Accuracy of digital guided implant surgery: expert consensus on nonsurgical factors and their treatments / 口腔疾病防治

@#The standardized workflow of computer-aided static guided implant surgery includes preoperative examination, data acquisition, guide design, guide fabrication and surgery. Errors may occur at each step, leading to irreversible cumulative effects and thus impacting the accuracy of implant placement. However, clinicians tend to focus on factors causing errors in surgical operations, ignoring the possibility of irreversible errors in nonstandard guided surgery. Based on the clinical practice of domestic experts and research progress at home and abroad, this paper summarizes the sources of errors in guided implant surgery from the perspectives of preoperative inspection, data collection, guide designing and manufacturing and describes strategies to resolve errors so as to gain expert consensus. Consensus recommendation: 1. Preoperative considerations: the appropriate implant guide type should be selected according to the patient's oral condition before surgery, and a retaining screw-assisted support guide should be selected if necessary. 2. Data acquisition should be standardized as much as possible, including beam CT and extraoral scanning. CBCT performed with the patient’s head fixed and with a small field of view is recommended. For patients with metal prostheses inside the mouth, a registration marker guide should be used, and the ambient temperature and light of the external oral scanner should be reasonably controlled. 3. Optimization of computer-aided design: it is recommended to select a handle-guided planting system and a closed metal sleeve and to register images by overlapping markers. Properly designing the retaining screws, extending the support structure of the guide plate and increasing the length of the guide section are methods to feasibly reduce the incidence of surgical errors. 4. Improving computer-aided production: it is also crucial to set the best printing parameters according to different printing technologies and to choose the most appropriate postprocessing procedures.

Lessons from the COVID-19 pandemic: Strengthening our commitment to eye care

@#It was on January 30, 2020 when the World Health Organization (WHO) declared the coronavirus disease 2019 (COVID-19) outbreak a public health emergency of international concern. By March 11, 2020, it was declared a pandemic.1 This was just several weeks after Dr. Li Wenliang, an ophthalmologist from Wuhan, first recognized a possible outbreak of an illness that resembled severe acute respiratory syndrome.2 Over the next three years, we saw the world race against time to understand the nature of the disease to save those infected and control further transmission across the continents. To date, almost 800 million people, that is, one out of 10 people have been infected, resulting in 7 million deaths worldwide.3,4 In an effort to control the spread of COVID-19, governments imposed lockdown measures. However, this resulted in the de-prioritization of non-communicable diseases including eye diseases as health facilities focused on treating infected patients or implementing vaccination programs. In a report by the WHO, at least 30% of countries had disrupted services for noncommunicable diseases.5 The crisis also resulted in changes in people’s health-seeking behavior, as the fear of COVID-19 outweighed the need for eye care. In the United States, a 60% drop in patient visits for eye care services was reported.6 In fact, the fear of exposure to COVID-19 was found to be associated with a four-fold increased risk of defaulting follow-up.7 Similarly, a study in India and Singapore also reported the fear of COVID-19 infection as a cause of the decline in patient consults.8 In response to this crisis, eye care professionals struggled to strike a balance between delivering quality eye care services while mitigating the risk of infection. Various international and local ophthalmologic professional organizations including the American Academy of Ophthalmology,9,10 Philippine Academy of Ophthalmology,11 and the Philippine Society of Cataract and Refractive Surgery12 have issued guidelines on the practice of ophthalmology during the COVID-19 pandemic. These recommendations have become the basis for new standards in eye care. The use of personal protective equipment has become essential at the workplace. Physical barriers such as large slit lamp breath shields and clinic dividers, temperature scanners, alcohol dispensers, and air purifiers with high efficiency particulate air filters have now become common fixtures in most if not all clinics. Changes in clinic processes and protocols have also been adopted to ensure the safety not just of the health care team but also the patients and their families. These include the use of telemedicine where applicable, meticulous patient scheduling, symptom screening prior to clinic visits, enforcement of proper social distancing, disinfection of ophthalmologic equipment, clinic furniture and fixtures, and sterilization of instruments. Even contactless, cashless payment options have now become standard in many facilities. COVID-19 precautions have also become part of ophthalmologic laser and surgical procedure protocols. The pandemic is far from over and it seems that we will have to live with COVID-19 for a very long time. There are many opportunities to improve eye care services by applying the lessons we learned during the pandemic. 1. There is no room for complacency. Infection control protocols must remain in place if we are to reassure patients that clinic visits are safe. 2. Telemedicine will continue to be an alternative to face-to-face consultations. However, a survey of ophthalmologists reported confidence in using telemedicine for diagnosing gross conditions of the eye but not posterior pole conditions or orbital fractures.13 Improving confidence in telemedicine consults may be accomplished with the use of home monitoring devices such as tonometers and digital applications for various tests including visual acuity, color vision, and visual fields.14 Innovations in home-based ophthalmic imaging will revolutionize tele-ophthalmology, such as the home-optical coherence tomography that may be particularly useful for patients with age-related macular degeneration and diabetic retinopathy.15 Enhancing physician confidence in telemedicine must be paralleled by building patient confidence as well. Technology can disenfranchise certain patient populations like the elderly and those without internet access, and we must continuously strive to reach them and encourage them to try remote consultations when needed. Telemedicine applications should also ensure data privacy and security. 3. Patient education remains crucial in affecting health-seeking behavior. It is important to maximize the utilization of various social media platforms for patient education. As we live in an age of disinformation, we must also remain vigilant against the peddling of wrong or harmful health-related information. In eye care, this may range from cureall eye drops to miracle spectacles to supplements which have no sound scientific basis. Community-based patient education programs and information campaigns may be useful for those without access to digital technologies. 4. It is time to reprioritize ophthalmologic care for patients with non-communicable conditions such as diabetes, hypertension, cancer, and autoimmune diseases. We should also renew collaborative ties with other members of the healthcare team. Many of our patients have suffered worsening of their eye conditions in the past three years, whether by neglect or due to the pandemic-related barriers that prevented their access to timely intervention. Vision is a precious sense that translates very heavily into one’s quality of life. Some of our patients who experienced a decline in their vision during the pandemic – from errors of refraction, cataract, and the like – may be fortunate to have their sight restored in the future. However, our patients suffering from conditions such as glaucoma or proliferative diabetic retinopathy, are in a race against time to control or prevent irreversible visual loss. We move forward with more urgency for their sake, taking our lessons from the pandemic and adapting to this new normal with a renewed commitment to deliver eye care.

Superior mesenteric veinous thrombosis with Bacteroides fragilis infection: a case report / 中国热带医学

@#Abstract: Superior mesenteric veinous thrombosis (SMVT) is a rare complication that often occurs in conjunction with intra-abdominal diseases such as diverticulitis, appendicitis, inflammatory bowel disease, etc. Its clinical symptoms are non-specific and include fevers, abdominal pain; it has no specific symptoms, and the diagnosis depends on clinical laboratory tests and imaging studies. The occurrence of superior mesenteric veinous thrombophlebitis is related to septic phlebitis caused by the sloughing of the embolus containing bacteria into the portal vein with blood flow. Due to the nonspecific clinical features of this disease, diagnosing it based on clinical characteristics and microbiological aspects is a challenge. A case of superior mesenteric veinous septic thrombophlebitis caused by Bacteroides fragilis infection is reported and to provide a reference for the diagnosis and treatment of such diseases. The patient was a 34-year-old man who was admitted the hospital with intermittent abdominal pain and fever. Computed tomography (CT) showed partial thrombosis of the superior mesenteric vein, colonoscopy revealed diverticulitis in the ileoceca, and the blood culture grew Bacteroides fragilis. The patient was treated with anti-infection (ceftazidime 2.0 g q12h intravenous infusion for 11 days; metronidazole 0.5 g, q8h intravenous infusion for 3 days) and anticoagulation (rivaroxaban 20 mg qd orally for 8 days. On the 11th day of hospitalization, the patient's condition improved, and he was discharged. In this case, for patients with fever and abdominal pain, superior mesenteric venous thrombophlebitis should be included in the differential diagnosis. Through auxiliary examination, blood sample culture and other technologies, clear diagnosis should be made in time to improve patient outcomes.

Current situation and effect evaluation of mobile applications for physical activity management in China / 中华健康管理学杂志

Objective:To analyze the current situation and effect of mobile applications for physical activity management in China.Methods:In this systematic review, search terms such as “exercise”, “sports”, “exercise”, “physical activity” and “mobile health” were used to retrieve the applications for physical activity management in the IOS Application Store developed in mainland of China. Then the Mobile Application Rating Scale (MARS) and the Behavior Change Technology (BCT) were used to evaluate the quality of the applications and analyze the behavior change technologies that applications adopted. Moreover, a systematic review of relevant experimental studies was applied to summarize the effectiveness of the applications in promoting physical activity.Results:Total of 141 applications were included in this analysis, and 58 behavior change techniques in 16 categories were applied. The most frequently used 4 categories of BCT were behavior comparison (67.4%), repetition and substitution (67.4%), knowledge construction (67.4%), feedback and monitoring (58.2%). The overall objective quality score of MARS was 3.17±0.42, of which, the score of engagements, functionality, aesthetic design and information quality was 2.67±0.73, 3.75±0.54, 3.44±0.59 and 2.83±0.55, respectively. The number of BCT adopted in each application had a linear relationship with the application′s objective quality score in MARS ( B=0.023, 95% CI: 0.018-0.029) and user rating ( B=0.040, 95% CI: 0.019-0.060) (both P<0.001). A total of 4 articles were included to test the effects of techniques (i.e., physical activity behavior monitoring, physical activity planning and physical activity guidance) in 4 applications. The overall quality of the literatures was good. The main outcomes were physical activity duration (3 articles) and step count (1 article). Compared with those who did not use the application or only used the accelerometer to monitor physical activity, subjects who used the application to monitor physical activity had significant longer physical activity durations and step count (both P<0.05). Conclusions:The number, function and technology of physical activity management applications in China are abundant, but the quality of the applications is moderate. The number of BCT is an important factor in evaluating application′s quality, but its effect on behavior change is still not clear.

User-centered design in time and resource-limited settings: Enhancing the usability of 'Hearing for Life' (HeLe) Device

Introduction@#The Hearing for Life (HeLe) is a novel newborn hearing screening device initially designed according to specifications of clinicians of the Philippine National Ear Institute (PNEI). Unfortunately, targeted end-users, rural health workers, had difficulty using it. This research applied the user-centered design (UCD) methodology involving rural health workers in recommending design, content, and function requirements for HeLe. @*Objectives@#This study aims to 1) describe how UCD was applied in a time-limited and resource-constrained environment, 2) assess the usability of the design prototypes, and 3) recommend design, content, and function requirements for HeLe. @*Methods@#This research is a descriptive study using mixed methods. Six rural health units (RHU) involved in the HeLe research program were purposively selected for the study. There were 30 participants included, five health care workers per RHU. Applying the UCD method, the study had three phases: 1) user profiling (where participants accomplished a survey questionnaire, 2) inspiration phase (focus group discussions, workflow analysis, and interviews with a technical expert were conducted), and 3) ideation phase (designing and assessment of prototypes were done). @*Results@#Participatory methods and structured procedures (i.e., card sorting, MoSCoW matrix prototyping, etc.) were applied to help determine and prioritize user requirements and elicit user feedback. These methods were chosen considering the time and resource constraints in the RHU. The prototype's System Usability Scale (SUS) score (81.94) was higher than the SUS score previously obtained (68) from the older version of the interface. Accuracy, durability, in-app instructions, feedback, and an easily understood interface were the most requested requirements for the telemedicine device. The need for the technology to be aligned with the RHU's workflow and available resources was highlighted in the focus group discussions. @*Conclusions@#The study documents practices and lessons learned in applying UCD methodology in design and development that have been demonstrated to improve usability of the device. The involvement of the users surfaced in the design, content, and functional requirements which can guide future iterations of HeLe and contribute to better understanding of ways to develop user-friendly telemedicine devices in the Philippines. This paper emphasizes that users should be involved in the entire process and not just recipients of the technology.

A case report and literature analysis of an infant with Batter syndrome caused by CLCNKA and CLCNKB gene mutation / 中国热带医学

@#Abstract: Bartter syndrome (BS) is a kind of inherited metabolic disease characterized by electrolyte and endocrine disorder, resulting from genetic gene mutation or deletion. Clinically, it manifests as vomiting, constipation, feeding difficulties, weight loss, growth retardation. The laboratory examination shows hypokalemia, metabolic alkalosis, hyperreninemia, aldosteronism, etc. As an autosomal recessive genetic disease, BS has an extremely low incidence rate, making diagnosis and treatment quite challenging. In recent years, with the progress of gene detection and other technologies, China has made great progress in the study of BS, more and more BS has been diagnosed accurately. According to known gene mutation types, it can be divided into type 1, type 2, type 3, type 4, type 5 and Gitelman syndrome, a total of 6 types, with type 4 further divided into type 4a and type 4b. At present, the most common type of children with BS in clinical practice is type 3, which is the classic type of BS. This paper reports a case of Bartter syndrome type 4b (BS4b). After two rounds of three-generation family gene sequencing, it was discovered that the infant had a combined mutation of both the CLCNKA and CLCNKB alleles, in addition to Alport syndrome, and both parents were carriers of this type of gene defect. The child was finally diagnosed as BS4b and Alport syndrome. This report, combined with the patient's clinical features, diagnosis and treatment process, as well as related literature analysis, aims to provide experience for understanding and diagnosis and treatment of this disease.

Caregiver satisfaction with the use of telemedicine in the neurodevelopmental evaluation of children at the Philippine Children’s Medical Center

Objectives@#This study aims to assess caregiver satisfaction with the use of telemedicine in the evaluation of children referred for neurodevelopmental evaluation at the Philippine Children’s Medical Center (PCMC) Neurodevelopmental Pediatrics Clinic.@*Materials and Methods@#A survey was conducted on caregivers of pediatric patients aged 3 months to 18 years and 11 months old for neurodevelopmental evaluation. A questionnaire to determine the demographic and clinical data and Parent/Caregiver-Reported Satisfaction Form were administered via email, Facebook messenger or phone call.@*Results@#Seventy-three caregivers completed the questionnaire. Most (95.9%) were mothers, 47.9% were college graduates with one parent working and 43% have an income of 10,000-20,000. Almost half (47.9%) of the children they care for were ages 3-months to 2-year 11 -months, predominantly males, with 35.6% diagnosed with autism spectrum disorder, and 69.9% were new patients. Caregivers were very highly satisfied with telemedicine in all domains (technical functioning, comfort and perceived privacy, access to care and overall satisfaction) as it obtained a mean of 4.51 and median of 5.00. There was no significant difference in the responses based on the age of the child and type of visit.@*Conclusion@#Caregivers showed very high level of satisfaction with the use of telemedicine in the neurodevelopmental evaluation of children at PCMC and holds a significant promise for its use both within the context of the pandemic and beyond.@*Recommendations@#Further studies on caregivers’ satisfaction with the use of telemedicine over a sustained period and comparing telemedicine and in-person assessment are recommended.

Optimal processing technology of Zhangbang vinegar-processed Olibanum with multi-indicator-response surface methodology and anticoagulant effect evaluation / 中国中药杂志

This study first optimized the processing technology for Zhangbang vinegar-processed Olibanum and investigated its in vitro anticoagulant activity. A multi-index-response surface methodology was used, with yield, powder yield, and the relative percentage of the content of six non-volatile components [11-keto-boswellic acid(KBA), 3-acetyl-11-keto-boswellic acid(AKBA), β-elemonic acid, α-boswellic acid(α-BA), β-boswellic acid(β-BA), and α-acetyl-boswellic acid(α-BA)] and three volatile components(octyl acetate, incensole, and incensole acetate) as evaluation indicators. Analytical hierarchy process(AHP) combined with coefficient of variation method was used to calculate the weight of each indicator and calculate the comprehensive score(OD). Furthermore, response surface methodology was used to investigate the effects of frying temperature(A), burning time(B), rice vinegar dosage(C), and steaming time(D) on the processing technology of vinegar-processed Olibanum. Vinegar-steamed Olibanum was prepared according to the optimal processing technology for in vitro anticoagulant experiments. The results showed that the weights of octyl acetate, incensole, incensole acetate, KBA, AKBA, β-elemonic acid, α-BA, β-BA, α-ABA, yield, and powder yield were 0.358 2, 0.104 5, 0.146 4, 0.032 9, 0.123 7, 0.044 4, 0.022 1, 0.042 2, 0.110 1, 0.012 2, and 0.0032, respectively. The optimal processing technology for Zhangbang vinegar-processed Olibanum was as follows. Olibanum(50 g) with a particle size of 1-5 mm was continuously stir-fried at a low heat of 150-180 ℃ until in a gel-like state, ignited for burning for 15 s, sprayed with 7.5 g of rice vinegar(15%), and steamed for 3 min without fire. Subsequently, the cover was removed, and the product was continuously stir-fried at 150-180 ℃ until in a soft lump shape, removed, cooled, and crushed. The results of the in vitro anticoagulant experiments showed that compared with the blank group, both Olibanum and vinegar-processed Olibanum significantly prolonged the activated partial thromboplastin time(APTT), thrombin time(TT), and prothrombin time(PT) of rat platelet-poor plasma(PPP), and the effect of vinegar-processed Olibanum was significantly better than that of Olibanum(P<0.05). The optimized processing technology for Zhangbang vinegar-processed Olibanum is stable, feasible, and beneficial for the further development and utilization of Olibanum slices. At the same time, using the content of volatile and non-volatile components, yield, and powder yield as indicators, and verifying through pharmacological experiments, the obtained results are more reasonable and credible, and have positive guiding significance for the clinical application of characteristic processed Olibanum products.

Preliminary evaluation of the trueness of 5 chairside 3D facial scanning techniques / 北京大学学报(医学版)

OBJECTIVE@#To quantitatively evaluate the trueness of five chairside three-dimensional facial scanning techniques, and to provide reference for the application of oral clinical diagnosis and treatment.@*METHODS@#The three-dimensional facial data of the subjects were collected by the traditional professional three-dimensional facial scanner Face Scan, which was used as the reference data of this study. Four kinds of portable three-dimensional facial scanners (including Space Spider, LEO, EVA and DS-FScan) and iPhone Ⅹ mobile phone (Bellus3D facial scanning APP) were used to collect three-dimensional facial data from the subjects. In Geomagic Studio 2013 software, through data registration, deviation analysis and other functions, the overall three-dimensional deviation and facial partition three-dimensional deviation of the above five chairside three-dimensional facial scanning technologies were calculated, and their trueness performance evaluated. Scanning time was recorded during the scanning process, and the subject's comfort was scored by visual analogue scale(VAS). The scanning efficiency and patient acceptance of the five three-dimensional facial scanning techniques were evaluated.@*RESULTS@#DS-FScan had the smallest mean overall and mean partition three-dimensional deviation between the test data and the reference data, which were 0.334 mm and 0.329 mm, respectively. The iPhone Ⅹ mobile phone had the largest mean overall and mean partition three-dimensional deviation between the test data and the reference data, which were 0.483 mm and 0.497 mm, respectively. The detailed features of the three-dimensional facial data obtained by Space Spider were the best. The iPhone Ⅹ mobile phone had the highest scanning efficiency and the highest acceptance by the subject. The average scanning time of the iPhone Ⅹ mobile phone was 14 s, and the VAS score of the subjects' scanning comfort was 9 points.@*CONCLUSION@#Among the five chairside three-dimensional face scanning technologies, the trueness of the scan data of the four portable devices had no significant difference, and they were all better than the iPhone Ⅹ mobile phone scan. The subject with the iPhone Ⅹ scanning technology had the best expe-rience.

Setting up a telenursing training program for heart failure self-care education

@#Given the complex nature of heart failure (HF), nurses in clinical practice and nurse educators should employ a methodical approach in providing effective health education to the patient and their families even remotely. However, the limited training programs available and unprecedented nature of COVID-19 has rendered nurses less prepared to deliver heart failure self-care education. The purpose of this article is to describe the development, implementation, and evaluation of a training program which aim to equip nurses with specific skills in delivering heart failure self-care education using information and communication technologies (telenursing) in the context of the physical restrictions brought by the COVID-19 pandemic. Four phases of program development and implementation were done: (1) Phase I: Planning Phase; (2) Phase II: Needs Assessment; (3) Phase III: Designing the Health Program; and (4) Phase IV- Implementation and Evaluation. Twenty-three nurses from a tertiary private hospital participated via video conferencing in the pilot implementation of the program led by doctorate students. Using Kaufman’s approach in qualitative evaluation, participants reported the training content, materials, and the method of delivery which were valuable, meaningful, and acceptable to them. They perceived the program further enhanced their competencies, and improved patient and organizational outcomes. Taking on a proactive role, nurses should explore measures of enhancing nurses’ knowledge and skills in self-care education through information and communication technologies (ICT). This training program based on participative planning and collaboration between academia and practice proves to be feasible and requires further empirical studies to test its effectiveness in real-word settings.

Evidências tecnológicas para assistência ambulatorial e domiciliar em urologia pediátrica: revisão de escopo / Technological evidence for outpatient and home care in pediatric urology: a scoping review

RESUMO Objetivo mapear as evidências sobre as tecnologias baseadas na internet e sua aplicabilidade no cuidado ambulatorial e domiciliar em urologia pediátrica. Métodos trata-se de revisão de escopo, com buscas conduzidas em seis bases de dados, sem limite de tempo, nos idiomas português, inglês e espanhol. Resultados 2.200 artigos foram obtidos, sendo 19 publicações elegíveis para a amostra final. As tecnologias baseadas na internet mais utilizadas foram telessaúde e telemedicina (47,3%), programas de intervenção online (21,0%) e aplicativos móveis (15,8%), com uma taxa menor de uso de serious game s, mídias sociais e vídeos de micção (5,3%), majoritariamente no contexto domiciliar. Conclusão o mapeamento das evidências tecnológicas na assistência ambulatorial e domiciliar em urologia pediátrica permitiu identificar os tipos de tecnologia e suas aplicações voltadas para o autogerenciamento dos sintomas e autoeficácia, para o monitoramento e acompanhamento do cuidado urológico. Contribuições para a prática: as evidências sintetizadas contribuem para uma prática profissional expandida, qualificada e inovadora junto à população pediátrica com sintomas urinários e intestinais, características relacionadas a uma prática avançada de enfermagem, além de favorecer diagnóstico precoce e maior adesão terapêutica, particularmente por apoiar intervenções personalizadas às necessidades do paciente pediátrico e sua família.

ABSTRACT Objective to map the evidence on web-based technologies and their applicability in outpatient and home care in pediatric urology. Methods this is a scoping review, with searches conducted in six databases, with no time limit, in Portuguese, English, and Spanish. Results 2,200 articles were obtained, with 19 publications eligible for the final sample. The most used web-based technologies were telehealth and telemedicine (47.3%), online intervention programs (21.0%), and mobile apps (15.8%), with a lower rate of use of serious games, social media, and urination videos (5.3%), mostly in the home setting. Conclusion the mapping of technological evidence in outpatient and home care in pediatric urology allowed us to identify the types of technology and their applications focused on self-management of symptoms and self-efficacy, for monitoring and follow-up of urologic care. Contributions to practice: the synthesized evidence contributes to an expanded, qualified, and innovative professional practice with the pediatric population with urinary and bowel symptoms, characteristics related to advanced nursing practice, in addition to favoring early diagnosis and greater therapeutic adherence, particularly by supporting interventions tailored to the needs of the pediatric patient and his family.

Tecnologia digital em próteses totais: propriedades dos materiais CAD-CAM e desenvolvimento de uma patente de inovação para simplificação do fluxo de trabalho / Digital technology in complete dentures: properties of CAD-CAM materials and development of an innovation patent to simplify the workflow

Recursos digitais, como a manufatura subtrativa (fresagem CAD-CAM) e a manufatura aditiva (impressão 3D) podem promover significativos avanços, reduzindo o tempo e o custo de produção de próteses totais (PTs). Assim, este estudo objetiva investigar as características superficiais (rugosidade e ângulo de contato), propriedades mecânicas (resistência mini-flexural) e a adesão de biofilme sobre polímeros de PMMA pré-polimerizado para fresagem CAD-CAM e sobre resinas para impressão 3D utilizados na fabricação de bases de PTs, bem como propor um fluxo de trabalho inovador para abreviar e simplificar as etapas de confecção de PTs. Para a análise in vitro, foram fabricados um total de 60 discos e 40 barras distribuídas igualmente em quatro grupos: fresagem CAD-CAM (GF), impressão 3D (GI) e PMMA convencional termopolimerizado por ciclo longo (GCL) ou por energia de micro-ondas (GCM). A rugosidade foi determinada pelo valor de Ra; o ângulo de contato foi medido pelo método da gota séssil; o teste de resistência à mini-flexão foi obtido por teste de flexão de três pontos, enquanto o comportamento frente à formação de biofilme foi analisado através da adesão de biofilme de C. albicans. Os dados foram analisados por meio de estatística descritiva e analítica (α = 0,05). Os resultados mostraram que o GI apresentou a maior rugosidade superficial (Ra: 0,317 ± 0,151µm) e os menores valores de resistência à miniflexão (57,23 ± 9,07MPa) e o GF apresentou a menor adesão de biofilme de C. albicans (log UFC/mL: 3,74 ± 0,57) e maior média de resistência à mini-flexão (114,96 ± 16,23 MPa). Não houve diferença estatística entre o GF e os grupos convencionais para rugosidade, ângulo de contato e resistência à mini-flexão. A patente de inovação desenvolvida estabeleceu um novo fluxo de trabalho para confecção de próteses totais através de um protocolo de três consultas em que foram feitas as moldagens anatômicas na 1ª sessão, juntamente com o registro do suporte labial, plano oclusal e linhas de referência para subsidiar a montagem dos dentes superiores. Uma prótese-teste foi confeccionada por meio de procedimentos convencionais ou CAD-CAM e avaliada na 2ª consulta, permitindo observar o resultado estético, executar a moldagem funcional e realizar o registro da relação maxilo-mandibular, fornecendo referências precisas para a confecção da prótese inferior. Com base nos resultados da fase in vitro deste estudo, os corpos-de-prova obtidos a partir de disco para fresagem CAD-CAM apresentaram resistência flexural e propriedades superficiais semelhantes às resinas convencionais e mostraram um comportamento inibidor da adesão de C. albicans, enquanto os espécimes produzidos por impressão 3D exibiram a menor resistência à flexão e a maior rugosidade da superfície. O dispositivo inovador apresentado para a execução das etapas clínicas relacionadas à fabricação de PTs mostrou-se efetivo para abreviar e simplificar as técnicas disponíveis, apresentando confiabilidade e previsibilidade para produção de PTs em número de sessões reduzido (AU).

Digital features like subtractive and additive manufacturing can promote breakthroughs by reducing the time and cost of making complete dentures (CDs). Thus, this study aims to investigate surface characteristics (roughness and contact angle), mechanical properties (mini-flexural strength), and biofilm adhesion on computer-aided design/computer-aided manufacturing (CAD-CAM) PMMA polymer, and threedimensional (3D) printed resin for denture´s base fabrication as well as to propose an innovative workflow. For in vitro analysis, a total of 60 discs and 40 rectangular specimens were fabricated from one CAD-CAM pre-polymerized PMMA disc (GF), one 3D-printed (GI), and two conventional heat-polymerized (GCL and GCM) materials for denture base fabrication. Roughness was determined by the Ra value; the contact angle was measured by the sessile drop method; the mini-flexural strength test was a three-point bending test while the biofilm formation inhibition behavior was analyzed through C. albicans adhesion. The data were analyzed using descriptive and analytical statistics (α = 0.05). Results showed that GI specimens presented the highest surface roughness (Ra: 0.317 ± 0.151 µm) and lowest mini-flexural strength values (57.23 ± 9.07 MPa) and the GF showed the lowest C. albicans adhesion (log CFU/mL: 3.74 ± 0.57) and highest mini-flexural strength mean (114.96 ± 16.23 MPa). There was no statistical difference between GF and conventional groups for roughness, contact angle, and mini-flexural strength. In turn, the presented novel workflow for complete dentures fabrication reached a three appointments protocol in which preliminary impressions were made in the 1st session, all together to maxillary registration of lip support, occlusal plane, and reference lines for teeth arrangement. A trial denture was manufactured and evaluated by the 2nd appointment through conventional or CAD-CAM procedures, allowing esthetics evaluation, final impression, and maxillomandibular relationship record and providing precise references for final dentures fabrication. Based on the findings of this in vitro study, GF presented surface and mechanical properties similar to conventional resins and show improved behavior preventing C. albicans adhesion, while GI specimens exhibited the lowest flexural strength, and highest surface roughness. The proposed device for CD´s fabrication clinical procedures reached feasibility and by simplifying available techniques, this protocol could achieve reliability and predictability to produce complete dentures with reduced working time (AU).

Tributo al Dr. Rafael Pérez Cristiá. Ex-Director General de la Agencia Reguladora de Medicamentos, Equipos y Dispositivos Médicos de Cuba (CECMED) / Tribute to Dr. Rafael Pérez Cristiá. Past Head and Director General of the Cuban Regulatory Agency for medicines and medical devices (CECMED)

Dr. Pérez Cristiá was the Head and Director General of Cuba's Center for State Control of Medicines and Medical Devices (CECMED) from 2000 until his passing in June, 2020. Professional background Dr. Pérez Cristiá was a research pharmacologist and toxicologist by training, obtaining academic merit recognition by the Cuban Academy of Sciences. He held several positions as researcher and professor at the University of Medicine in Havana, Cuba and at the National University of Carabobo in Valencia, Venezuela. He also held various scientific appointments as President of the Cuban National Society of Toxicology, as honorary founding member of the National Toxicology Commission of Ecuador, permanent member of the General Council of Scientific Degrees in Health Sciences at the National Commission of Scientific Degrees, Ministry of Higher Education, Cuba. Dr. Pérez Cristiá was also appointed member of the MEDICC's Joint Academic Council. Apart from being a prominent scientist in his native Cuba, Dr. Pérez Cristiá became a referent in public health systems and policy both in Cuba and across the LATAM region. The following quote by Dr. C. William Keck, MEDICC's Executive Director summarizes Dr. Pérez Cristiá' s unanimous contribution to Cuba's public healthcare system: "Dr. Pérez Cristiá was an important leader as Cuba, a small and resource-scarce country, became a global biotech powerhouse and biotechnology evolved as a key component of Cuba's public health system that provides universal health care for its citizens. Safe and effective medicines and technologies to all, especially the most vulnerable, is one of the country's more important public health strategies, in which, Dr. Pérez Cristiá was a key decision maker" 1 As a visionary and leader in regulatory systems and policy in Cuba, during his 21 years as Head and Director General of the CECMED, Dr. Pérez Cristiá implemented the culture and knowledge of regulatory sciences as a key component of the institution's core values and mission. Since, regulatory sciences, have become strategic tools to support the dialogue between the Cuban health agency regulators and the key Cuban stakeholders from the biotechnology industry, research and development institutions, public health advocates, among other relevant players impacting healthcare in Cuba.2 Dr. Pérez-Cristiá was a charismatic individual and great communicator. One of his personal dreams and professional desire was to keep motivating the regulatory professional and experts from Cuba and the Latin America so as to be fully engaged and inspired. Dr. Pérez Cristiá aimed for every regulatory professional to comprehend and internalize the goals and values of regulatory sciences. To this effect, Dr. Pérez Cristiá was constantly fostering collaborations within his team, as well as developing strategic regulatory networks at the regional Latin American level and globally. His professional vision was always linked the present and the future, respecting everyone's knowledge and opinions. CECMED's key milestones and accomplishments Under Dr. Pérez's leadership, the CECMED gained recognition from the Pan American Health Organization (PAHO) as one of the leading National Reference Authorities (NRA's) in the Latin American region for Medicines and Biologics. The PAHO classification system, granted CECMED the Level 4 in 2010 (highest classification).3 Below, is a list of other key regulatory milestones: The CECMED served as General Coordinator of the PAHO Regional National Regulatory Authorities (NRA's) for two consecutive mandates (2014 - 2016). The CECMED served as General Coordinator of the National Center for the Regulation of Medicines of the Bolivarian Alliance for the Peoples of Americas (ALBAMED) (2009 - 2010). CECMED became a WHO National Regulatory Reference Center for Vaccines (2000). CECMED became Observer of the International Council Harmonization (ICH) (2016). CECMED became Associate Member of the International Coalition of Medicines Regulatory Authorities (ICMRA) (2021). In addition to the above accomplishments, throughout the past three decades, the CECMED's Quality Management System was also certified in several occasions by the Spanish Association for Standardization and Certification (AENOR) and the National Office of Standardization, becoming an IQnet member for the past 10 years.3 Furthermore, in September 2004 the CECMED became a member of the Developing Nations Vaccine Regulators' Network (DCVRN). The CECMED was able to become a network member as the Agency fulfilled the critical regulatory functions required by WHO, also meeting the criteria of having at least one prequalified vaccine manufacturer for supply via a United Nations agency. Apart from the above, the CECMED has gained recognition from all of the LATAM regional Regulatory Authorities and global Regulatory Agencies, such as Health Canada, US-FDA, The National Medical Products Administration (NMPA) of China, The Russian Regulatory Agency, Swiss Medic, the Paul Ehrlich Institute, among other. The CECMED's Office of Innovation A paramount contribution by Dr. Pérez Cristiá to public health and access to biopharmaceutical innovation in Cuba, (prospectively across the LATAM region) has been the creation of the CECMED's Office of Innovation in October, 2019. First of its kind in the Latin American region, the CECMED's Office of Innovation was built on a comprehensive regulatory framework with the aim to accelerate innovation enabling successful transition of novel products from research and development to clinical research, granting patients' early access to innovative medicines.4 This initiative has been propelled by the speed and complexity of new discoveries challenging both capacities and creative thinking of the Cuban regulatory authority, coupled with the change from a rigid, one-size fits all regulatory system to a more adaptive and flexible model (without compromising rigor) becoming an alternative, valuable and innovative regulatory tool. LATAM Endowed Chair in Regulatory Sciences Another key contribution linked to Dr. Pérez Cristiá's vision as a regulatory leader in the LATAM region has been the creation of a specialized training program in Regulatory Sciences for the regional Regulatory professional's community. Dr. Pérez Cristiá envisioned the creation of an Endowed Chair collaborating with renowned academic institutions in Cuba and across the Latin American region. Basically, the development of a professional training program to convey advanced training and expertise in drug regulation across the LATAM region, granting access to an international, multidisciplinary academic curriculum aimed at improving professional regulatory skills, teaching regulatory sciences as an imbedded culture based on an undergraduate and graduate curriculum. Furthermore, the Endowed Chair would allow access to expand the scope of regulatory research through publications, promoting joint academic initiatives as well as providing opportunities to collaborate with other institutions and regulatory agencies (both regional and global). Acknowledgements The authors of this tribute, are honored to have shared the contributions and legacy of Dr. Perez-Cristiá, Head and Director of the Cuban Regulatory Authority (CECMED) during his 20 years of tenure. Dr. Perez Cristia's commitment, professional legacy and teachings will permanently prevail, as he was unanimously regarded as a regulatory referent in public health in Cuba, across the Latin American region and globally.

Holmium laser ablation of the prostate (HoLAP) with moses technology for the surgical treatment of benign prostatic hyperplasia

ABSTRACT Purpose: The expansion of technology is leading to a paradigm shift in several urological fields (1, 2). In particular, the adoption of lasers within the surgical treatment of patients with benign prostatic hyperplasia (BPH) is considered one of the most relevant innovations (3-5). In this video, we aimed to report our experience with holmium laser for the ablation of the prostate (HoLAP) in patients with obstructive lower urinary tract symptoms (LUTS) due to BPH. Materials and Methods: From 2018 to 2020, 10 patients with obstructive LUTS secondary to BPH were treated at our Institution with HoLAP (120W Holmium laser Lumenis® with Moses® technology). Main inclusion criteria were: 1) International Prostate Symptom Score ≥12; 2) prostate volume ≤65mL, 3) maximal flow rate (Qmax) ≤15ml/s at preoperative non-invasive uroflowmetry. Results: Mean patient age was 65 (range: 59-72) years. Preoperative mean prostate volume was 50 (range: 35-65) mL. Mean operative time was 66 (range: 45-85) minutes with a mean laser time/operative time ratio of 0.51 (range: 0.44-0.60). Voiding symptoms, Qmax and post voiding residual were significantly improved after 3 and 12 months (all p <0.05). No postoperative urinary incontinence was detected. Conclusions: The present findings suggest that HoLAP is a slightly time-spending procedure, thus its use should be limited to prostate volume <70-80mL. However, no postoperative complications were recorded at all. This technique showed to be a safe option in patients with low-intermediate prostate volume, also in patients whose antiaggregant/anticoagulant therapy is maintained.

Situación en la realización de pruebas diagnósticas para SARS-CoV-2 (COVID-19) ante nueva variante Ómicron (B. 1. 1. 529) / Situation in the performance of diagnostic tests for SARS-CoV-2 (COVID-19) in the face of the new Ómicron variant (B. 1. 1. 529)

INTRODUCCIÓN: El virus SARS-CoV-2, con el tiempo ha mutado y sigue presentando múltiples variantes, lo que ha dado lugar a una variación genética en la población de cepas virales circulantes en el transcurso de la pandemia de COVID-19. La Organización Mundial de la Salud (OMS) ha estandarizado dichas variantes según el interés y preocupación que ocasionan. El espectro de la enfermedad es amplio e incluye desde cuadros leves y autolimitados hasta neumonía atípica severa y progresiva, falla multiorgánica y muerte. Se detecta en la saliva de pacientes con enfermedad por coronavirus (COVID-19) ha sido que este fluido biológico fuera relevante en términos del diagnóstico y transmisión de la infección. Se cree que el virus se replica en la nariz y la garganta, como se evidencia por la alta carga viral en la etapa temprana de infección en estas áreas. La Organización Mundial de la Salud (OMS), el 26 de noviembre de 2021, designó al nuevo linaje B.1.1.529 del virus SARS-CoV-2 como Variante de Preocupación (VOC) para la salud pública, asignando el nombre según el alfabeto griego, Ómicron. Esta variante tiene significativamente más mutaciones que las variantes anteriores de SARS-CoV-2, por lo que es más transmisible, es decir se propaga con mayor facilidad. El incremento considerable de la detección de casos sospechosos de la variante B.1.1.529, ha llevado a OMS a tomar la decisión de designarla como una variante de preocupación como una medida de precaución. En medida de este contexto de la variante Ómicron los equipos de respuesta de los laboratorios de la OPS/OMS recomiendan las pruebas de laboratorio para diagnóstico de SARS-CoV-2 como diagnóstico molecular (RT-PCR en tiempo real) y diagnóstico por detección de Antígeno (Pruebas rápidas de antígeno, Ag-RDT). OBJETIVO: El objetivo del presente informe es describir la alta demanda de la realización de las pruebas diagnósticas para SARS-CoV-2 ante la nueva variante Ómicron (B.1.1.529) del SARS-CoV-2. METODOLOGÍA: Se efectuó una búsqueda electrónica en las páginas oficiales de las principales agencias gubernamentales de la región sobre el proceso de realización de las pruebas diagnósticas para SARS-CoV-2 ante la nueva variante Ómicron. La búsqueda fue limitada a documentos desarrollados en idioma español o inglés, sin restricción por fecha de publicación. La selección de las publicaciones se realizó a partir de la lectura de título y resumen, así como la selección a partir de la lectura de texto completo fue efectuada por un solo revisor. RESULTADOS: En cuanto a las recomendaciones sobre la realización de pruebas diagnósticas para el SARS-CoV-2 ante la nueva variante Ómicron, encontramos lo siguiente: Agencias Internacionales: OMS: La OMS recomienda a los estados miembros mejorar la vigilancia con pruebas rápidas (antigénicas), investigación rigurosa de conglomerados y rastreo de contactos sospechosos de ser infectados con la variante Ómicron. Adicionalmente, recomienda que las capacidad nacional de testeo y secuenciación genómica deben ser adecuadamente planificados por posibles incrementos en la demanda de pruebas diagnósticas. OPS: La OPS recomienda mantener los protocolos ya implementados de rutina para la detección molecular de SARS-CoV-2; también recomienda mantener el uso rutinario de las pruebas rápidas de antígeno según los protocolos de cada país [2]. Además, con el fin de mejorar la vigilancia genómica, la OPS recomienda incrementar la secuenciación con envío de muestras a los laboratorios de referencia de secuenciación de la Red Regional de Vigilancia Genómica de COVID-19 de la OPS/OMS (COVIGEN) y mantener o aumentar las capacidades en aquellos laboratorios que tienen plataformas de secuenciación ya implementadas [2]. Por otro lado, en la alerta epidemiológica del 10 de enero de 2022, la OPS recomienda el uso racional de pruebas diagnósticas frente al incremento acelerado de casos en varios países de Europa y América y el aumento abrupto del consumo de pruebas diagnósticas. Las recomendaciones comprenden criterios de priorización para el uso de pruebas de COVID-19, tanto antigénicas y moleculares, y son las siguientes: 1) todos los casos con indicación de hospitalización por síntomas respiratorios; 2) profesionales de la salud con síntomas respiratorios; 3) detección en pacientes que necesitan ser hospitalizados por otras razones según normativa de cada país; 4) profesionales con síntomas respiratorios que forman parte de servicios esenciales y presenciales. CDC: La CDC, junto a los laboratorios de salud pública de Estados Unidos y la Asociación de Laboratorios de Salud Pública, está implementando una vigilancia mejorada de especímenes con falla de detección del gen S (sospechoso de la variante Ómicron). La CDC solicita a los laboratorios de salud pública que le envíen los especímenes sospechosos lo más pronto posible para la confirmación del posible caso de variante Ómicron y consiguiente caracterización virológica [4]. De esta manera, Estados Unidos tiene un sistema de vigilancia mejorada y multifacética para detectar las variantes circulantes en el país. Este sistema obtiene datos de vigilancia genómica provenientes de 1) Vigilancia Nacional de Cepas de SARS-CoV-2; 2) Contratos de apoyo que tiene la CDC con laboratorios comerciales, y 3) Repositorios públicos (GISAID y NCBI). CONCLUSIONES: El objetivo del presente informe es describir la alta demanda de la realización de las pruebas diagnósticas para SARS-CoV-2 ante la nueva variante Ómicron (B.1.1.529) del SARS-CoV-2. La información provino de fuentes gubernamentales o de agencias internacionales que evaluaron e proceso de realización de las pruebas diagnósticas para SARS-CoV-2 ante la nueva variante Ómicron. Algunas agencias internacionales (OMS, OPS y CDC) recomiendan el incremento de las capacidades de realización de pruebas diagnósticas y secuenciación del genoma de especímenes sospechosos de ser variante Ómicron. También recomiendan el uso racional de pruebas diagnósticas. En el caso del CDC, se fortaleció el sistema de vigilancia a través de la obtención de especímenes provenientes de los laboratorios nacionales, laboratorios comerciales y repositorios públicos. La Comisión Europea recomienda incrementar las capacidades de las pruebas diagnósticas para la identificación rápida de la variante Ómicron. En el Reino Unido, frente a la alta prevalencia de COVID-19 se procedió a usar racionalmente las pruebas diagnósticas y las personas que tienen resultados positivos en las pruebas de antígenos pueden aislarse sin necesidad de realizar una prueba molecular confirmatoria. Ante la gran demanda de pruebas diagnósticas para COVID-19 y el récord de contagios en Argentina, la Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT), autorizó la realización de test de autoevaluación de venta exclusiva en farmacias para los productos aprobados de auto test de antígeno COVID-19 y test de prueba rápida para COVID-19, asimismo estas pruebas proporcionan resultados orientativos, sin valor diagnóstico concluyente. El Ministerio de Salud de Colombia, ante la sobredemanda de las pruebas diagnósticas moleculares y pruebas de antígenos para COVID-19, define criterios para el uso de estás en sus lineamientos y solamente se podrán utilizar la población de mayor riesgo, con comorbilidades o menores de tres años y las pruebas diagnósticas definidas por el Ministerio de Salud y Protección Social. En cuanto algunos países, como Ecuador, Colombia, Argentina a racionalizar las pruebas diagnósticas de COVID-19, priorizando a personas con comorbilidades, menores de 3 años de edad, o con prescripción médica. Concluyendo lo expuesto con los informes consultados, el linaje B.1.1.529 (Ómicron) del virus SARS-CoV-2 como variante de preocupación (VOC) para la salud pública es responsable de un aumento en la capacidad de transmisión, una mayor prevalencia de casos y una reducción d la capacidad de identificación de casos por escasez de pruebas diagnósticas; por consiguiente algunas agencias recomendaron incrementar la capacidad de los laboratorios en la realización de pruebas diagnósticas, así como el uso racional de éstas.

Discovery and confirmation of protein action site AK1 of ginsenosides in brain based on DARTS technology / 中国中药杂志

This study aims to explore the targets of ginsenosides in brain based on drug affinity responsive target stability(DARTS) technology. Specifically, DARTS technology was combined with label-free liquid chromatography tandem mass spectrometry(LC-MS) to screen out the proteins in the brain that might interact with ginsenosides. Based on the screening results, adenylate kinase 1(AK1) was selected for further confirmation. First, the His-AK1 fusion protein was yielded successively through the construction of recombinant prokaryotic expression vector, expression of target protein, and purification of the fusion protein. Biolayer interferometry(BLI) was employed to detect the direct interaction of Rg_1, Re, Rb_1, Rd, Rh_2, F1, Rh_1, compound K(CK), 25-OH-PPD, protopanaxa-diol(PPD), and protopanaxatriol(PPT) with AK1, thereby screening the ginsenoside monomer or sapogenin that had strong direct interaction with the suspected target protein AK1. Then, the BLI was used to further determine the kinetic parameters for the binding of PPD(strongest interaction with AK1) to His-AK1 fusion protein. Finally, molecular docking technology was applied to analyze the binding properties between the two. With DARTS and LC-MS, multiple differential proteins were screened out, and AK1 was selected based on previous research for target verification. Fusion protein His-AK1 was obtained by prokaryotic expression, and the response(nm) of Re, Rg_1, Rd, Rb_1, Rh_1, Rh_2, F1, PPT, PPD, 25-OH-PPD, and CK with His-AK1 was respectively 0.003 1, 0.001 9, 0.042 8, 0.022 2, 0.013 4, 0.037 3, 0.013 9, 0.030 7, 0.140 2, 0.016 0, and 0.040 8. The K_(on), K_(off), and K_D values of PPD and His-AK1 were determined by the BLI as 1.22×10~2 mol~(-1)·L·s~(-1), 1.04×10~(-2) s~(-1), 8.52×10~(-5) mol·L~(-1). According to the molecular docking result, PPD bound to AK1 with the absolute value of the docking score of 3.438, and hydrogen bonds mainly formed between the two. Thus, AK1 is one of the protein action sites of ginsenosides in the brain. The direct interaction between ginsenoside metabolite PPD and AK1 is the strongest.

Independent innovation research, development and transformation of precise bionic repair technology for oral prosthesis / 北京大学学报(医学版)

According to the fourth national oral health epidemiological survey report (2018), billions of teeth are lost or missing in China, inducing chewing dysfunction, which is necessary to build physiological function using restorations. Digital technology improves the efficiency and accuracy of oral restoration, with the application of three-dimensional scans, computer-aided design (CAD), computer-aided manufacturing (CAM), bionic material design and so on. However, the basic research and product development of digital technology in China lack international competitiveness, with related products basically relying on imports, including denture 3D design software, 3D oral printers, and digitally processed materials. To overcome these difficulties, from 2001, Yuchun Sun's team, from Peking University School and Hospital of Stomatology, developed a series of studies in artificial intelligence design and precision bionics manufacturing of complex oral prostheses. The research included artificial intelligence design technology for complex oral prostheses, 3D printing systems for oral medicine, biomimetic laminated zirconia materials and innovative application of digital prosthetics in clinical practice. The research from 2001 to 2007 was completed under the guidance of Prof. Peijun Lv and Prof. Yong Wang. Under the support of the National Natural Science Foundation of China, the National Science and Technology Support Program, National High-Tech R & D Program (863 Program) and Beijing Training Project for the Leading Talents in S & T, Yuchun Sun's team published over 200 papers in the relevant field, authorized 49 national invention patents and 1 U.S. invention patent and issued 2 national standards. It also developed 8 kinds of core technology products in digital oral prostheses and 3 kinds of clinical diagnosis and treatment programs, which significantly improved the design efficiency of complex oral prostheses, the fabrication accuracy of metal prostheses and the bionic performance of ceramic materials. Compared with similar international technologies, the program doubled the efficiency of bionic design and manufacturing accuracy and reduced the difficulty of diagnosis and cost of treatment and application by 50%, with the key indicators of those products reaching the international leading level. This program not only helped to realize precision, intelligence and efficiency during prostheses but also provided functional and aesthetic matches for patients after prostheses. The program was rewarded with the First Technical Innovation Prize of the Beijing Science and Technology Awards (2020), Gold Medal of Medical Research Group in the First Medical Science and Technology Innovation Competition of National Health Commission of the People's Republic of China (2020) and Best Creative Award in the First Translational Medical Innovation Competition of Capital (2017). This paper is a review of the current situation of artificial intelligence design and precision bionics manufacturing of complex oral prosthesis.

Perceptions Of Digital Medical Education Among Post Graduate Medical Students: Mixed Method Survey In Covid 19 Situation

Background:Digital health literacy and digital skills should become prerequisite competencies for health professionals to facilitate the implementation and leverage the potential of digital technologies to improve health. The primary objective of our study was to investigate perceptions of medical students on the role of online teaching in facilitating medical education during the COVID-19 pandemic. Material And Methods:A cross-sectional study wasconducted at the national level using both offline and online (mixed) survey for a period of 3 months (Dec -Feb2020) with a self-administered questionnaire devised on the basis of a literature search “on current online teaching methods following the Covid-19 pandemic situation”among the Post Graduate medical students. Result:Our Study response s consisted of post graduate medical students (n=398) across Indiaamong them 29.9% agreed to that online teaching is helpful during covid-19 situation. Some of the barriers includeexperience, mode of accessing, tools used, internet facilities, availability of Audio-visual aids, user friendlinessof soft-ware. Conclusion:During Covid -19 pandemic online lectures provided a sustainable method of teaching-learning.Some of the facilitators in our study include web learning teaching mode, feasibility of class timing, easy grabbing of information, able to answer during online exam or class.

Depression, anxiety, and stress levels in pregnant women who do not have access to regular antenatal services due to existing COVID-19 community quarantine measures and their perception on telemedicine / Philippine Journal of Obstetrics and Gynecology

Background@#The COVID-19 pandemic has brought about mental anguish to the general population. This pandemic has changed the way we deliver healthcare. The enhanced community quarantine measures have caused the institution to close the outpatient department, leading to apprehensions among patients. Shifting to telemedicine to reach out to the patients as an alternative to face-to-face prenatal services is the current practice. @*Objectives@#This study was conducted to assess the level of depression, anxiety, and stress in pregnant women enrolled under obstetric (OB) service who now have no access to regular antenatal services, as well as to determine the acceptance of telemedicine as a satisfactory alternative to regular prenatal visits. @*Materials and Methods@#This is a descriptive study among patients currently enrolled under OB service in a tertiary hospital in Cebu City and Mandaue City. Respondents have been provided the social media page and given prenatal checks by phone calls from the OB resident doctors since March 2020. A data collection form was filled up online consisting of three parts: (1) the mother's sociodemographic and obstetrical information, (2) a validated tool, the depression, anxiety, and stress-21 scale to assess depression, anxiety, and stress, and (3) query on whether telemedicine has helped alleviate depression, anxiety, and stress. @*Results@#Among the 196 patients surveyed, 21.94% were found to be moderately to severely depressed, 35.2% were moderately to severely anxious, and 8.61% were moderately to severely stressed. About 96.43% of the patients felt that telemedicine alleviated depression, anxiety, and stress during this crucial time. @*Conclusion@#The level of depression, anxiety, and stress among the patients was generally normal or low. However, 21.93%, 35.2%, and 8.61% were found to be moderately to severely depressed, anxious, and stressed, respectively. Telemedicine was found to be a satisfactory alternative to regular prenatal visits. Respondents accepted telemedicine for the following reasons: unwilling to go to the hospital for fear of contracting the virus, fear of certain lockdown measures such as no available public transportation and no crossing of borders were allowed.

Research on the Development Trend of Pharmaceutical Intermediates Application Technology in China from the Perspective of Patent / 中国药房

OBJECTIVE：To assist enterprises to understand the technical points a nd development trend of pharmaceutical intermediates industry ，and to provide new development ideas and technical support for pharmaceutical intermediates application technology. METHODS ：Taking the core technology involved in pharmaceutical intermediates as the research object and divided into four levels ，the patent data of pharmaceutical intermediates published （announced）before Feb. 2nd，2020 in State Intellectual Property Office （SIPO），INCOPAT and PatSnap patent databases were searched. Patent analysis method was used to analyze the patent application trend and patent applicants of pharmaceutical intermediates ，and the secondary and tertiary technologies of pharmaceutical intermediates were analyzed in detail. Finally ，SPSS 24.0 software was used for curve fitting prediction analysis of the number of patent applications for pharmaceutical intermediates in China. RESULTS ：A total of 12 103 related patents were retrieved. Under the secondary technology classification ，there were 331 patents for antibiotic drug intermediates ，474 patents for antipyretic and analgesic drug intermediates ，1 227 patents for cardiovascular drug intermediates ，and 1 550 patents for anticancer drug intermediates. The numbers of patent applications for pharmaceutical intermediates in the world and China were increasing year by year ，and Chinese mainland had the largest number of patent applications. The number of patent applications in Jiangsu ， Shanghai and Shandong ranked the top 3. Among the top 10 patent，8 were domestic enterprises or universities ，and they also ranked the top 2 in the composition of pharmaceutical intermediates applicants in China. Among the secondary technologies of pharmaceutical intermediates ，cardiovascular pharmaceutical intermediates accounted for the largest proportion of patent applications （32％），followed by anticancer pharmaceutical intermediates （30％）. Among the tertiary technologies ，there were patent applications for the products （35％），methods（35％）and uses （28％）of pharmaceutical intermediates. The curve fitting of the number of patent applications for pharmaceutical intermediates in China showed that the current trend of patent applications was the best fitted with the cubic curve model ，and it was predicted that the number of patent applications in 2020 and 2021 will be 688 and 781 respectively. CONCLUSIONS ：The technology of pharmaceutical intermediates has developed rapidly in China ，and universities and enterprises have considerable R&D strength. In addition to expanding in technological innovation ，enterprises can also consider the development idea of school-enterprise cooperation and patent cross licensing among enterprises to help the better deve lopment of China ’s pharmaceutical intermediates industry.