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Objectives: The goal of this research was to see how reliable and valid three selected parameters from different analysis were in detecting the vertical skeletal pattern. Methods: There were 94 cephalometric x?rays used in all. The vertical skeletal pattern was assessed using the mandibular plane angle by Steiner, Frankfort mandibular angle by Tweed, and facial axis angle by McNamara. According to the diagnostic results of the majority of the measures, the samples were classified as normo?divergent, hypodivergent, or hyperdivergent. Kappa statistics, positive predictive value, and sensitivity were employed to verify the validity and reliability of the analyses. Results: A statistically significant weak negative correlation was found between Frankfort mandibular angle and facial axis angle in female group (p value < 0.01). A good agreement was found between mandibular plane angle with final diagnosis (K = 0.726). The mandibular plane angle showed highest sensitivity and positive predictive value in hypodivergent group (0.939, 0.816) and normo?divergent group (0.795, 0.833), respectively. Conclusion: For determining the facial vertical growth pattern the most accurate indicators were identified to be mandibular plane angle (SN?GoGn) and Frankfort mandibular angle.
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Ashi points play a significant role in the clinical localization and qualitative diagnosis of acupuncture, as well as in selecting acupoints along the meridians and applying tonifying or reducing techniques. This paper introduces the theoretical basis and existing technical methods of objectification of ashi point diagnosis and treatment. It proposes that using sensory quantitative testing to determine the temperature and tenderness thresholds of ashi points could help to identify the pathological characteristics of "cold" "heat" "deficiency" or "excess" of ashi points. In addition, the possibility of objectification of ashi point diagnosis-treatment plan is explored from three perspectives, precision of selection of ashi point therapy, objectification of effect evaluation of ashi point analgesia, and differentiation of the studies on ashi point analgesic mechanism, aiming to provide new research ideas for the modernization of traditional Chinese acupuncture.
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Acupuncture Therapy , Meridians , Acupuncture Points , Acupuncture , AnalgesiaABSTRACT
Introducción: el apoyo al automanejo, la participación y retroalimentación son centrales en la implementación de una atención centrada en el usuario en el marco del modelo de cuidados crónicos. Esto ha demostrado mejorar diversos resultados sanitarios. Objetivo: estimar el grado de participación de los pacientes hipertensos y diabéticos, en las decisiones sobre su plan de tratamiento en población adulta chilena. Métodos: análisis secundario de la Encuesta Nacional de Salud (ENS) 2016-2017, muestra aleatoria estratificada de hogares, multietápica por conglomerados, representativa de la población adulta chilena. Se incluyó población mayor de 15 años hipertensa o diabética bajo tratamiento. Se describen las prevalencias expandidas de la variable percepción de participación en la toma de decisio-nes sobre plan terapéutico en escala Likert de 5 niveles, según edad, sexo, zona urbana/rural y nivel educacional. Se utilizó regresión logística y OR ajustados. Resultados: el 72,3% de los diabéticos y el 71,9% de los hipertensos, refieren "nunca" haber sido consultados al preparar su plan de tratamiento. En la población hipertensa, existe una percepción de participación significativamente más baja en mujeres que en hombres (OR ajustado por edad = 0,5 (IC 95% de 0,3-0,8) no se observaron diferencias estadísticamente significativas según edad, ruralidad ni nivel educacional. Conclusiones: la población hipertensa y diabética percibe bajos niveles de participación en el diseño de su plan terapéutico y los resultados sugieren inequidad de género en hipertensos. Este estudio permitirá evaluar futuras políticas y modificaciones al modelo de cuidados crónicos en el sistema de salud chileno.
Introduction: Self-management support, activation, participation, and feedback are core elements in chronic care models. Patients' participation in decision-making has been shown to improve health outcomes. Objective: To estimate the degree of participation of hypertensive and diabetic patients in decisions about their treatment plan in the general Chilean adult population. Methods: Secon-dary analysis of the "Encuesta Nacional de Salud (National Health Survey) (ENS) 2016-2017" multistage random stratified sample of households representative of the Chilean adult population. Hypertensive or diabetic populations older than 15 years of age that were under treatment were included. The weighted prevalence of the variable "perception of participation in decision making about their treatment plan" was described on a Likert scale of 5 levels, according to age, sex, urban/rural area, and educational level. We used logistic regression and adjusted OR. Results 72.3.5% of diabetic and 71.9% of hypertensive patients say they have "never" been asked their opinion about their treatment plan. In the hypertensive population, women perceived less participation than men (OR adjust by age =0.5 [IC 95% de 0.3-0.8]), with no significant differences observed by age, rurality, or educational level. Conclusions: Hypertensive and diabetic populations perceive low levels of participation in the design of their therapeutic plan, results also suggest gender inequity. This study contributes essential insights for the reformulation of Chilean chronic care models and may stand as a baseline to evaluate the implementation of future health policy.
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Objective:To analyze the dosimetric effects on off-center tumour treatment plan resulting from the MR-Linac-based isocenter position radiotherapy plan.Methods:The cases of 19 patients who were treated in Sun Yat-sen University Cancer Center in 2020 were collected in this study. Two different IMRT plans were designed for each patient with off-center tumor both for group A with planned isocenter position as IMRT and group B with planed target center position as geometric center. The conformity index and homogeneity index of target, the dose normal tissue and the number of MU were compared between two plans.Results:The two IMRT plans met clinical dosimetric requirements. No statistical differences were found both in homogeneity index and conformity index ( P>0.05). Also there was no differences found in doses to normal tissues. However, the MU number (1 149±903, t=2.804, P=0.012) in group A was higher than that in group B (970±652). Conclusions:It is feasible to perform MR-Linac-based off-center treatment plan.
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It is imperative to build an esophageal cancer database that meets China′s conditions to manage and use the clinical diagnosis and treatment data of esophageal cancer. The tumor registration database has been constructed since 1929 in Western countries. Nowadays many comprehensive tumor registration databases exist around the world, such as the SEER database, which provide valuable resources for studying tumor etiology and evaluating treatment plans. The authors introduce the development of current international consensus esophageal cancer database and esophageal cancer staging bases, summarize the construction experiences and clinical significance of esophageal cancer databases from Western countries, and present prospects for the development of esophageal cancer databases in the future.
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In order to understand the evolution of the diagnosis and treatment plans of corona virus disease 2019 (COVID-19), and provide convenience for medical staff in actual diagnosis and treatment, this paper uses the 9 diagnosis and treatment plans of COVID-19 issued by the National Health Commission during the period from January 26, 2020 to August 19, 2020 as research data to perform comparative analysis and visual analysis. Based on text mining, this paper obtained the text similarity and summarized its evolution law by expressing and measuring the similarity of the overall diagnosis and treatment plans of COVID-19 and the same modules, which provides reference for clinical diagnosis and treatment practice and other diagnosis and treatment plan formulation.
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Humans , COVID-19 , Data Mining , SARS-CoV-2ABSTRACT
BACKGROUND: The diagnosis and treatment of the terrible triad of the elbow have achieved a breakthrough. OBJECTIVE: To introduce the definition, basic anatomy, stable structure, injury mechanism and classification of terrible triad of the elbow, and to discuss the treatment plan deeply. METHODS: The first author searched PubMed, CNKI and Wanfang databases for the articles published before September 2019. The keywords were “terrible triad of the elbow, elbow joint, fracture dislocation” in English and Chinese, respectively. A large number of articles concerning the terrible triad of the elbow in recent years were reviewed, and the treatment strategy was summarized. RESULTS AND CONCLUSION: For the terrible triad of the elbow, the operator must carefully check the patient before operation, carefully analyze the imaging examination results and three-dimensional printed model, and accurately judge the bone structure of the elbow and degree of ligament injury. During the operation, the stability of the radial head, the fracture of the coronoid process and the injury of the lateral ligament complex are usually reconstructed through a single lateral approach or a combination of internal and external approaches. Then, the stability of elbow joint is tested to determine whether it is necessary to repair the medial ligament complex or use the hinged external fixator to restore the stability of elbow joint. Early active rehabilitation is needed. The above systematic treatment can reduce postoperative complications, accelerate fracture healing, and improve elbow joint function and patients’ quality of life.
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The outbreak of pneumonia caused by novel coronavirus (COVID-19) at the end of 2019 was a major public health emergency in human history. In a short period of time, Chinese medical workers have experienced the gradual understanding, evidence accumulation and clinical practice of the unknown virus. So far, National Health Commission of the People's Republic of China has issued seven trial versions of the "Guidelines for the Diagnosis and Treatment of COVID-19". However, it is difficult for clinicians and laymen to quickly and accurately distinguish the similarities and differences among the different versions and locate the key points of the new version. This paper reports a computer-aided intelligent analysis method based on machine learning, which can automatically analyze the similarities and differences of different treatment plans, present the focus of the new version to doctors, reduce the difficulty in interpreting the "diagnosis and treatment plan" for the professional, and help the general public better understand the professional knowledge of medicine. Experimental results show that this method can achieve the topic prediction and matching of the new version of the program text through unsupervised learning of the previous versions of the program topic with an accuracy of 100%. It enables the computer interpretation of "diagnosis and treatment plan" automatically and intelligently.
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Humans , Betacoronavirus , China , Coronavirus Infections , Diagnosis , Therapeutics , Machine Learning , Pandemics , Pneumonia, Viral , Diagnosis , Therapeutics , Practice Guidelines as TopicABSTRACT
Objective@#To summarize the treatment options for congenital maxillary lateral incisor agenesis (MLIA).@*Methods @#Review the literature, summarize the current treatment options and advantages and disadvantages of various methods of MLIA, and analyze cases. @*Results @#When a patient′s occlusion and other conditions are suitable for space closure and canine substitution, closure of the gap is the recommended method, as it has good aesthetic results and leads to good periodontal health. However, when closure cannot be performed, a dental implant has a strong advantage compared with other restoration methods. When planning implants for MLIA patients, doctors should carefully select the correct surgery time and take care with the implant position to obtain good results.@* Conclusion@#In the choice of a treatment plan for MLIA, we need to use the concept of multidisciplinary combined treatment to obtain a more satisfactory treatment effect with regard to aesthetics and function.
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OBJECTIVE@#To select the optimized treatment plan of acupuncture for lateral femoral cutaneous neuritis by using multiple indexes decision-making method based on the clinical evidence.@*METHODS@#The randomized control trials (RCTs) regarding acupuncture for lateral femoral cutaneous neuritis in the CNKI database, CBM database, WANFANG database, VIP database, PubMed, Cochrane Library and Embase published before December 31, 2017 were comprehensively collected. The modified Jadad scale was used to evaluate the quality of the RCTs. Then the evaluation indexes were selected and the dimensions of evaluation indexes were standardized by using extreme difference transformation method. The weight of each index was determined by using relative comparison method and the standardized matrix was weighted. Thus, the ideal solution and the negative ideal solution were obtained, and the relatively degree of each treatment plan to the ideal solution was calculated to propose the optimized plan of acupuncture for lateral femoral cutaneous neuritis.@*RESULTS@#A total of 18 RCTs were included, the optimized plan of acupuncture for lateral femoral cutaneous neuritis was using thin fire needle to rapidly prick the abnormal skin region with fast needle insertion-withdrawal technique; the fire needle was applied repeatedly; intensive pricking to form a treatment area; the treatment was given once every 5 days.@*CONCLUSION@#Based on the current clinical evidence, the optimized plan of acupuncture for lateral femoral cutaneous neuritis is using thin fire needle to prick the abnormal skin region; the multiple methods of plum-blossom needling met the characteristic of lateral femoral cutaneous neuritis and is suitable for clinical selection. The main acupoints are points in the abnormal skin area or the acupoints in the foot- meridian and foot- meridian, combined with lumbar Jiaji (EX-B2) points.
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Humans , Acupuncture Therapy , Meridians , Needles , Neuritis , Therapeutics , Randomized Controlled Trials as TopicABSTRACT
Objective@#To design and implement an automatic independent check software (AutoReview) for the radiotherapy treatment plan and improve the efficiency of independent check.@*Methods@#The patient′s electronic treatment plan chart in the record and verify (R&V) system database accessed by the SQL language was read and parsed. Based on the treatment plan information obtained from the chart, AutoReview extracted all parameters related to the treatment plan from the treatment planning system and the R&V system, and saved the structured data into a local database. For different check items, corresponding check logic was designed and the program was written to realize the automatic independent check. In total, 664 clinical treatment plans for one month were selected as a sample to evaluate the clinical application effect.@*Results@#Compared with manual check, AutoReview improved the check efficiency by nearly 60 times and the problem detection rate was elevated by 19.2%. In the two-year clinical application, the software operation was stable, and 14509 treatment plans were automatically checked and identified 588 cases with problems, accounting for 4.05%.@*Conclusion@#AutoReview can effectively improve the efficiency and accuracy of independent check in radiotherapy treatment plan.
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Objective@#To compare the dosimetrics of the plan target volume (PTV) and organs at risk (OARs) between two treatment planning approaches for patients with multiple brain metastases from non-small cell lung cancer on CyberKnife.@*Methods@#20 patients with multiple metastases from lung carcinoma were reviewed and analyzed, who had been treated by CyberKnife from December 2017 to December 2018. The CyberKnife stereotactic radiotherapy plans of the 20 cases were re-planed with single plan for multiple lesions and multiple plans per lesion. The dosimetry differences of PTV and OARs isodose disribution, conformity index (CI), total beam counts and total monitor units (MUs) were compared in the two types of plans.@*Results@#The two types of plans could satisfy over 95% PTV coverage of the prescription dose. The maximum and mean dose of normal brain adjacent to the PTV were reduced in multiple plan approach effectively. Moreover, the maximum and mean dose of OARs (brainstem) dropped by 1.62% and 5.57% (t=1.09, P<0.01) respectively. The number of treatment nodes and total MU declined by 4.63% (t=1.87, P<0.01)and 1.06% in multiple plan approach, which could significantly shorten the clinical treatment time. The differences in CI index between these two types of plans was of no statistical significance.@*Conclusions@#For patients with multiple brain metastases of similar diameter and volume from non-small cell lung cancer to be treated on CyberKnife, multiple plans per lesion could not only reduce dose to normal brain tissue and OARs, but also improve the treatment efficiency.
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Objective To compare the dosimetrics of the plan target volume (PTV) and organs at risk (OARs) between two treatment planning approaches for patients with multiple brain metastases from non-small cell lung cancer on CyberKnife.Methods 20 patients with multiple metastases from lung carcinoma were reviewed and analyzed,who had been treated by CyberKnife from December 2017 to December 2018.The CyberKnife stereotactic radiotherapy plans of the 20 cases were re-planed with single plan for multiple lesions and multiple plans per lesion.The dosimetry differences of PTV and OARs isodose disribution,conformity index (CI),total beam counts and total monitor units (MUs) were compared in the two types of plans.Results The two types of plans could satisfy over 95％ PTV coverage of the prescription dose.The maximum and mean dose of normal brain adjacent to the PTV were reduced in multiple plan approach effectively.Moreover,the maximum and mean dose of OARs (brainstem) dropped by 1.62％ and 5.57％ (t =1.09,P＜0.01) respectively.The number of treatment nodes and total MU declined by 4.63％ (t=1.87,P＜0.01) and 1.06％ in multiple plan approach,which could significantly shorten the clinical treatment time.The differences in CI index between these two types of plans was of no statistical significance.Conclusions For patients with multiple brain metastases of similar diameter and volume from non-small cell lung cancer to be treated on CyberKnife,multiple plans per lesion could not only reduce dose to normal brain tissue and OARs,but also improve the treatment efficiency.
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@# Objective: To investigate the therapeutic effect of dendritic cell-induced killer cells (DC-CIK) combined with 5-fluorouracil (5-FU) and loaded with CD133+ HT-29 cell lysate or RNA on mice bearing colon cancer HT-29 cell transplanted tumor, and to explore the underlying mechanism. Methods: Colon cancer xenograft model was established in BALB /c nude mice by using human colon cancer HT-29 cells at logarithmic growth phase; Antigen-free DC-CIK, 5-FU+DC-CIK, R+DC-CIK (loaded with total RNA of CD133+ cells), L+DC-CIK (loaded with CD133+ cell lysate), 5-FU and normal saline were respectively injected into transplanted mice, and the treatment efficacies on the growth of transplanted tumor in each group after three treatment cycles were observed, and the tumor growth curve was drawn. The nude mice were sacrificed by cervical dislocation and the tumor volume and body weight were measured. qPCR was used to detect the expression of AKT mRNA in transplanted tumor tissue, and WB was used to detect the expression of phosphorylated AKT protein. Results: After treatment, the body mass of nude mice in R+DC-CIK group, L+DC-CIK group and 5-FU+DC-CIK group increased steadily, while the body mass of nude mice in DC-CIK group and 5-FU group decreased gradually; the tumor growth speed of nude mice in R+DC-CIK group, 5-FU+DC-CIK group and L+DC-CIK group was significantly slower than that of the control group (P<0.05). Compared with 5-FU and DC-CIK alone, the combined treatment with loaded lysate/RNA had more sig nificant effect on mRNA and protein expressions of AKT(P<0.05). Conclusion: The effect of DC-CIKwithdifferentloadingoritscombinationwith5-FUisbetterthanthatofchemotherapy alone. One of the mechanisms is related to the down-regulation ofAKT level.
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El tratamiento endodóntico debe considerar que los dientes presentan una morfología del sistema de canales radiculares con alta variabilidad y complejidad. por lo tanto, el conocimiento acabado de la anatomía radicular y la planificación del procedimiento utilizando sistemas imagenológicos previos a la realización del tratamiento endodóntico, como la tomografía computarizada 3D (CBTC), mejoran el pronóstico, aumentando las probabilidades de éxito. el objetivo de este reporte es mostrar la secuencia de una resolución clínica de un primer premolar inferior (diente 4.4) con una anatomía compleja, utilizando el CBTC tanto en el diagnóstico como en la planificación.
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Humans , Female , Adult , Young Adult , Bicuspid/diagnostic imaging , Imaging, Three-Dimensional/methods , Dental Pulp Cavity/diagnostic imaging , Tooth Root/ultrastructure , Tooth Root/diagnostic imaging , Bicuspid/ultrastructure , Image Processing, Computer-Assisted , Dental Pulp Cavity/ultrastructureABSTRACT
OBJECTIVE:To provide reference for the formulation of individualized treatment plan for patients with cardiogenic ischemic stroke. METHODS:For a patient with cardiogenic ischemic stroke,clinical pharmacists adjusted lipid-lowering scheme according to disease progress combined with treatment principle of ischemic stroke and cardiogenic ischemic stroke;recommended second-level prevention and assisted physicians to adjust anti-infective plan according to individual situation of patient. When patients suffered from liver dysfunction,it was recommended to stop using drugs that may cause liver dysfunction,detect renal function damage early,analyze renal function impairment caused by insufficient fluid circulation,timely supplement fluid and provide whole-process pharmaceutical care in respects of anticoagulation, lipid-lowering and anti infection treatment, etc. RESULTS:Physician adopted the recommend of pharmacists and they formulated individualized treatment plan for cardiogenic ischemic stroke patients together;liver and kidney function recovered,and the condition of patient was improved. INR control (1.8)was better at discharge,and discharged education was provided for the patients at the same time. CONCLUSIONS:Clinical pharmacists participate in the treatment for the patient with cardiogenic ischemic stroke and assist physicians to optimize treatment plan according to disease condition. When ADR occurs,timely adjustment of treatment plan ensures the safety and effectiveness of patient medication.
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[Abstact] Objective To analyze the related parameters of the treatment plans for the pancreatic cancer with the Cyber-knife system.Methods The clinical data of 129 patients with single-target pancreatic cancer for the first time who underwent CyberkKnife radiosurgery between January 2017 and December 2017 in Shanghai Changhai Hospital were retrospectively analyzed.The parameters were all selected from the MultiPlan @4.0.2 treatment planning system and the data were analyzed.Results The volume of the targets in 129 patients with pancreatic cancer was 3.355-238.936 cm3,with the average volume of 51.43 ± 55.64 cm3.Patients were averagely treated for 5 to 8 sessions,and the average prescription dose was 6 Gy × 6 fraction,which equaled to 58 Gy in the biological equivalent dose (BED).The collimators with 20 mm and 15 mm accounted for up to 31％ and 27％,respectively,which were the top 2 options.The finally designed the conformal index(CI),new conformal index(nCI),and the homogeneity index were 1.14 ± 0.09,1.29 ± 0.09 and 1.42 ± 0.04,respectively.The coverages of tumor target was 80.3％-95.6％,with the average of 90.0 ± 4.6％.The treatment nodes,beams and Mus are 79,180 and 7 060 in average.The estimated treatment time was 42 ± 8 minutes.The organs at risk can be protected very well.Conclusions Reasonable Cyber-knife treatment plan can guarantee that stereotactic body radiation therapy can effectively treat Pancreatic Cancer.
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Objective To determine whether the quality insurance verification of Cyberknife Synchrony meet the clinical requirements of 3D tumor motion. Methods CT images were collected with modified Sunchrony phantom, and then a Synchrony E2E treatment plan was developed.A ball-cube with EBT film was loaded on the bed,and then placed in different movement directions to implement phantom verification plan.E2E film analysis software was used for film analysis to obtain the tracking error. Results The treatment accuracy of Synchrony in one-dimensional, two-dimensional and three-dimensional directions were 0.91, 1.03 and 0.90 mm respectively. Conclusion The present quality assurance validation method of Synchrony meets the demand of clinical three-dimensional tumor motion.
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Objective To analyze the radiation dose to the normal lung tissue of patients with early stage of non-small cell lung cancer treated by Cyberknife. Methods A retrospective analysis was conducted by summarizing the treatment plans of 264 patients with early stage non-small cell lung cancer from January 2011 to December 2013 in Tianjin Medical University Cancer Institute and Hospital. Sorted by the tumor volumes and locations, the Cyberknife plans were evaluated by means of dose volume histograms ( DVH) , homogeneity indexes ( HI) , percentage volumes receiving at least x Gy ( Vx ) of dose, i. e. , V5 , V10 , V20 , and V30 of the ipsilateral and contralateral lungs. For the tumors approximate to the hilus, the contralateral lungs were included in the optimization process, and the dose-volume metrics were analyzed for the contralateral and bilateral lungs. Results For the tumors close to the chest wall, V5≥(15. 21 ± 3. 12)％ in ipsilateral lung tissue and V5≥(1. 34 ± 0. 67)％ in contralateral lung tissue were observed. For the tumors near the hilus, V5≥(39. 4 ± 11. 90) ％ in ipsilateral lung tissue and V5≥(1. 48 ± 0. 34) ％ in contralateral lung tissue were observed. The irradiated volume ratios of both ipsilateral and contralateral lung tissue increased with the enlargement of tumor sizes. After including the contralateral lung tissue into the optimization, the irradiated volume ratios of the contralateral and bilateral lung tissue (V5,V10) decreasedsignificantly(t=2.44,4.81,3.53,3.17,P<0.05). Conclusions Higherriskof radiation injury in both ipsilateral and contralateral lung tissue can be expected for tumors near the hilus than near the chest wall. After including contralateral lung tissue into the planning optimization, lower dose to the contralateral and whole lung tissue was achieved, indicating a better protection of normal lung tissue.
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OBJECTIVE:To provide reference for reducing the occurrence of chemotherapy-induced constipation and optimizing constipation therapy.METHODS:Medical records of malignant lung tumor inpatients meeting inclusion criteria were collected from respiration department of our hospital,and then investigated and analyzed statistically in respects of patient's gender,age,constipation history,tumor types and phases,physical status score,living habit change,chemotherapy plan (including adjuvant drug),constipation occurrence,prevention and treatment,etc.The related factors of chemotherapy-induced constipation were investigated.RESULTS:A total of 135 patients were enrolled in the investigation.Of 135 patients,66 patients had constipation with incidence of 48.89％,among which 96.97％ were grade 1 and grade 2 constipation.The onset of constipation were independent from age,gender and living habit change (P＞0.05).The patients with history of constipation,advanced tumor stage,the period of treatment≥ 3 days,the use of palonosetron and combined with aprepitant had higher prevalence of constipation (P＜0.05).The clinical symptoms were improved spontaneously in 21.21％ patients,33.33％ after diet adjustment and 45.45％ by drug treatment as suppositories glycerol,lactulose;24.24％ patients used lactulose to prevent constipation at rehospitalization.CONCLUSIONS:Chemotherapy-induced constipation was commonly occurred and related to serval factors and had not got enough attention yet.The clinical pharmacists should assist the physicians to make individual chemotherapy regimen as well as the prevention of adverse drug reactions.