Evaluation of knee cartilage based on MRI artificial intelligence reconstruction model of knee joint / 中华骨科杂志

Objective:To explore the feasibility of the AI intelligent reconstruction model based on knee joint magnetic resonance data developed by Nuctech Company Limited for evaluating knee cartilage injury.Methods:Thirty-three patients (a total of forty-one knees) who were hospitalized with severe knee osteoarthritis in Beijing Tsinghua Changgung Hospital from May 2021 to April 2022 were selected. All of them were planned to be performed total knee arthroplasty (TKA) for the treatment of knee osteoarthritis. Fifteen males with an average age of 71±5 years old and twenty six females with an average age of 71±9 years old were included in this study. There were 19 cases of left knee and 22 cases of right knee. Thin layer MRI examination on the patients' knee joints was performed before the surgery, and artificial intelligence model based on the thin layer MRI data of the knee joint was reconstructed. The cartilage part of the model was selected and corrected by Principal Component Analysis (PCA) in order to realize model straightening. The tibial plateau cartilage of knee joint which intercepted during operation was classified according to the International Cartilage Repair Society (ICRS). Finally the results were compared with the ICRS classification results of knee artificial intelligence reconstruction model and artificial recognition of knee joint MRI images.Results:Compared with the grade of cartilage injury intercepted during our operation which was according to the ICRS classification, the sensitivity of artificial intelligence reconstruction model for the diagnosis of cartilage injury with ICRS classification grade four was 93.1%. The specificity of artificial intelligence reconstruction model was 91.4%. The positive predictive value (PPV) of artificial intelligence reconstruction model was 92.2%. And the negative predictive value (NPV) of artificial intelligence reconstruction model was 80.3%. The area under ROC curve (AUC) was 0.92. The ICRS classification consistency between artificial intelligence model and physical inspection results was good with kappa value 0.81 ( P<0.001) . In the aspect of artificial recognition of cartilage injury grading in MRI images, the sensitivity of artificial recognition was 92.10% compared with the manual identification of cartilage injury classification in MRI images. The specificity of artificial recognition was 91.60%. The positive predictive value (PPV) of artificial recognition was 97.20% and the negative predictive value (NPV) of artificial recognition was 78.8%. The kappa value of the cartilage injury classification in MRI images consistency between artificial recognition and manual identification was 0.79 ( P<0.001). Conclusion:Based on the evaluation of cartilage injury by AI reconstruction model of knee joint, the sensitivity and specificity of the diagnosis of ICRS grade IV cartilage injury can be acceptable, but still needs to be improved.

The method of determining oral implantation sites based on an anatomical model of mandibular premolar area of a Beagle dog / 中国基层医药

Objective:To investigate the method of determining oral implantation sites based on an anatomical model of mandibular premolar area of a Beagle dog.Methods:This study was performed in the Second Affiliated Hospital of Zhejiang Chinese Medical University between January 2019 and October 2020. Mandibular anatomical structure and measurement data were compared between before and after removal of premolar teeth to determine safe implantation areas and oral implantation sites.Results:Among all mandibular premolars, the roots of the 1 st to 4 th premolars (P1-P4) gradually increased. The diameter of the mesial roots of the double root teeth P2, P3, and P4 was (2.72 ± 0.45) mm, (3.22 ± 0.32) mm, (4.16 ± 0.34) mm, respectively, which was significantly shorter than those in the distal roots [P2: (2.98 ± 0.29) mm, P3: (3.48 ± 0.27) mm, P4: (4.58 ± 0.22) mm]. The length of distal roots P2, P3 and P4 was (8.79 ± 0.41) mm, (9.21 ± 0.31) mm, (10.12 ± 0.36) mm), respectively, which was significantly shorter than that of mesial root [P2: (8.91 ± 0.69) mm, P3: (9.48 ± 0.27) mm, P4: (11.58 ± 0.24) mm]. Among all mandibles, the distance (H) from the mental foramen to the first molar and the width (W) of the alveolar crest increased successively [H1: (7.24 ± 0.49) mm, H2: (8.28 ± 0.71) mm, H3: (9.52 ± 0.37) mm, W1: (5.71 ± 0.81) mm, W2: (5.82 ± 0.28) mm, W3: (6.72 ± 0.54) mm]. Conclusion:The mental foramen and the distal part outside the canine apical area are safe implantation areas. In the safe implantation area, the length and diameter of the implant prosthesis do not exceed the root length in the implantation area and the maximum diameter in the buccal lingual direction.

Ergonomics of anatomical bra models for breastfeeding: a contribution of nursing / Ergonomía de modelos anatómicos de sostén para lactancia materna: una contribución de la enfermería / Ergonomia de modelos anatômicos de sutiã para amamentação: uma contribuição da enfermagem

ABSTRACT Objectives: to analyze the ergonomics of two models of breastfeeding bras. Methods: descriptive study carried out with 152 infants in a Brazilian university hospital. The prototypes were separated into two groups (A and B). To compare the two bra models, the Odds Ratio (OR) was used as a measure of the strength of the association. In subjective perceptions, the Modified Borg Scale, and the chi-square test of independence (χ2) were used. To compare the two prototypes, the Z test and logistic regression analysis were performed. A significance level of 5% was considered. Results: the bra in group B was more suitable for ergonomics of physical and psycho-aesthetic comfort than the bra in group A (p < 0.0001), according to the logistic regression tests. Conclusions: modeling B was ergonomically adequate, with usability and evaluation criteria centered on breastfeeding women.

RESUMEN Objetivos: analizar la ergonomía de dos modelados de sostén para lactancia materna. Métodos: estudio descriptivo realizado con 152 lactantes en un hospital universitario brasileño. Los prototipos fueron separados en dos grupos (A y B). Para comparar los dos modelados de sostén, fue utilizado la Odds Ratio (OR) como una medida de intensidad de la asociación. En las percepciones subjetivas, se utilizaron la Escala de Borg Modificada y el test chi-cuadrado de independencia (χ2). Para comparar los dos prototipos, se realizó el test Z y análisis de regresión logística. Se consideró un nivel de significación de 5%. Resultados: el sostén del grupo B fue el más adecuado para ergonomía de conforto físico y psicoestético del que el del grupo A (p < 0,0001), segundo los testes de regresión logística. Conclusiones: el modelado B fue ergonómicamente adecuado, con criterios de usabilidad y evaluación centrada en las lactantes.

RESUMO Objetivos: analisar a ergonomia de duas modelagens de sutiãs para amamentação. Métodos: estudo descritivo realizado com 152 lactantes em um hospital universitário brasileiro. Os protótipos foram separados em dois grupos (A e B). Para comparar as duas modelagens de sutiãs, foi utilizado a Odds Ratio (OR) como uma medida de intensidade da associação. Nas percepções subjetivas, utilizaramse a Escala de Borg Modificada e o teste qui-quadrado de independência (χ2). Para comparar os dois protótipos, realizou-se o teste Z e análise de regressão logística. Considerou-se um nível de significância de 5%. Resultados: o sutiã do grupo B foi o mais adequado para ergonomia de conforto físico e psicoestético do que o do grupo A (p < 0,0001), segundo os testes de regressão logística. Conclusões: a modelagem B foi ergonomicamente adequada, com critérios de usabilidade e avaliação centrada nas lactantes.

Biomechanical evaluation of posterior atlanto-occipital clivus screw fixationtechniques / 中华骨科杂志

Objective:To provide a theoretical basis for the clinical application of the posterior route through atlas occipital articular slope screw internal fixation system through the biomechanical study.Methods:Eight cadavers of healthy adults aged 35-60 years and 155-180 cm in height were selected. The specimens with complete anatomical structure and without surgical operation were established as normal models. The model of occipito-atlantoaxial complex was established by breaking the articular capsule, ligament and other connecting structures and cutting the dentate process. The device was established as an internal fixation model through the specimen of atlantooccipital joint slope screw internal fixation system. Given normal model and internal fixation of 1.5 N·m in the moment of flexion, lateral bending and axial rotation and to measure the specimen C 0-C 1 and C 0-C 2 segment of the range (range of motion, ROM), comparative analysis of pillow neck area within the normal model and fixed model changes the range of movement, after the evaluation through the slope between atlas and the occipital screw internal fixation system of mechanical properties. Results:In the normal model, the flexion, flexion and extension, lateral bend and axial rotation ranges of C 0-C 1 segments were 23.85°±2.43°, 4.74°±0.55°, 5.77°±0.75°, respectively; the corresponding activity ranges of C 0-C 2 segments were 30.66°±3.05°, 9.09°±1.37°, 70.97°±9.48°, respectively; in the internal fixation model, the flexion and extension, lateral bend and axial rotation ranges of C 0-C 1 segments were 0.71°±0.24°, 0.24°±0.06°, 0.34°±0.09°, respectively. The corresponding activity range of C 0-C 2 segment was 3.09°±0.82°, 0.74°±0.07°, 1.22°±0.10°, respectively. Compared with the normal model, the range of activity of the internal fixation model in all directions was significantly reduced (<3°), and the reduction ratio of activity was more than 90%. Conclusion:The posterior route through pillow slope screw internal fixation system can effectively reduce the range of motion of the occipital neck in flexion, extension, lateral bending and rotation, and has safe and reliable biomechanical stability.

Digital anatomic study on sacral lateral mass screw for sacral fracture / 中华创伤杂志

Objective@#To investigate the anatomical features of the safe zone for sacral lateral mass screw placement and find the safe trajectory, so as to provide reference for clinical application.@*Methods@#The three-dimensional computed tomography scan materials of sacrococcygeal vertebrae in 60 patients admitted to the Liaocheng People's Hospital of Shandong Province were analyzed by Mimics software to establish three-dimensional models. There were 33 males and 27 females, aged 25-78 years, with an average age of 45.7 years. After the safe zone was separated from sacral lateral mass model, a maximum cylinder was placed into the safe zone according to its anatomical feature. The cylinder was established as safe trajectory. Anatomical data were measured, including the length and diameter of screw trajectory, the distance between the entry point and the middle jaw, and adjacent upper and lower foramen, as well as the intersection angle between the screw direction and sagittal plane, between the screw direction and the adjacent upper end plate.@*Results@#The restriction factor of screw size on S1, S2 lateral mass was transverse diameter, while the restriction factor on S3, S4 was the distance between adjacent intervertebral foramen. The maximal length of screw from S1 to S4 was 30 mm, 35 mm, 30 mm, 14 mm respectively, while the maximal diameter was 12 mm, 9 mm, 5 mm, 5 mm respectively. The best entry point of S1 mass screw was lateral to the zygopophysis. The best entry point of S2-S4 mass screw was located at the midpoint of a line connecting the lateral edge of adjacent posterior sacral foramen approximately about 2 cm from median sacral crest. The leaning angles of screw was increased successively, and the sagittal plane was slightly inclined. There were significant differences between male and female groups in the leaning angle in S2 [male: (35.8±1.2)°, female: (37.9±3.7)°] and the distance between entry point and median sacral crest [male: (20.5±1.0)mm, female: (19.1±1.4)mm](P<0.05), while there was no significant difference in other parameters (P>0.05).@*Conclusions@#Cylindrical bony channel which is feasible for screw placement can be found in the lateral mass of sacrum. Individualized measurement can provide reference for application of lateral mass screw.

Current status and future perspectives of the application of medical 3D visualization technology in accurate surgery of liver tumors / 临床肝胆病杂志

There is a rapid development of 3D visualization (3DV) technology in the medical field nowadays. The 3DV model of the liver established by original CT and/or MRI imaging data can provide information on the complex structure of the liver in a variety of modes and help surgeons to perform better preoperative evaluation and individualized planning, so as to realize optimal protective liver resection and finally help patients get the best benefits. This article reviews the research advances in 3DV technology and precision surgery for liver tumors.

Digital anatomic study on sacral lateral mass screw for sacral fracture / 中华创伤杂志

Objective To investigate the anatomical features of the safe zone for sacral lateral mass screw placement and find the safe trajectory,so as to provide reference for clinical application.Methods The three-dimensional computed tomography scan materials of sacrococcygeal vertebrae in 60 patients admitted to the Liaocheng People's Hospital of Shandong Province were analyzed by Mimics software to establish three-dimensional models.There were 33 males and 27 females,aged 25-78 years,with an average age of 45.7 years.After the safe zone was separated from sacral lateral mass model,a maximum cylinder was placed into the safe zone according to its anatomical feature.The cylinder was established as safe trajectory.Anatomical data were measured,including the length and diameter of screw trajectory,the distance between the entry point and the middle jaw,and adjacent upper and lower foramen,as well as the intersection angle between the screw direction and sagittal plane,between the screw direction and the adjacent upper end plate.Results The restriction factor of screw size on S1,S2 lateral mass was transverse diameter,while the restriction factor on S3,S4 was the distance between adjacent intervertebral foramen.The maximal length of screw from S1 to S4 was 30 mm,35 mm,30 mm,14 mm respectively,while the maximal diameter was 12 mm,9 mm,5 mm,5 mm respectively.The best entry point of S1 mass screw was lateral to the zygopophysis.The best entry point of S2-S4 mass screw was located at the midpoint of a line connecting the lateral edge of adjacent posterior sacral foramen approximately about 2 cm from median sacral crest.The leaning angles of screw was increased successively,and the sagittal plane was slightly inclined.There were significant differences between male and female groups in the leaning angle in S2 [male:(35.8 ± 1.2) °,female:(37.9 ± 3.7) °] and the distance between entry point and median sacral crest [male:(20.5 ± 1.0) mm,female:(19.1 ± 1.4) mm] (P ＜ 0.05),while there was no significant difference in other parameters (P ＞ 0.05).Conclusions Cylindrical bony channel which is feasible for screw placement can be found in the lateral mass of sacrum.Individualized measurement can provide reference for application of lateral mass screw.

Modelos anatómicos personalizados impresos en 3D como herramientas para el aprendizaje y la preparación de intervenciones / Custom 3D printed anatomical models as tools for learning and preparation of Interventions / Modelos anatômicos personalizados impressos em 3D como ferramentas para aprendizagem e preparação de intervenções

Objetivo: presentar un método de desarrollo basado en dos casos de modelos anatómicos personalizados impresos en 3D, el\r\nprimero una arteria cerebral y el segundo una estructura ósea del húmero humano, a fin de ejemplificar el uso de herramientas\r\nde visualización tridimensionales para planificar intervenciones quirúrgicas. Método: se seleccionaron imágenes médicas de\r\ntomografías computarizadas o imágenes de resonancia magnética de pacientes anónimos y la sección específica del órgano se\r\nsegmentó con el software 3D Slicer. El modelo se convirtió en mallas poligonales en tres dimensiones, se optimizó y se imprimió\r\nen 3D. La morfología del órgano representada en el modelo anatómico se validó con especialistas para determinar si son oportunas\r\npara planificar procedimientos médicos. Resultados: diversos modelos anatómicos de los mismos casos se elaboraron en dos laboratorios de fabricación digital, uno en la Universidad El Bosque y otro en el FabLab Valencia, con diferentes variables en su\r\nproceso técnico y características, dada la dificultad de morfologías y delicadeza de las estructuras presentes en el cuerpo humano.\r\nConclusiones: con el método presentado sí es posible realizar modelos anatómicos personalizados en 3D para visualizar y simular\r\nestructuras anatómicas de pacientes útiles en la planeación de cirugías y la enseñanza de anatomía, que podrían mejorar el éxito\r\nen las intervenciones y el entrenamiento de profesionales en áreas de la salud.

Objective: To present a method of development based on\r\ntwo cases of custom anatomical models printed in 3D; the\r\nfirst one a cerebral artery and the second a bone structure\r\nof the human humerus, to exemplify the use of three-dimensional\r\nvisualization tools to perform planning of surgical\r\noperations. Method: It consisted of: a) Searching CT or MRI\r\nimages of anonymous patients, b) Segmenting with the 3D\r\nSlicer software the specific section of the organ, c) Converting\r\nthe model into polygonal meshes in three dimensions, d)\r\nOptimizing and printing in 3D, e) Validating with specialists\r\nthe organ morphology to determine if they are pertinent to\r\nplanning medical procedures. Results: Models were made in\r\ntwo different manufacturing laboratories; El Bosque University\r\nand FabLab in Valencia, with various anatomical models\r\nmanufactured of the same case with different variables in their\r\nprocess and characteristics given the difficulty of morphologies\r\nand delicacy of the structures present in the human body.\r\nConclusion: The method presented does provide useful results\r\nas an example for the planning of surgeries and anatomy\r\nteaching of anatomical structures in different scenarios that\r\ncould improve the success in interventions and the training of\r\nprofessionals in health areas.

Objetivo: apresentar um método de desenvolvimento de\r\nmodelos anatômicos personalizados em 3D para exemplificar\r\no uso de ferramentas de visualização para realizar planificação\r\nde operações cirúrgicas. Realizaram-se dois modelos como\r\nexemplo; o primeiro uma artéria cerebral e o segundo uma\r\nestrutura óssea do úmero humano. Método: o método de\r\ntrabalho consistiu em a) Buscar imagens médicas realizadas\r\ncom CT ou MRI de pacientes anônimos, b) Segmentar com o\r\nsoftware 3D Slicer a seção específica do órgão, c) Converter o\r\nmodelo em malhas poligonais em três dimensões, d) Otimizar\r\ne imprimir em 3D, e) Validar com especialistas a morfologia do\r\nórgão para determinar se são pertinentes para planejar procedimentos\r\nmédicos. Resultados: fabricou-se em dois laboratórios\r\nde fabricação diferentes, um na Universidad El Bosque e outro\r\nno FabLab Valencia, diversos modelos anatômicos do mesmo\r\ncaso com diferentes variáveis em seu processo e características\r\ndada a dificuldade de morfologias e delicadeza das estruturas\r\npresentes no corpo humano. Conclusão: o método apresentado\r\nproporciona resultados úteis para o planejamento de\r\ncirurgias e ensino de anatomia de estruturas anatômicas em\r\ndiferentes cenários que poderiam melhorar o êxito das intervenções\r\ne o treinamento de profissionais na área de saúde.

Application of computer-aided design and 3D printing model in operation for complex mandibular fractures / 中华创伤杂志

Objective To investigate the value of computer aided design and 3D printing model in operation for complex mandibular fractures.Methods The clinical data of 136 patients with complex mandibular fractures treated from June 2006 to June 2016 were retrospectively analyzed.The patients were divided into 3D group (n =28) and conventional group (n =108) based on the use of computer aided design and 3D printing model.There were 24 males and four females in 3D group,with the age of (33.8 ± 15.4) years.There were 91 males and 17 females in conventional group,with the age of (30.3± 11.9)years.The 3D group used computer aided design and 3D printing model to develop the surgical plan,and the conventional group used traditional CT scan image data.The operation time,intraoperative blood loss,incidence of postoperative adverse events,and the distance differences between the ipsilateral and the five contralateral maxillofacial markers were compared between the two groups (△L1:the difference between the mandibular angle point and the condyle apex;△L2:the difference between the mandibular angle point and the chin vertex;△L3:the difference between the apex of the chin and the apical point;△L4:the difference between the inner mandibular angle point and the Inferior alveolar margin point;△L5:the distance between the inner mandibular angle and the sagittal plane).Results The operation time in the 3D group and the conventional group were 155 (126.25,183.75)min and 235 (156.25,268.75)min,respectively.The intraoperative blood loss in the 3D group and the conventional group were 100 (50.0,187.5) ml and 125 (100.0,200.0) ml,respectively.In the 3D group,one patient had mild occlusion disorder.In the conventional group,4 patients had postoperative infection,1 repulsion reaction of internal fixation device,and 19 mild occlusion disorder.The differences between the two groups in operation time and postoperative adverse events were statistically significant (P ＜ 0.05),but there was no significant difference in intraoperative blood loss (P ＞ 0.05).There was no significant difference between the ipsilateral △L and contralateral △L in two groups (P ＞ 0.05).No significant difference in △L4 was found (P ＞ 0.05),but there were significant differences in △L1,△L2,△L3,and △L5 between the two groups (P ＜0.05).Conclusion For patients with complex mandibular fractures,the use of computer-aided design and 3D printing model can helps shorten operation time,reduce postoperative adverse events and hence improve the fracture reduction outcome.

Learning curve of radiology residents during training in fluoroscopy-guided facet joint injections / Curva de aprendizado de residentes em radiologia durante treinamento em punção de articulações facetárias guiada por fluoroscopia

Abstract Objective: To develop a simulator for training in fluoroscopy-guided facet joint injections and to evaluate the learning curve for this procedure among radiology residents. Materials and Methods: Using a human lumbar spine as a model, we manufactured five lumbar vertebrae made of methacrylate and plaster. These vertebrae were assembled in order to create an anatomical model of the lumbar spine. We used a silicon casing to simulate the paravertebral muscles. The model was placed into the trunk of a plastic mannequin. From a group of radiology residents, we recruited 12 volunteers. During simulation-based training sessions, each student carried out 16 lumbar facet injections. We used three parameters to assess the learning curves: procedure time; fluoroscopy time; and quality of the procedure, as defined by the positioning of the needle. Results: During the training, the learning curves of all the students showed improvement in terms of the procedure and fluoroscopy times. The quality of the procedure parameter also showed improvement, as evidenced by a decrease in the number of inappropriate injections. Conclusion: We present a simple, inexpensive simulation model for training in facet joint injections. The learning curves of our trainees using the simulator showed improvement in all of the parameters assessed.

Resumo Objetivo: Desenvolver um simulador para treinamento em punção de articulações facetárias guiada por fluoroscopia e avaliar a curva de aprendizado neste procedimento em um grupo de residentes de radiologia. Materiais e Métodos: Tomando uma coluna lombar humana como modelo, desenvolvemos cinco vértebras lombares feitas de metacrilato e gesso. Essas vértebras foram combinadas para formar um modelo anatômico de coluna lombar. Utilizamos um invólucro de silicone para simular a musculatura paravertebral. O modelo foi colocado dentro do tronco de um manequim de plástico. Recrutamos 12 voluntários dentre residentes de radiologia de nosso departamento. Cada aluno realizou 16 punções de articulações facetárias em nosso simulador em uma única sessão de treinamento. Usamos três parâmetros para avaliar as curvas de aprendizado: tempo de procedimento, tempo de fluoroscopia e qualidade do procedimento, definida pelo posicionamento da agulha. Resultados: As curvas de aprendizado de todos os estudantes mostraram melhora nos tempos de procedimento e fluoroscopia com o treinamento. O parâmetro de qualidade do procedimento também mostrou melhora, definida por decréscimo no número de punções inadequadas. Conclusão: Apresentamos um modelo simulador simples e de baixo custo para treinamento em punção de articulações facetárias. As curvas de aprendizado de nossos estudantes mostraram melhora em todos os parâmetros avaliados.

Simulação Médica no Ensino Universitário de Pediatria / Medical Simulation in the University Teaching of Pediatrics

RESUMO Objetivos Demonstrar as vantagens do uso de manequins simuladores no ensino prático médico, em particular pediátrico, e estudar os diferentes tipos de manequins/modelos existentes, especificidades e utilização própria de cada um deles. Métodos A formação médica baseada na transmissão teórica de conhecimentos e com aprendizagem clínica praticada em doentes reais não é viável atualmente, pois depende da oportunidade e disponibilidade dos doentes em determinado momento. Hoje em dia, a Medicina recorre a modelos de simulação médica, permitindo o desenvolvimento da proficiência necessária à execução de determinado procedimento. A simulação médica proporciona diversas vantagens: não requer doentes reais e disponíveis, possibilita repetição da técnica com correção de erros, aumenta o nível de confiança do aluno em suas capacidades e não oferece risco ao doente. Desde 2009, o ensino de Pediatria no Estágio de Saúde Infantil dos alunos do sexto ano do Mestrado Integrado em Medicina na Faculdade de Medicina de Coimbra contempla aulas práticas com modelos, onde os alunos treinam técnicas como: intubação pediátrica, manobra de Ortolani, punção venosa em membros superiores, punção lombar, intubação orotraqueal, auscultação do murmúrio vesicular, punção venosa, avaliação da fontanela normotensa e da hipertensão da fontanela. Esta componente prática de ensino estimula e agrada aos alunos, que todos os anos a elegem como uma das preferidas do Estágio de Saúde Infantil no âmbito do Mestrado Integrado. Resultados Aquisição de conhecimentos e prática de técnicas médicas, invasivas e não invasivas, por parte dos alunos, recorrendo a modelos de simulação médica pediátricos, nomeadamente: intubação pediátrica, manobra de Ortolani, punção venosa em membros superiores, punção lombar, intubação orotraqueal, auscultação do murmúrio vesicular, punção venosa, avaliação da fontanela normotensa e da hipertensão da fontanela. Feita a avaliação destas mesmas aulas pelos alunos por meio de questionário de preferências, ficou claro que esta é uma das aulas preferidas dos alunos do sexto ano de Medicina em Estágio de Saúde Infantil do Mestrado Integrado em Medicina. Conclusões Foi possível aos alunos desenvolver competências na realização de procedimentos médicos, com uma avaliação muito positiva pelos estudantes do Estágio em Saúde Infantil do Mestrado Integrado em Medicina.

ABSTRACT Objectives To demonstrate the advantages of using simulator mannequins in practical medical education and particularly in pediatrics, studying the different kinds of existing mannequins/models, their specific characteristics and uses. Methods Medical training based on the theoretical transmission of knowledge and clinical learning practiced on real patients is currently unviable because it is dependent on the timing and availability of patients at any given moment. Nowadays, medicine uses medical simulation models, thus facilitating the development of proficiency in skills required for the execution of particular procedures. Medical simulation provides several advantages: it does not require real and available patients, techniques may be repeated in order to address errors, students’ confidence in their abilities is promoted, and there is an absence of risk for the patient. Since 2009, the child health internship undertaken as part of the pediatric education section of the Integrated Master’s degree at the University of Coimbra Faculty of Medicine by sixth-year students has included practical classes with models where students practice techniques such as pediatric intubation, the Ortolani maneuver, venipuncture in upper limbs, lumbar puncture, endotracheal intubation, breath sounds auscultation, venipuncture, evaluation of normotensive fontanelle, and hypertension fontanelle. This practical component stimulates and appeals to students, who repeatedly select these classes as one of their favorites on the child health internship completed as part of the Integrated Master’s degree in Medicine. Results Students used medical simulation models to acquire knowledge and practice medical, invasive and non-invasive techniques such as: pediatric intubation, the Ortolani maneuver, venipuncture in the upper limbs, lumbar puncture, endotracheal intubation, breath sounds auscultation, venipuncture, evaluation of normotensive fontanelle, and hypertension fontanelle. Upon the students’ assessment by means of a preference questionnaire, it became clear that these classes were some of those preferred by sixth-year students completing the child health internship as part of their Integrated Master’s degree. Conclusions Students completing child health internships as part of the Integrated Master’s degree in medicine were able to develop skills in performing medical procedures, with very positive assessments given by these students on the experience.

Design and manufacture of a novel orientation device of elbow rotation center / 中华创伤骨科杂志

Objective To report the design and manufacture of a novel orientation device of elbow rotation center.Methods The anatomical data of distal humeral elbow were obtained from 3 reports on the anatomy of the distal humerus retrieved from CNKI from 2004 through 2014.Software UGS.0 NX,CAD/CAM animation and video were used to design the 3D model of our novel orientation device of elbow rotation center.The glass fiber physical model of the device was manufactured using 3D printing technology.Five healthy volunteers were recruited for a simulated surgery experiment to test the efficacy and accuracy of the device,including 4 males and 1 female,from 25 to 36 years of age.Results No change was observed before and after the device was disinfected regarding the length (129 mm),width (116 mm) or height (215 mm),or other shapes.Satisfactory X-ray images of the elbow were obtained in the 5 volunteers.The fluoroscopy frequency required ranged from 6 to 11 times,averaging 8.2 times.The time needed for orientation ranged from 442.2 to 554 seconds,averaging 489.2 seconds.Conclusions Our self-designed orientation device can be used to accurately position and orientate the rotation center of elbow joint,showing its reasonable design.Glass fiber materials can be used to manufacture our orientation device.

Imaging study of maxillary sinus in normal adults using cone-beam CT / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo estimate different dimensions of maxillary sinus measured on cone-beam computerized tomography (cone-beam CT), and determine the differences in side and gender.METHODScone-beam CT image data from 200 normal adults was selected and analyzed by Invivo Dental software. The craniocaudal diameter, anteroposterior diameter, width and volume of maxillary sinus were measured as well as the thickness of the orbital floor. Statistical analysis was performed with SPSS 11.5.RESULTSThere were no statistically significant differences in the craniocaudal diameter, anteroposterior diameter, width and volume of maxillary sinus between sides (P>0.05, respectively). Significant differences were noted in the craniocaudal diameter and volume of bilateral maxillary sinus and the width of right maxillary sinus based on gender (P0.05, respectively).CONCLUSIONOur findings indicate that cone-beam CT can be used to measure different dimensions of maxillary sinus and provide imaging anatomical data for clinical treatment.

Study of the influent factors and reconstructing condition for the virtual endoscopy technique Fly-Thru (FT) in bile duct model in vitro / 中华超声影像学杂志

Objective To investigate the factors affecting Fly-Thru (FT) and the best reconstruction conditions in a bile duct model.Methods The bile duct model was made with corn powder and rubber pipes.FT data of bile duct in vitro were acquired with a 3-dimensional probe of Toshiba Aplio 500,and the data were reconstructed offline in Fly-Thru workstation.Two US doctors assessed the FT images in three degrees.Results The images were divided into good,moderate and poor groups with corresponding score 3,2,1.Of 162 images,72 were rated as grade 1,57 as grade 2 and 33 as grade 3.According to x2 analysis,the diameter,scanning way,and Filter were brought into multinomial regression,then the scanning way was found to be correlated to FT images quality as well as filter (likelihood ratio =87.598,294.290,x2 =9.492,313.722,respectively,P ＜0.01).Best images of FT can be acquired by transverse scanning,reconstructing in Filter =3,gain =5(0,dynamic range (DR) =50 and threshold ranging 40-90.Conclusions Best FT images in the model could be achieved by scanning in short-axis,and reconstructing the data in Filter =3,gain =50,DR =5(0 and threshold ranging 40-90,which would be basic information for advanced clinic study.

Different materials and techniques for accurate molding for adaptation in angled implants / Diferentes materiais e técnicas para moldagem precisa na adaptação em implantes inclinados

OBJECTIVE: To evaluate the marginal misfit between intermediate and micro-unitmetal cylinder, by varying the angle of the implants, using two different types of material and different molding techniques. METHODS: A model was made with three implants (one perpendicular to the horizontal plane and two inclined) using micro-unit intermediates. A rod attached to the master model served as a control condition to evaluate the suitability of the twenty specimens, carried out with the help of an optical stereomicroscope (Pantec, Brazil; Materials Testing Laboratory, São Leopoldo Mandic, Campinas, São Paulo). RESULTS: Evaluator reliability was assessed using theIntraclass Correlation Coefficient, obtaining 99.6% (excellent). There were significant differences between groups, and the Mann-Whitney test compared groups in pairs for a more accurate result. CONCLUSION: The group which presented the best behavior was open tray and condensation silicone and the worst result, that needed to be cast several times, was closed tray and condensation silicone. .

OBJETIVO: Avaliar a desadaptação marginal entre intermediário micro-unit e cilindro metálicos, variando a angulação dos implantes, com dois tipos de materiais e diferentes técnicas de moldagem. MÉTODO: Modelo com três implantes (um perpendicular ao plano horizontal e dois inclinados) usando intermediários micro-units. Uma barra mestre acoplada ao modelo serviu de situação controle para avaliar a adaptação dos vinte corpos de prova, feitas com estereomicroscópio óptico. RESULTADOS: A confiabilidade do avaliador foi avaliada com Índice de Correlação Intraclasse, obtendo 99,6% (ótimo). Houve diferença estatisticamente significante entre os grupos, e com o teste Mann-Whitney comparou-se os grupos aos pares para um resultado mais preciso. CONCLUSÃO: O grupo que apresentou melhor comportamento foi o de tray aberta e silicone por condensação. O de pior resultado, que foi preciso ser moldado diversas vezes, foi o de tray fechada e silicone por condensação. .

Microsurgical training model with nonliving swine head. Alternative for neurosurgical education

PURPOSE: This paper proposes a practical model of microneurosurgical training using a nonliving swine head. METHODS: Fresh porcine heads were obtained from butchery and dissected at our Laboratory of Microsurgery. Brain and skull base surgery were trained under microscopic magnification. RESULTS: Several neurosurgical procedures could be simulated in the nonliving pig model, including transcallosal approach to the lateral ventricle, lateral sulcus and middle fossa dissection, and posterior fossa surgery. CONCLUSION: The swine model perfectly simulates standard microneurosurgical procedures, and is a useful tool for developing and refining surgical skills. .

An alternative experimental model for training in microsurgery / Modelo experimental alternativo para treinamento em microcirurgia

OBJECTIVE: to describe a new model of training in microsurgery with pig spleen after splenectomy performed by undergraduate students of the Discipline of Operative Technique of the UFPR Medical School. METHODS: after the completion of splenectomy we performed dissection of the vascular pedicle, distal and proximal to the ligation performed for removal of the spleen. After complete dissection of the splenic artery and vein with microscope, clamps were placed and the vessels were cut. We then made the anastomosis of the vessels with 9.0 nylon. RESULT: the microsurgical training with a well-defined routine, qualified supervision and using low cost experimental materials proved to be effective in the practice of initial microvascular surgery. CONCLUSION: the use of pig spleen, which would be discarded after splenectomy, is an excellent model for microsurgical training, since besides having the consistency and sensitivity of a real model, it saves the sacrifice of a new animal model in the initial learning phase of this technique. .

OBJETIVO: descrever um novo modelo de treinamento em microcirurgia com baço de suínos após esplenectomia realizada pelos alunos de graduação da disciplina de técnica operatória do curso de medicina da UFPR. MÉTODOS: após a realização da esplenectomia realizamos dissecção do pedículo vascular distal e proximal a ligadura realizada para a retirada do baço. Após a dissecção completa da artéria e veia esplênica ,com microscópio, são colocados os clampes e o vaso é seccionado. É então realizada a anastomose dos vasos com mononylon 9,0. RESULTADO: o treinamento microcirúrgico, com uma rotina bem definida, supervisão qualificada e utilizando materiais experimentais de baixo custo, mostrou-se efetivo na prática de cirurgia microvascular inicial. CONCLUSÃO: a utilização do baço suíno, que seria desprezado após esplenectomia, é um excelente modelo para treinamento microcirúrgico, pois além de ter a consistência e delicadeza de um modelo real poupa o sacrifício de um novo modelo animal, na fase inicial de aprendizado desta técnica. .

Observations and measurements of Wiltse paraspinal sacrospinalis splitting approach in Chinese people / 中国组织工程研究

BACKGROUND:Application of Wiltse paraspinal sacrospinalis splitting approach can reduce paraspinal muscle injuries caused by operations, but there are stil no precise criteria to determine anatomic locations of longissimus-multifidus cleavage planes. OBJECTIVE:To have an intimate knowledge of structural characteristics of Wiltse paraspinal sacrospinalis splitting approach, to determine specific locations of longissimus-multifidus cleavage planes in different lumbar segments, and to provide experiences and references for its clinical applications by observations and measurements of autopsies and magnetic resonance images in Chinese people. METHODS:Ten embalmed adult cadavers were used for anatomical observations. The natural cleavage planes between longissimus and multifidus were noted and bluntly dissected bilateraly. Measurements were done between these planes and the midline at levels of spinous processes of L2 and L4. 400 patients’ images of lumbar spines were also used for observations. Measurements were taken bilateraly between longissimus-multifidus cleavage planes and the midline at levels of discs from L2/L3 to L5/S1. The correlations between these distances and sex or age were analyzed. RESULTS AND CONCLUSION:No important vessels or nerves were found in the longissimus-multifidus cleavage planes of al 10 cadavers. Superior facets and roots of transverse processes could be exposed at the bottom of the planes. At L2, the mean distance was (2.3±0.3) cm; at L4, (3.4±0.6) cm. Of al 400 images, the mean distances from L2/L3 to L5/S1 were respectively (19.71±1.93) mm, (23.49±2.49) mm, (27.49±2.84) mm and (31.36±3.15) mm. No strong correlation was discovered between sex or age with respect to measured distances. This study provides valuable references for clinical application of Wiltse paraspinal sacrospinalis splitting approach. We suggest routine measurements of magnetic resonance imaging before surgeries to reduce iatrogenic injuries.

Application of Spine Decide software in clinical teaching of spine surgery / 中国组织工程研究

BACKGROUND:Spine, due to its complicated structure and special functions, is always the difficulty and emphasis in clinical practice and medical education. It is an interesting top how to apply modern software in clinical teaching. OBJECTIVE:To investigate the application of Spine Decide software in clinical teaching of spine surgery. METHODS:Teachers can actively guide students to learn the diagnosis of spine diseases and to design surgery program using Spine Decide software. Then the students wil participate in the surgical operation of the patients, which helps them better understand the diagnosis and treatment of spine surgery disease and the occurrence and development of spine diseases. RESULTS AND CONCLUSION:The students actively participated in the process of learning through Spine Decide software, which helps them learn systematical y, structural y the pathogenesis, diagnosis, treatment and prognosis of spine diseases in a short period. Application of Spine Decide into teaching activities has greatly improved the students’ abilities in self-learning and clinical analysis. Their enthusiasm to the learning and creativity has been greatly improved compared to traditional teaching methods;innovation and exploration have breakthrough improvement, final y achieving a good teaching effect.

Portable Document Format File Showing the Surface Models of Cadaver Whole Body

In the Visible Korean project, 642 three-dimensional (3D) surface models have been built from the sectioned images of a male cadaver. It was recently discovered that popular PDF file enables users to approach the numerous surface models conveniently on Adobe Reader. Purpose of this study was to present a PDF file including systematized surface models of human body as the beneficial contents. To achieve the purpose, fitting software packages were employed in accordance with the procedures. Two-dimensional (2D) surface models including the original sectioned images were embedded into the 3D surface models. The surface models were categorized into systems and then groups. The adjusted surface models were inserted to a PDF file, where relevant multimedia data were added. The finalized PDF file containing comprehensive data of a whole body could be explored in varying manners. The PDF file, downloadable freely from the homepage (http://anatomy.co.kr), is expected to be used as a satisfactory self-learning tool of anatomy. Raw data of the surface models can be extracted from the PDF file and employed for various simulations for clinical practice. The technique to organize the surface models will be applied to manufacture of other PDF files containing various multimedia contents.