Cuerpo extraño de presentación tardía en bronquiotronco izquierdo. Caso clínico

RESUMEN Introducción: la introducción fortuita de un cuerpo extraño en las vías respiratorias es un accidente dramático que puede provocar complicaciones, aunque raro en los adultos, y sobre todo su presentación tardía, y en bronquio izquierdo. Caso clínico: se reporta el caso de un paciente de 71 años con un cuerpo extraño de presentación tardía en bronquiotronco izquierdo, que consultó por un cuadro de sepsis respiratoria, sin otros síntomas asociados, cuatro meses posteriores a referir haberse tragado un hueso de pollo, ocasión ésta en que el examen físico y los estudios radiológicos fueron negativos. Se realizó estudio con TAC de tórax y broncoscopia flexible evidenciándose una imagen sugerente de un cuerpo extraño en el bronquiotronco izquierdo. Discusión: después de realizar broncoscopia rígida y extracción de cuerpo extraño, presenta varias complicaciones, que requieren ingreso en terapia intensiva, la evolución clínica posterior fue favorable, con radiografía de tórax de control con adecuada reexpansión pulmonar y dándose de alta a los 55 días después del diagnóstico. Conclusiones: en presencia de un paciente con sepsis respiratoria después de un cuadro de broncoaspiración se debe tener en cuenta el diagnóstico de aspiración de un cuerpo extraño. La extracción del cuerpo extraño resulta la solución definitiva.

ABSTRACT Introduction: the fortuitous introduction of a foreign body in the respiratory tract is a dramatic accident that can cause complications, although rare in adults, and especially its late presentation, and in the left bronchus. Clinical case: we report the case of a 71-year-old patient with a late-onset foreign body in the left bronchial trunk, who consulted for respiratory sepsis, with no other associated symptoms, four months after reporting having swallowed a chicken bone. On which occasion the physical examination and radiological studies were negative. A CT scan of the chest and flexible bronchoscopy were performed, revealing an image suggestive of a foreign body in the left bronchial trunk. Discussion: after performing rigid bronchoscopy and extraction of a foreign body, he presented several complications, which required admission to intensive care, the subsequent clinical evolution was favorable, with a control chest X-ray with adequate lung re-expansion and being discharged 55 days later. of the diagnosis. Conclusions: in the presence of a patient with respiratory sepsis after a picture of bronchoaspiration, the diagnosis of aspiration of a foreign body should be taken into account. Extraction of the foreign body is the definitive solution.

RESUMO Introdução: a introdução fortuita de corpo estranho no trato respiratório é um acidente dramático que pode causar complicações, embora raras em adultos, e principalmente sua apresentação tardia, e no brônquio esquerdo. Caso clínico: relatamos o caso de um paciente de 71 anos com corpo estranho de início tardio no tronco brônquico esquerdo, que consultou por sepse respiratória, sem outros sintomas associados, quatro meses após relatar ter engolido osso de galinha. ocasião em que o exame físico e os estudos radiológicos foram negativos. Realizou-se TC de tórax e broncoscopia flexível, revelando imagem sugestiva de corpo estranho em tronco brônquico esquerdo. Discussão: após realização de broncoscopia rígida e extração de corpo estranho, apresentou diversas complicações, que exigiram internação em terapia intensiva, a evolução clínica posterior foi favorável, com radiografia de tórax de controle com reexpansão pulmonar adequada e alta hospitalar 55 dias depois do diagnóstico. Conclusões: na presença de um paciente com sepse respiratória após quadro de broncoaspiração, deve-se levar em consideração o diagnóstico de aspiração de corpo estranho. A extração do corpo estranho é a solução definitiva.

Analysis and reflection on the filing management of traditional Chinese medicine preparations in medical institu- tions / 中国药房

OBJECTIVE To compare and study the supporting policies for the filing man agement system of traditional Chinese medicine preparation prepared by traditional technology （hereinafter referred to as “TCM preparation ”）in medical institutions issued by the state and various provinces ，and their development ，so as to provide reference for the improvement of the follow-up supervision and management of the filing works. METHODS According to Announcement on the Filing Management of TCM Preparations Prepared by Medical Institutions Using Traditional Processes issued by former National Food and Drug Administration （hereinafter referred to as the Announcement）as well as notices and specific implementation rules issued by provincial bureaus ，the filing work data of 10 provinces in recent 3 years were selected for comparison ，sorting，statistics，classification and induction. The policy characteristics and progress of filing work were studied. RESULTS & CONCLUSIONS According to the local actual situation，some provinces had refined or expanded the contents of several parts of the Announcement，such as the scope of TCM preparations，the situation not allowed to record ，the filing process and working time requirements ，the disclosure ，change and cancellation of filing information ，and the implementation of supervision and management. The statistical results of filing data in 10 provinces showed that compared with 2019，the number of TCM preparation declared for filing and medical institutions declared for filing had increased with growth rate of 91.0％ and 48.8％ respectively in 2020. There is still room for improvement in the supporting policies for the filing of TCM preparations ，which can be optimized by referring to the features of some provinces ’ implementation policies ，refining the construction of norms and standards ，and strengthening the construction of regulatory system platform. It is necessary to optimize policy and strengthen the capacity building of reporting institutions in advance ；carry out daily supervision and control risk based on risk during the filing management ；emphasize follow-up supervision ，strengthen the construction of ADR monitoring system in medical institutions ，and carry out life cycle supervision and management constructively afterwards，in order to promote the further development of TCM preparations in medical institutions.

Status Analysis and Improvement Suggestions on Filing Review Trial Implementation of Shanghai's Class II Passive Medical Device Registration / 中国医疗器械杂志

This article collected the statistics of Shanghai's class II passive medical device registration filing review trial implementation. It summarized and analyzed the common issues in the filing review stage, and gave suggestions for registration applicants and reviewers in order to further improve the quality of application materials and improve the efficiency of review.

Analysis on the filing mechanism for cross provincial immediate reimbursement of medical insurance in China / 中华医院管理杂志

Objective:To analyze the filing mechanism for cross provincial immediate reimbursement of medical insurance in China, so as to provide reference for optimizing the filing mechanism and improving the filing accessibility of insured personnel.Methods:Taking the filing policy of cross provincial immediate reimbursement of medical insurance in 2019 as the research object, on the basis of a comprehensive understanding of the national filing policy background, 90 coordinating regions in Zhejiang Province, Hubei Province and Ningxia Hui Autonomous Region were taken as survey samples to evaluate the relevant policies and extract key parameters, including filing identification methods, filing-related settlement benefits and filing ways. The parameters were compared and analyzed by using descriptive statistical methods.Results:The results of the survey showed that in terms of identity recognition methods, the provision of various supporting materials(residence permit, work certificate, etc.)was still the main way to carry out identity recognition for medical insured persons in different places.Filing-related reimbursement benefits were mainly adjusted by limiting the area of medical insurance treatment and adjusting the benefits parameters(reimbursement ratio). In terms of filing channels, 51(56.7%)sample co-ordination areas had realized at least one remote filing mode.Conclusions:The inclusiveness of filing identity verification mechanism for the floating population needs to be further improved, the filing-related treatment policies need to be further improved, and the convenience and standardization of filing channels need to be strengthened.

Informatización de registros médicos en clínicas estomatológicas / Computerization of medical records in dental clinics

RESUMEN Introducción: las nuevas tecnologías de la Informática y las comunicaciones han impactado en todas las áreas de la vida del ser humano y con especial énfasis en el sector de salud pública. El proceso de informatización de salud es abarcador en su concepción y en su proyección. Objetivo: implementar una aplicación informática para la gestión de la información de los procesos de registros médicos en el área de admisión de las clínicas estomatológicas Policlínico Universitario "Pedro Borrás Astorga" y Clínica Estomatológica Docente "Antonio Briones Montoto Métodos: la investigación obedece a un estudio de investigación-desarrollo tecnológico que tiene como objetivo desarrollar el prototipo de una aplicación informática para la gestión de los procesos de registros médicos empleando las tecnologías de la información y las comunicaciones. Resultados: uno de los retos de esta investigación es implementar un sistema para los centros de salud de estomatología mediante el análisis, diseño y elaboración, de una aplicación informática agradable al usuario, que ayudará al personal de salud a mejorar los procesos de inscripción del paciente, agenda de turnos, agenda servicio y archivo, siendo esta una herramienta informática implementada sobre plataforma web que da solución al problema a resolver en la entidad. Conclusiones: este proceso de informatización del sector lo constituye el paciente y se garantiza la calidad, oportunidad y consistencia de la información, que redundará en un incremento continuo y sostenido de la calidad en la atención médica, así como aporta resultados y apoyo a la toma de decisiones.

ABSTRACT Introduction: new information and communications technologies have impacted all areas of human life, with special emphasis on the public health sector. The informatization process of health system is comprehensive in its conception and projection. Objective: to implement a computer application for the management of information from the medical records processes in the area of admission of Pedro Borrás Astorga University Polyclinic and Antonio Briones Montoto Teaching Dentistry Clinic. Methods: the research complied with a technological- development research which was aimed at developing the prototype of a computer application for the management of the medical record processes using information and communication technologies, from the study of the current needs and shortcomings of this service. The target group of the study was constituted by the Dentistry Clinics of the country and the chosen sample belongs to the pilot institutions: Pedro Borrás Astorga University Polyclinic and Antonio Briones Montoto Teaching Dentistry Clinic, both from Pinar del Río municipality. Results: one of the challenges of this research is to implement a system for dentistry health-care centers through the analysis, design and development of a user-friendly computer application that will help health personnel to improve the processes of patient registration, shift schedule, agenda service and archive, being this an implemented computer tool on a web platform that provides a solution to the problem to be solved in the entity. Conclusions: the process of computerization of the health sector is aimed at the patient and guarantees the quality, suitability and consistency of information, which will result in a continuous and sustained increase in the quality of medical care, in order to achieve results and for decision making.

Development thinking on the advantages of the preparation of filing system on the traditional Chinese medicine in medical institutions / 国际中医中药杂志

The Chinese Medicine Law and the Drug Administration Law have been carried out and implemented that it is good opportunities to develop traditional Chinese medicine preparations and to promote the inheritance, innovation and development of traditional Chinese medicine by giving full play to the advantages of the traditional Chinese medicine preparations for filing, clarifying the train of thought of the filing system, and unblocking the channels for the filing system. This paper focuses on the analysis of the advantages and development of the traditional Chinese medicine preparation record system in medical institutions.

Survey of the record filing situations of Shenzhen biosafety laboratories in 2017 / 中华医学科研管理杂志

Objective Aims to reduce the hidden risks of laboratory biosafety,understand the status of biosafety laboratory record filing situations in Shenzhen,and also to provide scientific basis for further standardizing the management of biosafety laboratory in Shenzhen.Methods In 2017,75 laboratories in Shenzhen completed record filing were surveyed,method ologies adopted including application materials review,phone call consultation and communication,carrying out corrective ac tions based on feedback peer review suggestions and finally complete the record filing.Results The first/second level laborato ry of biosafety in shenzhen is mainly public medical institutions,followed by private hospitals.In 2017,the first three recordfiling LABS were Futian district,nanshan district and longgang district.According to the data analysis,lack of the second category of pathogenic microorganism laboratory activity project risk assessment report,and laboratory layout diagram function partition is not clear were two of the more prominent problems in the software and hardware of laboratory management respectively.Conclusions Basically,the overall record filing of Shenzhen biosafety laboratory is good,however,more measurements should be developed to deal with identified problems to further strengthen the standardized management of laboratory biosafety.

Impacts of policy and regulatory changes on medical device industry / 医疗卫生装备

Objective To study the impacts of changes in medical device policies and regulations on the industry when the state department decides to revise Medical Devices Supervisory Management Act.Methods The impacts were discussed from the aspects of the scale of enterprise, number of product filing and registration and industry development environment. Results The changes of the policies and regulations had no great effect on the scale of enterprise while standardized the enterprise filing and registration and facilitated its development.Conclusion Management system based on medical device product lifecycle has been initially formed.Medical equipment enterprises should actively grasp the new regulatory changes and improve the quality compliance management by innovating product and technology, in order to make good use of the dividends brought about by changes in policies.

Practice and Recommendation of Public Hospital Personnel Filing System Reform / 中国医院管理

Many provinces are carrying on Public Hospital Personnel Filing System Reform while facing a series of barriers cause a slow progress or the results not up to expectations.Supporting policies' adjustment is called to ensure the smooth progress of the reform.

Research and development of medical record assistant management system / 医疗卫生装备

Objective To establish a basic information database of hospital medical records management and improve the management process.Methods The system was developed with C# programming language,basic information from Oracle 10g databases of HIS and electronic medical record system (EMRS),which stored corresponding information during the process into SQL 2005 database and generated early warning information based on statistical analysis on medical records.Results The system realized standardized filing of medical records,synchronized filing of electronic medical record and the first page of medical record,normalized lending of medical record,auto generation of statistical reports,auto alarming in case of standard-exceeded information and etc,which could be used as a platform for medical record management.Conclusion The system enhances the efficiency and management of medical record section,and thus is worthy promoting practically.

Endodontic Management of Variants of C-Shaped Canal: Case Series

A thorough knowledge of the root canal morphology is required for successful endodontic therapy. One of the most important anatomic variations is the C-shaped configuration of the root canal system. The presence of high incidence of transverse anastomoses, lateral canals, and apical deltas makes it difficult to clean and seal the root canal system in these teeth and may complicate endodontic interventions. Meticulous mechanical and chemical debridement of the canal space with additional efforts is essential for complete elimination of pulpal pathology in the anatomical irregularities. Obturation of the canal space also requires special attention as obtaining a three dimensional fill of a C-shaped canal may prove to be a problem due to the various intricacies present within the root canal system. Hence, this case series presents various types of C-shaped canal morphologies of mandibular second molars and their management.

A study of stability training and reliability of bladder filling before radiotherapy for pelvic tumors / 中华放射肿瘤学杂志

Objective To explore the reliability of patients' sensation of the need to urinate,and to investigate the optimal volume and duration of bladder filling and training method for the stability of bladder filling. Methods From 2014 to 2015,Fifty patients with pelvic tumor were divided into group A and group B,according to whether they had the history of diseases or surgery in the pelvis or urinary system. Both groups received training of the sensation of the need to urinate. The training required patients to drink a fixed volume of water every time they emptied the bladder. The bladder capacity was measured by a bladder scanner ( BladderScan BVI 9400) ,and a rating scale of the sensation of the need to urinate was completed at 30 min,45 min,1 h,and over 1 h when the patient sensed the limit for bladder capacity. The optimal volume and duration of bladder filling or optimal frequency for the training were explored. The paired t-test method was performed for the difference between the predictive value and the measured value,Pearson method was performed for correlation between the sensation of the need to urinate and the measured value. Results In the A and B groups,there was no significant difference between the predicted value and measured value ( A:predicted value and measured value P=0. 777,B:predicted value and measured value P=0. 061) ,suggesting that the measured value could be used to reflect the predictive value. Compared with group B,group A had a higher correlation between the sensation of the need to urinate and the measured value ( rA=0. 812, rB=0. 762).The correlation between the predictive value and the measured value became the highest at 45 min and 1 h ( r=0. 858 and 0. 916) ,and the corresponding bladder filling volume and score of the sensation of the need to urinate were 330-450 ml and 4-6,respectively. The correlation between the predictive value and the measured value increased with the frequency of the training ( r2=0. 914, r3=0. 917, r4=0. 930, r5=0. 951,r6=0. 962) . Conclusions Before radiotherapy,patients with pelvic tumor should received at least 4-6 rounds of the training of bladder filling. Patients should drink 800-1 400 ml of water every time they empty the bladder,and the optimal bladder filling volume and the reliable and stable sensation of the need to urinate will be achieved after 45 min-1 h. For the patients with the history of urinary system diseases or pelvic surgery,the bladder filling volume needs to be measured using a bladder scanner ( BladderScan BVI 9400) during the training before radiotherapy.

Sealing Ability of MTA Used as a Root End Filling Material: Effect of the Sonic and Ultrasonic Condensation

Despite the excellent properties of mineral trioxide aggregate (MTA), the condensation technique may have some influence in its sealing ability. The purpose of this study was to compare the sealing ability of sonic and ultrasonic setting of MTA. Thirty-four extracted human teeth had their canals prepared and filled with Sealapex sealer and gutta-percha using the active lateral condensation technique. The teeth were rendered waterproof and apicoectomy performed at 3 mm from the apex. Root-end cavities (3.0 mm deep and 1.4 mm diameter) were prepared with diamond ultrasonic tips. The root-end cavities were filled with Pro-Root MTA® with ultrasonic vibration, sonic vibration or no vibration. The positive control group did not receive any material while the negative control group was totally rendered waterproof. After material set, the specimens were immersed in Rodhamine B for 24 h, under vacuum in the first 15 min, then washed, dried and split longitudinally for evaluating the infiltration at the dentin/material interface. Data were analyzed using ANOVA and Tukey's tests at 5% significance level. Sonic vibration promoted the lowest infiltration values (p<0.05). It was concluded that sonic vibration could be considered an efficient aid to improve the sealing ability of MTA when used as root-end filling material.

Resumo O objetivo deste estudo foi avaliar in vitro, a influência da vibração sônica e ultrassônica no selamento marginal proporcionado pelo MTA. Trinta e quatro dentes humanos tiveram seus canais radiculares instrumentados e obturados com cimento Sealapex® pela técnica da condensação lateral ativa. Os dentes foram impermeabilizados e seccionados os 3 mm apicais. Retrocavidades (3 mm de profundidade e 1,4 mm de diâmetro) foram preparadas com pontas ultrassônicas diamantadas. As retrocavidades foram preenchidas com Pro-Root MTA® com auxílio da vibração ultrassônica, com auxílio da vibração sônica e sem vibração alguma. O grupo controle positivo não recebeu material retrobturador, enquanto que o negativo foi totalmente impermeabilizado. Após a presa do material, os espécimes foram mergulhados em Rodamina B por 15 min em vácuo, permanecendo nesta solução por mais 24 h. Em seguida, foram lavados, secados e clivados longitudinalmente para avaliação da infiltração do corante na interface dentina/material retrobturador. Os dados foram analisados utilizando a análise de variância e o teste de Tukey (p<0,05). Observou-se que apenas a vibração sônica foi diferente apresentando os menores índices de infiltração. Pode-se concluir que vibração sônica contribui com a melhora da capacidade de selamento marginal proporcionado pelo MTA quando empregado como material retrobturador. .

Effects of anticurvature filing on danger zone width in curved root canals / 대한치과보존학회지

The aim of this study was to compare the effects of anticurvature filing with stainless steel k-file versus nickel-titanium ProFile in the shaping of mesial root canals of extracted mandibular molars. A total of 60 canals from 30 mesial roots of mandibular molar teeth were randomly assigned to three groups with n=20 each. They were prepared with different instruments and methods: The first group with stainless steel k-file and circumferential filing, the second with precurved stainless steel k-file and anticurvature filing and the third with ProFile (.06 taper) and anticurvature filing. Using a micro-computed tomography system (skyscan-1076, SKYSCAN, Antwerpen, Belgium), pre-and post-operative specimens were scanned. Subsequently, canal images were superimposed and changes in root dentin thickness were measured at distal side (danger zone) of the canal. The data was analyzed using a one-way ANOVA and the comparison of means was conducted using a post hoc multiple comparison Tukey test. There were significant differences in the change of root dentin thickness at the 7.5~8.5mm level between group 1 and 2, 3.5~6mm level between group 1 and 3 and 3.5~6mm level between group 2 and 3(n=20, P<0.05).

Postoperative Pain Occurrence after Applying Cortisomol Sealer / 医学研究杂志

Objective To compare the occurrence of postoperative pain after applying two diferent root canalsealers in root canal treatment.Methods A total of 400 teeth were randomly divided into two groups:group A using ZincOxide engenol(ZOE),group B using Cortisomol sealer.The occurrence of postoperative pain was evaluated chnically 24~72h after root filling.Results The diference in pain among the two groups were statistically significant after treatment.The group B caused minimum irritation and least pain among the two groups.Conclusions The root canal therapy using Cortisomol sealer can significantly reduce pain.

Effect of anticurvature filing method on preparation of the curved root canal using ProFile / 대한치과보존학회지

This study investigated the effect of anticurvature filing method on preparation of the curved root canal using ProFile. Thirty six resin blocks were divided equally into three groups by instrumentation motions: anticurvature filing motion, circumferential filing motion and straight up-and-down motion. Each resin block was sectioned at 8 mm level from the apex and at the greatest curvature of the canal and reassembled in metal mold by a modified Bramante technique. All groups were instrumented with the ProFile system. At each levels, image of sectioned surface were taken using CCD camera under a stereomicroscope at x40 magnification and stored. Distances of transportation at the inner and outer area of curvature and the centering ratio were determined and compared by statistical analysis, along with the assessment of the increase of root canal cross-sectional area. The results were as follows; 1. In all groups, there was no statistical difference in the mean increase of root canal cross-sectional area, the centering ratio, and the mean distances of transportation at the inner area of curvature at each level. 2. At 8 mm level from the apex, the mean distances of transportation at the outer area of curvature decreases in following order anticurvature filing motion, circumferential filing motion, straight up-and-down motion but, no significant difference at the greatest curvature of the canal among three groups. Effect of anticurvature filing motion using ProFile does not seem to be different from other instrumentation motions at the inner area of curvature in curved root canal.

Shaping ability of four rotary nickel-titanium instruments to prepare root canal at danger zone / 대한치과보존학회지

The aim of this study was to evaluate the shaping abilities of four different rotary nickel-titanium instruments with anticurvature motion to prepare root canal at danger zone by measuring the change of dentin thickness in order to have techniques of safe preparation of canals with nickel-titanium files. Mesiobuccal and mesiolingual canals of forty mesial roots of extracted human lower molars were instrumented using the crown-down technique with ProFile, GT(TM) Rotary file, Quantec file and ProTaper(TM). In each root, one canal was prepared with a straight up-and-down motion and the other canal was with an anticurvature motion. Canals were instrumented until apical foramens were up to size of 30 by one operator. The muffle system was used to evaluate the root canal preparation. After superimposing the pre- and post-instrumentation canal, change in root dentin thickness was measured at the inner and outer sides of the canal at 1, 3, and 5 mm levels from the furcation. Data were analyzed using two-way ANOVA. Root dentin thickness at danger zone was significantly thinner than that at safe zone at all levels (p 0.05). ProTaper removed significantly more dentin than other files especially at furcal 3 mm level of danger and safe zones (p < 0.05) Therefore, it was concluded that anticurvature motion with nickel-titanium rotary instruments does not seem to be effective in danger zone of lower molars.

Computerized Medical Records and Implications for Medical Education in Ophthalmology / 医学教育

Medical education with computerized medical records has been introduced in our ophthalmology department. Software needs to be improved, especially for filing and for charting terminology. Nevertheless clinical education with the new charts is superior to that with conventional methods since we make use of the computer's advantages of free access and ability to file and handle information.

Registro e controle de publicações seriadas pelo sistema de arquivamento com margem vertical visível (visirecord): experiência da catalogação retrospectiva da coleção do Instituto Adolfo Lutz / Registration and control of serials publications through the Visible Vertical Margin Filling System (Visirecord): an experience of retrospective cataloging of the Instituto Adolfo Lutz collection

Foi feita uma recatalogação das publicações seriadas na Biblioteca do Instituto Adolfo Lutz. O sistema adotado foi o de arquivamento com margem vertical visível (Visirecord) por ser de manuseio essencialmente prático e com características próprias para informações rápidas e precisas quanto à coleção de publicações seriadas. A catalogação da coleção foi retrospectiva e o tombamento dos volumes e das coleções foi feito durante este trabalho, pois a Biblioteca não tombava as suas publicações seriadas. Foi adotado o tombo em 2 livros separados - para coleção e volumes - por se tratar de patrimônio da Instituição. O trabalho, cuja duração foi de 2 anos, já aprovou completamente a aplicação do sistema vertical como catalogação auxiliar do bibliotecário. Suas finalidades principais refletem na aquisição, correspondência referente às publicações e ao acervo propriamente dito (AU).