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Conventional clinical trials of antitumor drugs are conducted at clinical sites. In contrast, without clinical sites or site-less, digital clinical trials can be performed online. Virtual clinical trials analyze the therapeutic response of virtual patients to digital drugs using artificial intelligence and may reduce the costs of trials. Precision oncology trials based on biomarkers can invite more people to join clinical trials and guide the optimal choice of therapeutics for cancer patients. Oncology clinical trials will enter the era of digital, virtual and precision medicine.
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There are many difficulties in digital medical teaching, including new course content, multiple key and difficult points, wide knowledge coverage, large knowledge structure span, high requirements for teachers, and few shared resources for online teaching during the epidemic. This research aims to give full play to the advantages of our team in the field of digital medicine, and promote the construction of network resources of this course and its extensive development in more universities through the exploratory and research on the course construction and teaching mode of the Digital Medicine MOOC (massive open online course). The questionnaire study found that the satisfaction score of the average satisfaction score of MOOC teaching in terms of students' pre-class preview, quick grasp of knowledge points in class and after-class review reached more than 90 points, and the score of improving students' learning initiative was (88.10±10.87) points. It can be seen that the use of MOOC teaching mode can significantly help students to preview before class, master knowledge points in class and review after class, and improve students' initiative in learning. The research suggests that the production of Digital Medicine MOOC should keep the consistency and individuality of all knowledge points under the framework of digital medical knowledge; teachers should focus on the explanation of basic knowledge points and deepen in further step integrated with frontiers of this field; it’s suggested to make a separate MOOC on frontier knowledge and application explanation, so as to cope with the outdated courseware content caused by the development and update of this subject.
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Abstract Science and technology are modifying medicine at a dizzying pace. Although access in our country to the benefits of innovations in the area of devices, data storage and artificial intelligence are still very restricted, the advance of digital medicine offers the opportunity to solve some of the biggest problems faced by medical practice and public health in Mexico. The potential areas where digital medicine can be disruptive are accessibility to quality medical care, centralization of specialties in large cities, dehumanization of medical treatment, lack of resources to access evidence-supported treatments, and among others. This review presents some of the advances that are guiding the new revolution in medicine, discusses the potential barriers to implementation, and suggest crucial elements for the path of incorporation of digital medicine in Mexico.
Resumen La ciencia y la tecnología han modificado la medicina a un ritmo vertiginoso. Si bien el acceso en México a los beneficios de las innovaciones en el área de dispositivos, almacenamiento de datos e inteligencia artificial aún es muy restringido, el avance de la medicina digital ofrece la oportunidad de solventar algunos de los problemas más grandes que enfrenta la práctica médica y la salud pública en este país. Las potenciales áreas en las que la medicina digital puede resultar innovadora son la accesibilidad a cuidados médicos de calidad, la centralización de las especialidades en grandes urbes, la deshumanización del trato médico, la falta de recursos para acceder a tratamientos avalados por evidencia, entre otros. Esta revisión presenta algunos de los avances que guían la nueva revolución en la medicina, revisa el potencial y las posibles barreras para su aplicación, además de sugerir elementos cruciales para el trayecto de incorporación de la medicina digital en México.
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Humans , Artificial Intelligence/trends , Delivery of Health Care/trends , Digital Technology/trends , Medical Records , Public Health , Stethoscopes , MexicoABSTRACT
The application of artificial intelligence in medicine has gradually received attention along with its development. Many studies have shown that machine learning has a wide range of applications in stomatology, especially in the clinical diagnosis and treatment of maxillofacial cysts and tumors. This article reviews the application of machine learning in maxillofacial cyst and tumor to provide a new method for the diagnosis of oral and maxillofacial diseases.
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Humans , Artificial Intelligence , Cysts/diagnosis , Machine Learning , Oral MedicineABSTRACT
Intrahepatic cholangiocarcinoma invading hepatic hilum has the biological characteristics and clinical features of both gallbladder cancer and hilar cholangiocarcinoma, and it also combines the pathophysiological changes of liver disease.There are a series of therapeutic difficulties such as difficult exposure of three hepatic hilum, complexity of liver resection,difficult treatment of combined liver diseases and insensitivity to radiotherapy and chemotherapy, which result in low radical resection rate, difficulty in operation, high operative risk and poor prognosis. The perihilar surgical technique system based on special clinical features, surgical methods and pathophysiological characteristics, evaluates the tumor resectability, the anatomy structure of three hepatic hilum and the reserved liver function comprehensively and accurately before surgery, completely exposes hepatic hilum via combining anterograde and retrograde route from extra and intra-hepatic direction to hepatic hilum, combined with accurate liver resection, accurate and high-quality biliary anastomosis and management of postoperative complication,which can improve surgical radicalization and safety, reduce surgical risk and postoperative complication rate, thereby improve the overall survival time of patients.
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Gallbladder cancer invading hepatic hilum has both the biological characteristics of gallbladder cancer and the clinical features of hilar cholangiocarcinoma. There are a series of therapeutic difficulties such as difficult exposure of hepatic hilum, multiple organ resection, resection and reconstruction of hilar vessels, complex cholangiojejunostomy and liver functional restriction, which result in low radical resection rate, difficulty in operation, high operative risk, more postoperative complications and perioperative mortality. The perihiliar surgical technique system adopts accurate preoperative three-dimensional imaging evaluation and liver function evaluation, and completely exposes hepatic hilum via combining anterograde and retrograde route from extra and intra-hepatic direction to hepatic hilum, which is beneficial to intraoperative re-evaluation. It can improve the R0 resection rate, quality of vascular resection and reconstruction, quality of cholangiojejunostomy, and reduce perioperative morbidity and mortality. Surgeons should pay attention to the combination of perihiliar surgical technique and oncology in order to screen which patients will benefit from operation.
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Perihilar biliary diseases have a wide spectrum of diseases including stones, inflammation, tumors, injuries and congenital malformations. Because of their characteristics such as anatomic variability, pathophysiological complexity, high operative difficulties, more postoperative complications and high operative risk, the perihilar biliary surgery is a high difficulty area in biliary surgery. For common clinical features ,common surgical methods and common technical difficulties of perihilar biliary diseases, the perihilar surgical technique system adequately evaluates hilar anatomy and its variations,liver function and volume of residual liver relying on threedimensional digital medical imaging technology, completely exposes hepatic hilum via combining anterograde and retrograde route from extra and intra-hepatic direction to hepatic hilum, then re-evaluates the relationship between the lesion and the hepatic artery and portal vein, and ultimately sets the surgical procedure . It is developed to improve the R0 resection rate, quality of cholangiojejunostomy, quality of vascular resection and reconstruction and safety of operation,eventually for the purpose of reducing postoperative complication rate and perioperative mortality and improving the prognosis. So surgeons should pay attention to the comprehensive system involving multiple disciplines in order to improve the effectiveness and safety in diagnosis and treatment of perihilar biliary diseases.
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With the advent of a new era of digital medicine,the emergence of a series of digital intelligent diagnosis and treatment technology has played an important role in the development of diagnosis and treatment of biliary malignant tumors.In this paper,the application of digital intelligent technology in the diagnosis and treatment of biliary malignant tumors is elaborated based on the relevant literature at home and abroad as well as the author's practical experience in the past 15 years.This paper introduces the application of digital medical technology represented by three-dimensional visuali zation,virtual simulation surgery,three-dimension printing technology,virtual reality,abdominal surgery navigation,medical big data and artificial intelligence-radiomics in preoperative evaluation,operation planning,and real-time intraoperative guidance,and looks forward to the new direction of intelligent technology in the diagnosis and treatment of biliary malignant tumors,so as to promote its diagnosis and treatment mode to intelligent assisted diagnosis and treatment.
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Digital intelligent diagnostic and treatment technology is a novel technology which is based by combining modern medicine with digitalized and intelligent high-tech to form a multidisciplinary and multi-knowledge domain. This technology plays an important role in areas including precision diagnosis, preoperative planning and surgical navigation. Its core technologies are: (1) quality control research on high-quality CT imaging data acquisition; (2) quality control and homogenization research on three-dimensional (3D) reconstruction; (3) high-quality 3D printed physical models; (4) virtual reality 3D simulation platform; (5) molecular fluorescence imaging to define tumor boundaries; (6) non-rigid registration multi-mode image fusion surgical navigation system; (7) image feature extraction and prediction model establishment. The workflow of this system includes: First, CT data acquisition and 3D visualization of hepatobiliary and pancreatic diseases; followed by individualized vascular assessment, liver volume calculation and surgical planning using the 3D model; then virtual simulation surgery, 3D printing, virtual reality technology and molecular fluorescence imaging accordance to the required specific conditions. Preoperative radiomics are used to predict the risk of complications and long-term follow-up results. Intraoperative multi-modal fusion image navigation and its consistency are evaluated with the findings in actual surgery and preoperative planning. This technology, hopefully, will bring in novel strategies and approaches in the diagnosis and treatment of hepatobiliary and pancreatic diseases.
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With the advent of the era of digital intelligent diagnosis and treatment, the clinical application of new techniques plays an important role in improving the diagnosis and treatment of pancreatic cancer. The rapid development of digital intelligent diagnosis and treatment techniques, such as three-dimensional visual simulation, three-dimensional printing, virtual reality, augmented-reality surgical navigation, and radiomics, shows the new directions of the diagnosis and treatment of pancreatic diseases and leads digital pancreatic surgery into the era of digital intelligence. With reference to related articles in China and foreign countries and the authors’ experience in the digital intelligent diagnosis and treatment of pancreatic cancer, this article elaborates on the current application of related techniques in the diagnosis and treatment of pancreatic cancer and introduces the application of these techniques in preoperative resectability assessment, individualized surgical planning, and visual-guidance surgery for pancreatic cancer, as well as the perspectives of the digital intelligent diagnosis and treatment techniques in improving clinical diagnostic rate of pancreatic cancer, selecting a reasonable treatment regimen, and improving the effect of surgical treatment.
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With the development of transportation and industry，car accidents，falling accidents and firearm injuries have be⁃come the main causes of spinal fractures and spinal cord injuries. The thoracolumbar spine is the joint of thoracic kyphosis and lumbarlordosis after human bipedalism. From the perspective of biomechanics，it belongs to the weakest area of the spine and is prone to trau⁃matic fractures. A review from the literatures suggests that thoracolumbar fractures account for 40% of all spinal fractures. In recent years，with the development of biomechanics，biomaterials and digital medicine of the spine，new ideas，techniques and materials have been used for surgical treatment of spinal fractures.“Reconstruction stabilization and early rehabilitation”has become the princi⁃ple of treatment for spine surgeons to treat spinal thoracolumbar fractures. Regardless of patients with severe spinal cord injury or ad⁃vanced osteoporosis，perioperative evaluation，preoperative planning，and intraoperative injury control operation should be made，and surgical treatment should be the first choice for early rehabilitation and social return. New technologies and viewpoints such as digitalspine surgery，biomaterials，biomechanics and spinal surgery robots are gradually applied in the clinic. While applying these technolo⁃ gies，there are also many hot issues that deserve our attention. Not only the surgeries for thoracolumbar fractures，but also the surgical indications and expected effects have been rapidly developed and improved.
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With the rapid development of digital technology, digital medicine has seen an upsurge in the 21st century, thus entering the era of precision and digital medicine. This article mainly introduces the application of digital technologies in plastic and reconstructive surgery, such as three-dimensional scan imaging, surgical navigation, microsurgical navigation, 3D printing, etc. In the era of big data, digital technologies have been widely applied in the preoperative design, navigation during surgery and post-operative evaluation of plastic surgery. Naturally the digital teams and societies of plastic surgery have come into being. Additionally this article puts forward the new prospects for more extensive applications of digital technologies such as surgical robots, 3D printing of prosthetic implants, and virtual reality. We believe that when the professionals who master artificial intelligence algorithms collaborate with the experts who have deep insight into medicine, the digital technologies can be applied better to the field of cosmetic surgery. This is our main task at present and the final goal.
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Currently, artificial intelligence technology is being developed rapidly and is used in many clinical areas, especially in stomatology. The application of artificial intelligence technology in stomatology is a new technological revolution. This study focuses on artificial intelligence and its application status. The advantages, current situation, and development prospect of the application of artificial intelligence technology in stomatology treatment and nursing, such as oral and maxillofacial surgery, implant, prosthetics, orthodontics, oral medicine therapy, guidance, and teaching, are provided.
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Objective:To explore the countermeasure of strengthening the electronic archives construction of digital medicine in medical industry so as to impel the establishment of electronic archives of digital medicine.Methods: The current situation and improvement of electronic files of digital medicine in medical industry are discussed and the countermeasure in the construction of electric archives of digital medicine was strengthened through analyzing the important role of medical electronic files in the development of hospitals and the existed insufficient in medically electronic file management.Results: The existed shortcomings in the management of medically electronic archives mainly included the lack of precise elaboration and accountability in the existed management system of medically electronic archives, the lack of professional electronic archivists and the hardware facilities should be improved in the management of electronic archives. The countermeasures of strengthening the construction of electronic archives of digital medicine in the medical industry mainly included that improving the management of electronic archives, improving the quality of managers, synchronizing the management of hospital electronic documents and paper documents, strengthening the technical maintenance for electronic archives, increasing the capital investment of electronic archives management and improving the storage of electronic files.Conclusion: Strengthening the construction of electronic files of digital medicine in medical industry is imperative. In order to improve the quality of electronic files, the existed problems in management measures should be clarified and corresponding countermeasures that aimed at problems should be formulated to solve the problems.
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Digital medicine underwent the conversion from "digital human" to digital medical technology and has been widely used in all aspects of clinical medicine in recent 10 years,especially in hilar cholangiocarcinoma (HCCA).It is difficult to accurately evaluate the longitudinal and vertical tumor invasion by preoperative conventional imaging assessment (CT,MRI,etc.) due to the complexity of this operation.Three-dimensional (3D) visualization can see more comprehensively,more clearly and more accurately on the basis of organs and lesions indicated by CT and MRI.Three-dimensional visualization digital medical technology can accurately,intuitively and stereoscopically display the situation of tumor invasion of the adjacent important vessels as well as the variation of vessels.It plays an important role in the aspects of preoperative evaluation,surgical planning,improving the success rate of operation and reducing complications for HCCA.It also transforms the past model of "crossing the river by feeling the stone" to now "crossing the river by watching the stone".Therefore,it is known as the paradigm of translational medicine.
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Digital medical technology is a powerful tool which has forcefully promoted the development of general surgery in China. In this article, we reviews the application status of three-dimensional visualization and three-dimensional printing technology in general surgery, introduces the development situation of surgical navigation guided by optical and electromagnetic technology and preliminary attempt to combined with mixed reality applied to complicated hepatectomy, looks ahead the development direction of digital medicine in the era of artificial intelligence and big data on behalf of surgical robot and radiomics. Surgeons should proactively master these advanced techniques and accelerate the innovative development of general surgery in China.
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After 30 years of development, three-dimensional printing technology has made great progress, and the model and surgical guide have been clinically applied. The three-dimensional printing of titanium and other metal prosthesis and dental crown after adequate research will be applied clinically, and three-dimensional bioprinting and related biological materials need further study. Three-dimensional printing provides opportunities for the development of oral medicine, which will change the way of clinical work, teaching and research. The dentists should integrate multi-disciplinary knowledge and understand the essence of new technology to meet the challenges of the era of digital medicine.
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It has been almost 10 years since digital medical technology has started to becommonly used in general surgery in China.Led by advances in three dimensional(3D) visualization technology, virtual reality, simulation surgery, and 3D printing, digital medical technology have played important roles in changing the current practice of general surgery in China to become more effective by improving diagnostic accuracy and a better choice of therapeutic procedure with a resultant increased surgical success rate and a decreased surgical risks.Furthermore, education of medical students and young doctors become better and easier.
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Objective To explore the morphological characteristics and change rule of thoracic joint angles in children aged from 10 to 12 years through thinner CT scanning and 3D reconstruction,and to provide theoretical basis for early diagnosis,treatment and prevention.Methods Totally 30 normal cases aged from 10 to 12 years were admitted into this study.There was no bone destruction,deformity,fractures,tumors and spine surgery involved.DICOM 3.0 data of multi-slice spiral CT (0.625 ～ 1.25 mm),ranging from T1 to T12,were used for 3D reconstruction,measurement and statistical analysis.Results The difference between left and right sagittal section angle of zygopophysis was less than 10°.There was no significant differences between T1,T11,and T12for sagittal section angle of upper zygopophysis (P ＞ 0.05).So was it between T3,T4,T9,T10 and T11 for sagittal section angle of lower zygopophysis (P ＞ 0.05).While there were significant differences between others(P ＜ 0.05).The was no significant difference between left and right coronal plane angle of zygopophysis (P ＞ 0.05).Coronal plane angle of lower and upper zygopophysis tended to be ‘ spike-like’,and the maximum points were at T7 to T9.For horizontal plane angle,left and right upper zygopophysis made significant differences between T2,T4,T8,T10 and T12 only,so did T7 lower zygopophysis (P ＜ 0.05).Horizontal angle of upper zygopophysis tended to be stable in the upper thoracic both in the left and right side,while a decreasing trend was shown in lower thoracic.Horizontal angle of lower zygopophysis showed a decreasing trend generally except individual vertebrae.Both upper and lower zygopophysis showed negative angle at T11 and T12 levels.Conclusion Thoracic joint angles(coronal,sagittal and horizontal angle) in children aged from 10 to 12 years can directly reflect the developmental regularity with growth,and it verified the tendency that horizontal facet joints of the cervical spine gradually changes to coronal facet joints thoracic spine and then changes to sagittal facet joints of lumbar spine.And the left and right side facet joints are basically symmetrical with the angle difference less than 10°.
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With the developments of digital medicine, Gd-EOB-DTPA enhanced magnetic resonance imaging, molecular imaging and optical/acoustic multi-modality imaging, the hepatopancreatobiliary surgery have entered the era of precise diagnosis and treatment.Bidimensional pattern of disease diagnosis and treatment is developing toward three-dimensional pattern, which make the diagnosis and treatment more comprehensive and clear.Morphological imaging is gradually developing towards molecular imaging.Ultimately, the goal of truly precise diagnosis and accurate treatment will be achieved.