacionales y en otras de carácter nacional, que resultan pertinentes y de gran utilidad para su formación en el nivel de grado y el posgrado. Conclusiones: Las profesiones abordadas requieren emplear los documentos normativos relacionados con sus funciones para contribuir con la calidad de los servicios de salud; de ahí la pertinencia de su incorporación en los planes de estudio de estas carreras(AU)

Introduction: Normative documents establish the state of the art related to a certain field of knowledge. There is a large number of standards related to health services and their management, whose application is relevant in this sector. Objective: To show the importance of technical standards in the training of professionals from the fields of biomedical engineering, health technology and health management. Development: Different aspects related to the performance and functions of professionals from the fields of biomedical engineering, health technology and health management are gathered in international and other national technical standards, relevant and useful for their training at the undergraduate and postgraduate levels. Conclusions: The addressed professions require the use of normative documents related to their functions in order to contribute to the quality of health services, hence the relevance of their incorporation into the curriculums of these major(AU)

ECG Patient Simulator Based on Mathematical Models.

In this work, we propose a versatile, low-cost, and tunable electronic device to generate realistic electrocardiogram (ECG) waveforms, capable of simulating ECG of patients within a wide range of possibilities. A visual analysis of the clinical ECG register provides the cardiologist with vital physiological information to determine the patient's heart condition. Because of its clinical significance, there is a strong interest in algorithms and medical ECG measuring devices that acquire, preserve, and process ECG recordings with high fidelity. Bearing this in mind, the proposed electronic device is based on four different mathematical models describing macroscopic heartbeat dynamics with ordinary differential equations. Firstly, we produce full 12-lead ECG profiles by implementing a model comprising a network of heterogeneous oscillators. Then, we implement a discretized reaction-diffusion model in our electronic device to reproduce ECG waveforms from various rhythm disorders. Finally, in order to show the versatility and capabilities of our system, we include two additional models, a ring of three coupled oscillators and a model based on a quasiperiodic motion, which can reproduce a wide range of pathological conditions. With this, the proposed device can reproduce around thirty-two cardiac rhythms with the possibility of exploring different parameter values to simulate new arrhythmias with the same hardware. Our system, which is a hybrid analog-digital circuit, generates realistic ECG signals through digital-to-analog converters whose amplitudes and waveforms are controlled through an interactive and friendly graphic interface. Our ECG patient simulator arises as a promising platform for assessing the performance of electrocardiograph equipment and ECG signal processing software in clinical trials. Additionally the produced 12-lead profiles can be tested in patient monitoring systems.

NO SIGNIFICANT EFFECT OF 3D MODELLING ON SURGICAL PLANNING IN SPINAL DEFORMITIES.

Objective: To evaluate the effect of 3d printed models on surgical pre-operative planning of complex spinal deformities. Methods: In our study, five orthopedic surgeons made surgical planning of 5 patients with severe spinal deformity in three conditions: X-ray with computer tomography (X-ray-CT), 3D-computed tomography (3dCT), and 3d printed spine models. Operation plans were examined according to the level and number of instrumentations, osteotomy level, and time required for decision-making. Results: X-ray-CT, 3dCT, and 3d modeling methods were compared, and no statistically significant difference was observed in the number of screws and osteotomy score to be used in operation. The time required for decision ranking is 3d Model, 3d CT, and Xray-CT. Conclusions: 3d printed models do not influence the operative plan significantly; however, it reduces surgical planning time at pre-op duration, and those models gave some opportunities to practice with implants on a patient's 3d spine model. Level of Evidence III; Diagnostic Studies - Investigating a Diagnostic Test .

Objetivo: Avaliar o efeito de modelos 3D impressos no planejamento pré-operatório cirúrgico de deformidades complexas da coluna vertebral. Métodos: Em nosso estudo, 5 cirurgiões ortopédicos fizeram o planejamento cirúrgico de 5 pacientes com deformidade espinhal grave em três condições: raio-X com tomografia computadorizada (raio X-CT), tomografia computadorizada com reconstrução 3D (3dCT) e modelo de coluna vertebral impressa (modelo 3d). Os planos de operação foram examinados de acordo com o nível e número de instrumentos, nível de osteotomia e tempo necessário para a tomada de decisão. Resultados: Foram comparados os métodos de modelagem de raio X-CT, 3dCT e modelo 3d e nenhuma diferença estatisticamente significativa foi observada no número de parafusos e escore de osteotomia a serem utilizados na operação. O ranking do tempo necessário para a tomada de decisão foi de modelo 3d, 3d CT e raio X-CT. Conclusões: Os modelos impressos em 3d não influenciam significativamente o plano operatório, porém reduzem o tempo de planejamento cirúrgico no pré-operatório e esses modelos deram algumas oportunidades de praticar com implantes no modelo de coluna 3d do paciente. Nível de evidência III; Estudos de Diagnóstico - Investigando um Teste de Diagnóstico .

No significant effect of 3d modelling on surgical planning in spinal deformities / Nenhum efeito significativo da modelagem 3d no planejamento cirúrgico em deformidades da coluna vertebral

ABSTRACT Objective: To evaluate the effect of 3d printed models on surgical pre-operative planning of complex spinal deformities. Methods: In our study, five orthopedic surgeons made surgical planning of 5 patients with severe spinal deformity in three conditions: X-ray with computer tomography (X-ray-CT), 3D-computed tomography (3dCT), and 3d printed spine models. Operation plans were examined according to the level and number of instrumentations, osteotomy level, and time required for decision-making. Results: X-ray-CT, 3dCT, and 3d modeling methods were compared, and no statistically significant difference was observed in the number of screws and osteotomy score to be used in operation. The time required for decision ranking is 3d Model, 3d CT, and Xray-CT. Conclusions: 3d printed models do not influence the operative plan significantly; however, it reduces surgical planning time at pre-op duration, and those models gave some opportunities to practice with implants on a patient's 3d spine model. Level of Evidence III; Diagnostic Studies - Investigating a Diagnostic Test .

RESUMO Objetivo: Avaliar o efeito de modelos 3D impressos no planejamento pré-operatório cirúrgico de deformidades complexas da coluna vertebral. Métodos: Em nosso estudo, 5 cirurgiões ortopédicos fizeram o planejamento cirúrgico de 5 pacientes com deformidade espinhal grave em três condições: raio-X com tomografia computadorizada (raio X-CT), tomografia computadorizada com reconstrução 3D (3dCT) e modelo de coluna vertebral impressa (modelo 3d). Os planos de operação foram examinados de acordo com o nível e número de instrumentos, nível de osteotomia e tempo necessário para a tomada de decisão. Resultados: Foram comparados os métodos de modelagem de raio X-CT, 3dCT e modelo 3d e nenhuma diferença estatisticamente significativa foi observada no número de parafusos e escore de osteotomia a serem utilizados na operação. O ranking do tempo necessário para a tomada de decisão foi de modelo 3d, 3d CT e raio X-CT. Conclusões: Os modelos impressos em 3d não influenciam significativamente o plano operatório, porém reduzem o tempo de planejamento cirúrgico no pré-operatório e esses modelos deram algumas oportunidades de praticar com implantes no modelo de coluna 3d do paciente. Nível de evidência III; Estudos de Diagnóstico - Investigando um Teste de Diagnóstico .

Corona protein impacts on alternating current biosusceptometry signal and circulation times of differently coated MnFe2O4 nanoparticles.

Background: We evaluated the impacts of corona protein (CP) formation on the alternating current biosusceptometry (ACB) signal intensity and in vivo circulation times of three differently coated magnetic nanoparticles (MNP): bare, citrate-coated and bovine serum albumin-coated MNPs. Methods: We employed the ACB system, gel electrophoresis and mass spectrometry analysis. Results: Higher CP formation led to a greater reduction in the in vitro ACB signal intensity and circulation time. We found fewer proteins forming the CP for the bovine serum albumin-coated MNPs, which presented the highest circulation time in vivo among the MNPs studied. Conclusion: These data showed better biocompatibility, stability and magnetic signal uniformity in biological media for bovine serum albumin-coated MNPs than for citrate-coated MNPs and bare MNPs.

Image quality, reading, and mammography service in four diagnostic imaging centers in Manizales, Colombia / Calidad de las imágenes, la lectura y el servicio de mamografía en cuatro centros de imagenología de Manizales, Colombia.

Introduction: Mammography quality is directly related to the ability to detect an abnormality and, therefore, quality control is necessary for diagnostic imaging centers. Objective: To evaluate image quality, reading, and mammography service in some diagnostic imaging centers in Manizales, Colombia. Materials and methods: Four diagnostic imaging centers participated voluntarily in the study under confidentiality agreements. Out of 520 women attending the centers, 318 had a mammography. The infrastructure, technology, and human resources of each unit were evaluated based on visual inspections. A radiologist expert in reading and clinical interpretation of mammary images evaluated the quality of the image and the reading. We made the statistical analysis using anova, the kappa index, and the percentage of disagreement. Results: We found images of diminished quality mainly due to the presence of artifacts in 75 % of those evaluated, as well as non-compliance with identification criteria and image labeling. There were difficulties in taking the lateral median oblique projection given the absence of the inframammary. The level of agreement in the BI-RADS reporting was low in the four centers with important differences in the report and description of findings. Conclusion: The city's diagnostic centers under evaluation are authorized for their operation. However, there are important deficiencies in image quality and reading, which highlights the need to seek quality standards starting from those aspects that can be improved upon.

Introducción. La calidad de la mamografía está directamente relacionada con la capacidad para detectar anormalidades y, por ello, es necesario el control de calidad en los centros de imágenes diagnósticas. Objetivo. Evaluar la calidad de la imagen, la lectura y el servicio de mamografía de algunos centros de imágenes diagnósticas en Manizales, Colombia. Materiales y métodos. Cuatro centros participaron de forma voluntaria y bajo acuerdos de confidencialidad en el estudio. De las 520 mujeres atendidas en ellos, a 318 se les hicieron mamografías. A partir de una inspección visual del servicio, se evaluaron la infraestructura, la tecnología y el personal de la unidad. Un radiólogo experto en lectura e interpretación clínica de imágenes mamarias evaluó la calidad de la imagen y la de su lectura. El análisis estadístico se hizo utilizando un anova y determinando el índice kappa y el porcentaje de desacuerdo. Resultados. Se encontró falta de calidad de las imágenes obtenidas, principalmente, por presencia de artificios en el 75 % de ellas, e identificación y rotulación deficientes; además, en la toma de la proyección oblicua medio-lateral, se encontró falta de visualización del ángulo inframamario. El grado de concordancia en el reporte BI-RADS fue bajo en los cuatro centros, con diferencias importantes en el informe y la descripción de los hallazgos. Conclusión. Los centros de imágenes diagnósticas evaluados están habilitados para el funcionamiento, pero se encontraron deficiencias importantes en la calidad de las imágenes y en su lectura, lo que pone de manifiesto la necesidad de establecer estándares de calidad y mejorar los aspectos que se puedan mejorar.