Tempo de tratamento ortodôntico com aparelhos autoligados: revisão de literatura

Introdução: Atualmente, braquetes autoligados têm sido sugeridos para reduzir o tempo de tratamento na Ortodontia. Objetivo: Dessa maneira, o presente estudo objetivou revisar a literatura acerca do tempo de tratamento com esses braquetes, em comparação com outros braquetes e tratamentos sugeridos. Revisão de literatura: Foi realizada pesquisa bibliográfica de caráter descritivo, que compreendeu o levantamento de referencial teórico na base de dados eletrônica Medline ­ PubMed. A seleção de artigos foi feita a partir dos títulos e resumos e a revisão compreendeu 4 artigos publicados na língua inglesa no período de 2019 a 2023. Conclusão: Há uma escassez de estudos clínicos envolvendo essa temática e o tratamento ortodôntico com aparelhos autoligados parece apresentar menor tempo de tratamento em comparação com aparelhos fixos tradicionais. No entanto, os estudos não mostraram diferenças estatisticamente significativas na redução desse tempo. Pode-se sugerir que mais estudos clínicos sejam conduzidos no intuito de elucidar essa questão.

Introduction: Currently, self-ligating brackets have been suggested to reduce treatment time in Orthodontics. Objective: Therefore, the present study aimed to review the literature about the treatment time with these brackets, in comparison with other brackets and suggested treatments. Literature review: Descriptive bibliographical research was carried out, which included the survey of theoretical references in the electronic database Medline ­ PubMed. The selection of articles was made based on titles and abstracts and the review comprised 4 articles published in the English language from 2019 to 2023. Conclusion: there is a shortage of clinical studies involving this topic and orthodontic treatment with self-ligating appliances seems to present shorter treatment time compared to traditional fixed appliances. However, the studies did not show statistically significant differences in reducing this time. It can be suggested that more clinical studies be conducted to elucidate this issue.

Retrasos en el diagnóstico y tratamiento del cáncer de mama en Medellín, Colombia / Delays in the diagnosis and treatment of breast cancer in Medellín, Colombia

Resumen OBJETIVO: Determinar los retrasos en el diagnóstico y tratamiento de pacientes con cáncer de mama atendidas en Medellín, Colombia, y describir sus características sociodemográficas y clínicas. MATERIALES Y MÉTODOS: Estudio retrospectivo, observacional y analítico de corte transversal efectuado en mujeres con cáncer de mama del registro personal de un cirujano. Se consideró retrasos en el paciente, proveedor y total, definidos como el tiempo trascurrido mayor a 90, 30 y 30 días, respectivamente; se recopilaron los datos demográficos, clínicos y paraclínicos. Para el análisis se utilizó estadística descriptiva. RESULTADOS: Se estudiaron 331 mujeres de las que 98.6% contaba con aseguramiento en salud; el 80.1% (n= 265) tuvieron retraso total del tratamiento, el 76.1% (n = 270) tuvo demora del paciente y el 78% (n = 277) demora del proveedor. En el análisis bivariado se establecieron asociaciones significativas entre un retraso total y el pertenecer al régimen subsidiado (OR = 1.17; IC95%: 1.06-1.29; p = 0.008). CONCLUSIÓN: En la muestra estudiada se encontraron retrasos importantes debidos a la responsabilidad de la paciente y el proveedor, y un retraso total del tratamiento asociado de forma significativa con pertenecer al régimen subsidiado.

Abstract OBJECTIVE: To determine the existence of delays in the diagnosis and treatment of breast cancer in women treated in Medellin (Colombia), to explore the associated factors, and to describe sociodemographic and clinical characteristics. MATERIALS AND METHODS: Retrospective, observational and analytical cross-sectional study of 331 women with breast cancer in Medellin (Colombia) in the personal record of a surgeon. Delays in the patient, provider and total were considered, defined as the time elapsed greater than 90 days, 30 days and 30 days, respectively; Demographic, clinical, and paraclinical data were collected and analyzed using descriptive statistics. RESULTS: 98.6% of the women had health insurance; 80.1% (n= 265) presented total treatment delay, 76.1% (N= 270) had patient delay, and 78% (n=277) provider delay; In the bivariate analysis, significant associations were established between total delay and belonging to the subsidized regimen (OR= 1.17; 95% CI 1.06-1.29; p= 0.008). CONCLUSION: Among the patients studied, important delays were found due to the responsibility of the patient and the provider, and a total delay to treatment significantly associated with belonging to the subsidized regimen.

Statistical analysis of duration of each phase of Unity MR-linac in clinical application / 中华放射肿瘤学杂志

Objective:To analyze the duration of each phase of Unity MR-linac in clinical application, aiming to provide reference for clinical optimization of the process time.Methods:Clinical data of 55 patients treated with Unity MR-linac were retrospectively analyzed. All patients were divided into the adapt to position (ATP) and adapt to shape (ATS) groups according to the planning method. The duration of each phase in the treatment process, the name and the time of each sequence, the number of beams, segments and total monitor units (MUs) were recorded and compared between two groups. In addition, the set-up time was counted according to different treatment sites. The time of each sequence and set-up time were expressed as the median M (Q 1, Q 3), and the number of beams, segments and total MUs of each plan were described as the mean±SD. Results:42 patients underwent ATP with a total of 305 treatment sessions: setup time was 3(2, 5) min, MR scanning time was 5(4, 7) min, registration time was 3(3, 4) min, adaptive planning time was 8(4, 12) min, beam on time was 8(6, 11) min, and the total time was 30(25, 36) min. 13 patients received ATS with a total of 65 treatment sessions: setup time was 2(2, 3) min, MR scanning time was 7(5, 8) min, registration time was 4(3, 5) min, time of delineation of target and organs at risk was 12(9, 16) min, adaptive planning time was 11(10, 14) min, beam on time was 10(9, 11) min and the total time was 55(49, 61) min. The set-up time according to treatment sites was 4(2, 4) min in the head and neck, 2(2, 4) min in the chest, and 3(2, 5) min in the abdomen. The number of fields, segments and total MUs during ATP were 8.1±1.7, 49.9±31.2, 846.75±363.44 in the head and neck, 8.0±2.0, 60.7±13.3, 790.21±279.00 in the chest, and 9.7±2.0, 81.2±22.3, 2007.32±1053.81 in the abdomen, respectively. The number of fields, segments and total MUs during ATS in head and neck of one case were 13, 39, 993.07, and 9.5±1.5, 65.5±6.3, 2763.26±835.41 in the abdomen.Conclusions:MR-guided radiotherapy yields huge potential in clinical application. However, there is still much room for the improvement of shortening the process duration.

Tiempo de ventilación mecánica invasiva y lesión renal aguda en pacientes críticos / Invasive Mechanical Ventilation Time and Acute Kidney Injury in Critically Ill Patients

Introducción: La evidencia científica vincula el uso de la ventilación mecánica invasiva con una mayor probabilidad de desarrollar lesión renal aguda, pero la falta de consenso sobre esta asociación no es infrecuente. Objetivo: Identificar la relación entre tiempos de ventilación mecánica y la aparición y gravedad de la lesión renal aguda. Métodos: Cohorte histórica realizada en una Unidad de Cuidados Intensivos del Distrito Federal, Brasil, entre 2016 y 2018. La población fue compuesta por 387 pacientes, pero la muestra consistió en 52 pacientes que necesitaron ventilación mecánica invasiva durante una semana y dos. El registro de los datos se realizó en un cuestionario estructurado compuesto por variables de identificación, datos clínicos, variables hemodinámicas y parámetros de laboratorio. Para los análisis de asociación se utilizaron las pruebas de Chi-cuadrado, Exacta de Fisher y Mann-Whitney. Los resultados con p < 0,05 se consideraron significativos. Resultados: La lesión renal aguda de diferentes severidades predominó en más de la mitad de los pacientes (55,80 por ciento), siendo el estadio 2 más prevalente (aproximadamente 30 por ciento ). Los pacientes que permanecieron en ventilación mecánica durante una semana o dos mostraron una disminución del riesgo de lesión renal aguda (OR 0,85; IC del 95 por ciento: 0,72 a 0,99, p = 0,038) y OR 0,77; IC 95 por ciento 0.63-0.94, p = 0,010, respectivamente). Conclusión: La lesión renal aguda de diferentes severidades estuvo presente en pacientes con ventilación mecánica invasiva. Sin embargo, el tiempo de ventilación mecánica solo no fue determinante de lesión renal aguda(AU)

Introduction: Scientific evidence associates the use of invasive mechanical ventilation with a higher probability of developing acute kidney injury, but the lack of consensus on this association is not uncommon. Objective: To identify the relationship between mechanical ventilation times and the onset and severity of acute kidney injury. Methods: Historical cohort carried out, between 2016 and 2018, in an intensive care unit of the Federal District, Brazil. The population consisted of 387 patients, but the sample consisted of 52 patients who required invasive mechanical ventilation for one week and two. The data were recorded with a structured questionnaire composed of identification variables, clinical data, hemodynamic variables and laboratory parameters. Chi-square, Fisher's exact and Mann-Whitney tests were used for the association analysis. Results with P < 0.05 were considered significant. Results: Acute kidney injury of different severity degrees predominated in more than half of the patients (55.80 percent), stage 2 being the most prevalent (approximately 30 percent). Patients who remained on mechanical ventilation for a week or two showed a decreased risk for acute kidney injury (OR: 0.85, 95 percent CI: 0.72-0.99, P = 0.038 and OR: 0.77, 95 percent CI: 0.63-0.94, P = 0.010, respectively). Conclusion: Acute kidney injury of different severity degrees was present in patients with invasive mechanical ventilation. However, the time of mechanical ventilation alone was not a determinant of acute kidney injury(AU)

Preliminary clinical practice of Elekta Unity MR-linac / 中华放射肿瘤学杂志

Objective:To summarize the experience of ELEKTA Unity MR-linac in clinical application in our hospital and analyze the positioning accuracy, process time and other related issues.Methods:A total of 14 patients enrolled in the Unity MR-Linac study were reviewed. All treatment time (including positioning, scanning, replanning, and beam discharge) and setup errors in 3directions were statistically analyzed. 11 patients with conventional accelerators using the multifunctional immobilization system (MIS) were randomly selected to make statistical analysis of the setup errors, and the differences between the Unity group and the conventional accelerators using the MIS were compared using t-test. Results:In the Unity group, the setup errors in X, Y and Z directions were (-0.15±0.30) cm, (0.02±0.57) cm and (-0.10±0.28) cm, respectively. The average treatment time was 36.87minutes. The average positioning time was 5.40minutes. The mean scan time was 7.48minutes, the mean adaptive plan time was 7.46minutes, and the mean beam time was 9.48minutes. In the conventional accelerator group, the setup errors were (0.05±0.25) cm, (-0.01±0.25) cm and (-0.03±0.23) cm, respectively. The results of the setup errors of patients fixed with MIS showed that there were significant differences in the left and right directions ( P<0.001), while there were no significant differences in the Y and Z directions ( P=0.061 and 0.374) between two groups. Conclusions:Except in the X direction, there is no significant difference in setup errors between the Unity and conventional accelerator groups in the condition of laser-free system. Under smooth circumstances, the treatment time by using ATP (adapt to position) workflow will also be within the range of tolerance of the patients. Magnetic-guided radiotherapy has a promising application prospect, whereas the procedure needs to be optimized.

Effects of gantry acceleration limitations on VMAT plans / 中华放射医学与防护杂志

Objective:To study the effects of gantry acceleration limitations of a linear accelerator (linac) on the dosimetry of volumetric modulated arc therapy (VMAT) plans, machine efficiency, and dose verification result of VMAT plans and to explore the optimal selection of gantry motion models in the Pinnacle treatment planning system.Methods:Ten cases of nasopharyngeal carcinoma, non-small cell lung cancer, sigmoid adenocarcinoma with retroperitoneal lymph node metastasis, and invasive ductal carcinoma of the breast were each selected for this study. Then two models were set up in the Pinnacle v9.10 treatment planning system, namely the one allowing gantry acceleration and the one limiting gantry acceleration. The same field arrangement, optimized target parameters, and optimized weights of VMAT plans were adopted in the two models, in order to analyze the dosimetric variations in targets and organs at risk (OARs) and compare the differences in treatment time and gamma passing rates.Results:The treatment time of the enrolled patients under the model allowing gantry acceleration was significantly lower than that of the patients under the model limiting gantry acceleration was adopted ( t=-6.751, -0.209, -19.523, -28.999; P< 0.05) and decreased by 15.27%, 18.07%, 19.71%, and 28.75%, respectively. Meanwhile, the conformity and uniformity of target areas were affected, while there was no statistical significance in the gamma passing rates in the validation of VMAT plans ( P>0.05). For the cases of nasopharyngeal carcinoma (NPC), the maximum dose to brainstem PRV increased by 1.25%. For the cases of lung cancer, the maximum dose to the spinal cord and lung V20 increased by 1.19% and 1.21%, respectively, while lung V5 decreased by 1.21%. For the cases of sigmoid adenocarcinoma with retroperitoneal lymph node metastasis, the mean doses to bilateral kidneys, livers, small intestine, and colon all increased. For the cases of breast cancer, lung V10 on the opposite side of cancer increased by 1.66% and the mean dose to the lungs on the same side of cancer decreased by 7.45%. Conclusions:The model allowing gantry acceleration allows the treatment time to be significantly shortened and the treatment efficiency improved. Although this model had the shortcomings such as affecting the conformity and uniformity of target areas to a certain extent and increasing the doses to some OARs, clinical requirements for dosimetry were still met. Therefore, it is recommended to use the model allowing gantry acceleration in the Pinnacle planning system.

Effect of the optimized nursing procedure in the conduit room on the patients undergoing percutaneous coronary intervention / 中国实用护理杂志

Objective:To explore the effect of the optimized nursing procedure in the conduit room based on Hammer′s theory of process reengineering on the treatment time, anxiety and depression, clinical outcomes of patients undergoing percutaneous coronary intervention (PCI).Methods:A total of 125 PCI patients were received and treated in the conduit room of the Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University. Among them, 63 patients who underwent PCI from April to October 2019 were taken as the control group, and 62 patients who underwent PCI from November 2019 to May 2020 were taken as the observation group. The patients in the control group were treated with the conventional nursing procedure in the conduit room, while those in the observation group were treated with the nursing procedure in the conduit room optimized based on Hammer′s theory of process reengineering. The anticoagulant administration time, transit time, catheterization activation time, door to balloon dilatation time (D to B) and D to B compliance rate of patients were compared between the two groups. Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to compare the differences of anxiety and depression between the two groups on the first day after PCI and 1 day before discharge. The incidence of adverse cardiac events during hospitalization, mortality, left ventricular ejection fraction on the 7th day after operation and hospitalization days were recorded.Results:The anticoagulant administration time, transit time, catheterization activation time, D to B time in the observation group were (10.41±1.86), (5.21±0.82), (48.26±6.42), (69.63±11.42) min, respectively, lower than the corresponding data of the control group, which were (17.65±2.94), (7.36±1.32), (57.26±7.61), (82.23±13.58) min. The D to B time compliance rate of patients in the observation group was 87.10% (54/62), which was higher than 69.84% (44/63) in the control group with statistical difference ( χ2 value was 5.49, P<0.05). The SAS and SDS scores of the patients in the observation group within 1 day after PCI were 38.89±5.94, 39.17±5.81, higher than 31.73±5.22, 33.77±5.32 in the control group with statistical difference ( t value was -7.16, -5.42, P<0.05). The incidence of adverse cardiac events during hospitalization, average hospitalization days and left ventricular ejection fraction on the 7th day after operation in the observation group were 8.06%(5/62), (11.26±2.14) d, (55.61±4.31)%, lower than 22.22%(14/63), (13.47±2.76) d, (52.21±3.22)% in the control group with statistical difference ( χ2 value was 4.86, t values were 4.99, 5.00, P<0.05). Conclusions:The nursing procedure in the conduit room optimized based on Hammer′s theory of process reengineering can effectively reduce the PCI patients′ treatment time, alleviate the anxiety and depression, improve the clinical outcome.

Implementation of Radiotherapy and Overcoming the Treatment Breaks in COVID-19 Crisis

Introduction: Tackling of; the patients who had defaultedfor radiation therapy due to implementation of lockdownfollowing COVID-19 outbreak, new patients presenting toout-patient department(OPD) and continuing Radiotherapytreatment without postponing during this health crisis ischallenging. Study objective was to evaluate the outcomesof hypofractionated radiation therapy in the COVID-19 eraand to provide guidance on measures for preparedness in theDepartment of Radiation Oncology to continue the treatmentand tackling treatment breaks.Material and Methods: Patients reporting to the OPD,patients who defaulted for treatment during lockdown phaseand newly diagnosed patients awaiting treatment wereincluded in the study. Hypofractionated schedules were usedfor treatment to reduce the overall treatment time and durationof hospital stayResults: Clinical response evaluation was done at the end of 1month by RECIST criteria. In Head and neck cancer patients60%, 26% and 13.3% of the patients showed CompleteResponse (CR), Partial response (PR) and Progressive diseaserespectively in primary disease and 46%, 40%, 13.3% of thepatients showed CR, PR and progressive disease respectivelyin nodal disease. Among Cervical cancer patients: 75% and25% of the patients showed CR and PR respectively. All Breastcancer patient were disease free at the time of assessment.Conclusion: Hypofractionated radiotherapy schedules to beused wherever feasible reducing the overall treatment timeand the exposure of Cancer patients to COVID-19 and viraltransmission can be mitigated with best clinical practice ofsanitization, wearing masks, Face shield, PPE and Socialdistancing.

Treatment non-compliance and government aided health schemes : a boon or a curse

Purpose: In this study we tried to analyze the prevalence of non-adherence to radiation treatment, the factors behind the unplanned breaks and the evaluation of strategies to overcome such breaks. Materials and Methods: Between January 2017 to October 2017, 486 patients were registered for radical radiotherapy of which 91 patients with unplanned treatment break were identified. We analyzed the social, economic, educational, and therapeutic barriers that led to treatment interruptions. Results: 91 patients of 486 patients registered for radical radiotherapy with unplanned treatment break were identified. The age of such patients ranged from 30 to 85 years with a median age of 52.5 years. 61 were males and 30 were females. 39 patients were from urban areas and 52 belonged to rural area. Of these 91 patients 85 patients were receiving cashless treatment based on BPL cards and 6 were cash paying patients. 52 Patients had Head and neck, 23 had gynecological, 7 with breast and 4 patients had esophageal cancers. Majority of patients in our study had treatment breaks during the mid to end phase of a radical radiotherapy schedule with the onset of Grade II or III acute reactions. Conclusion: As majority of patients were supported by government schemes without any binding factor, some compelling factors like blocking the BPL cards to avail other benefits, or to impose some kind of penalties to avoid wastage of government efforts and resources.

Corticotomia selectiva y ortodoncia: distancia y tiempo en que se logra realizar un desplazamiento. Revisión bibliografica / Corticotomia selectiva y ortodoncia: distancia y tiempo en que se logra realizar un desplazamiento. Revisión bibliografica / Corticotomia seletiva e ortodontia: distância e tempo em que um deslocamento é alcançado. Revisão bibliográfica

La corticotomía se define como una osteotomía, en la cual, se corta el hueso cortical, perforando o alterando mecánicamente de una manera quirúrgica controlada y al mismo tiempo penetrando mínimamente en la mé-dula ósea para acelerar el movimiento dental ortodóntico en respuesta a una demanda de los pacientes en cuanto a la efectividad del tratamiento y al rápido movimiento de cada zona. Objetivo: mediante una revisión bibliográfica, determinar la distancia y tiempo en que se logra realizar un desplazamiento o movimiento orto-dóntico después de haber realizado una corticotomía selectiva. Para la búsqueda, se utilizaron Plataformas como Pubmed, Scielo, Science Direct y Google Scholar, en las que se empleó palabras claves como distan-cia, tiempo, corticotomía selectiva y tratamiento de ortodoncia y se buscaron artículos publicados entre el 2001 y 2017. Resultados: se obtuvo que los movimientos se realizan en un periodo de 4 meses, respecto a la distancia y se observó que se logra desplazar un promedio de 3.5mm. Conclusiones: en pacientes adultos, ha aumentado la exigencia sobre reducir tiempos de tratamiento, la ortodoncia facilitada por corticotomía con-sigue llevar a cabo un tratamiento exitoso y disminuir los tiempos de tratamiento. Sin embargo, la evidencia es escasa, pues está basada principalmente en reportes de casos, por lo cual se requiere mayor investigación acerca de este procedimiento.

Corticotomy is defined as an osteotomy, in which the cortical bone is cut, perforated or mechanically altered in a controlled surgical way and at the same time minimally penetrating the bone marrow to accelerate orthodon-tic dental movement in response to a demand for patients regarding the effectiveness of the treatment and the rapid movement of each zone. Objective: by means of a bibliographic review, determine the distance and time in which an orthodontic movement is achieved after having performed a selective corticotomy. For the search, Platforms such as Pubmed, Scielo, Science Direct and Google Scholar were used, in which keywords such as distance, time, selective corticotomy and orthodontic treatment were used and articles published between 2001 and 2017 were searched. Results: It was obtained that the movements are carried out in a period of 4 months, with respect to the distance and it was observed that an average of 3.5mm can be moved. Conclu-sions: in adult patients, the demand for reducing treatment times has increased; orthodontics facilitated by corticotomy achieves successful treatment and decreases treatment times. However, the evidence is scarce, since it is mainly based on case reports, so more research is required about this procedure.

A corticotomia é definida como uma osteotomia, na qual o osso cortical é cortado, perfurado ou alterado mecanicamente de maneira cirúrgica controlada mais penetração mínima na medula óssea para acelerar o movimento dentário ortodôntico em resposta a uma demanda por pacientes quanto à eficiência do tratamento e ao movimento rápido de cada zona. Objetivo: por meio de uma revisão bibliográfica, determinar a distância e o tempo em que um movimento ou deslocamento ortodôntico é alcançado após a realização de uma cortico-tomia seletiva. MATERIAL Y MÉTODOS: Para a pesquisa, foram utilizadas plataformas como Pubmed, Scielo, Science Direct e Google Scholar, nas quais foram utilizadas palavras-chave como distância, tempo, corticoto-mia seletiva e tratamento ortodôntico e foram pesquisados artigos publicados entre 2001 e 2017. Resultados: se observou que os movimentos são realizados em um período de 4 meses, em relação à distância obser-vou-se que uma média de 3,5 mm pode ser movimentada. Conclusões: em pacientes adultos, a demanda por redução do tempo de tratamento aumentou, a ortodontia facilitada pela corticotomia consegue o sucesso do tratamento e diminui o tempo de tratamento. No entanto, as evidências são escassas, uma vez que se baseiam principalmente em relatos de casos, sendo necessárias mais pesquisas sobre esse procedimento.

Effect of surface treatment reagents and treatment time on bond strength of glass fiber posts to resin cement / 中国组织工程研究

BACKGROUND: At present, there is no uniform standard for the treatment time of chemical reagents for surface treatment of glass fiber posts. Therefore, studying the effect of treatment time of glass fiber post surface treatment reagents on the bond strength between fiber posts and resin cements is of great significance. OBJECTIVE: To evaluate the effect of two chemical agents on the bonding strength of glass fiber post and resin cement after surface pretreatment of glass-fiber posts at different times. METHODS: Forty-eight glass fiber posts were randomly divided into eight groups according to different surface treatment methods, six in each group. Group A received no special treatment; group B was treated with silanization for 1 minute; group C1 underwent a 30% hydrogen peroxide surface treatment for 5 minutes prior to 1-minute silanization; group C2underwent a 30% hydrogen peroxide surface treatment for 10minutes prior to 1-minutesilanization; group C3 underwent a 30% hydrogen peroxide surface treatment for 15 minutes prior to 1-minute silanization; group D1 underwent a 35% phosphoric acid surface treatment for 30 seconds prior to 1-minute silanization; group D2 underwent a 35% phosphoric acid surface treatment for 60 seconds prior to 1-minute silanization; group D3 underwent a 35% phosphoric acid surface treatment for 90 seconds prior to 1-minute silanization. The surface morphology of the treated glass fiber posts was observed under scanning electron microscope. The glass fiber post was bonded to the resin cement to form a cylindrical resin block and cut into a thin sample. The sheet was placed on a universal testing machine for micro-extrusion experiments. The failure mode of the specimens was observed under a stereomicroscope. RESULTS AND CONCLUSION: (1) Scanning electron microscope: the surface of the fiber post had different degrees of matrix dissolution and fiber bundle exposure after hydrogen peroxide and phosphoric acid treatment, but did not destroy the integrity of the fiber bundle. (2) Micro-extrusion experiments: the order of the bonding strength was as follows: group C3 > group C2 > group C1 > group D2 > groupD3 > groupD1> group B > group A, and there was significant difference between groups (P< 0.05) except for groups A and B, groups C2 andC3, and groups D2and D3. (3) Stereo microscope: the failure mode in the groups A and B was almost destruction in adhesion. The other six groups showed destruction in adhesion, but the cohesive failure and mixed failure were increased, and the failure mode changed from destruction in adhesion into cohesive failure and mixed failure. (4) These results indicate that the optimal treatment time of 30% hydrogen peroxide is 10 minutes, and the optimal treatment time of 35% phosphoric acid is 60 seconds. 30% hydrogen peroxide solution treatment of fiber post surface for 10 minutes has great clinical application value.

Research on prognosis and warning indicators of acute ischemic stroke treated with thrombolytic therapy / 中华急诊医学杂志

Objective To investigate the indicators of thrombolytic therapy in patients with acute ischemic stroke,find out the early warning value,and provide guidance for decision-making of emergency doctors.Methods Patients with acute ischemic stroke who were treated with thrombolytic therapy from January,2010 to August,2017 in our hospital were enrolled in this study.According to the modified Rankin scale,patients were divided into the good prognosis group and poor prognosis group.Logistic regression model was used to evaluate the relative dependent risk factors.Results Totally 210 patients were enrolled in the good prognosis group and 152 patients in the poor prognosis group.Multivariate logistic regression analysis showed that NIHSS score on admission,blood glucose,systolic blood pressure before thrombolytic therapy,homocysteine,onset-to-needle time and previous history of diabetes mellitus were independent risk factor for poor prognosis (P＜0.05).Conclusions Risk factors as NIHSS score on admission,blood glucose,systolic blood pressure before thrombolytic therapy,homocysteine,onsetto-needle time and previous history of diabetes mellitus are early warning indicators of poor prognosis in patients with acute ischemic stroke treated with thrombolytic therapy.

Key factors affecting the correlation between improving work efficiency and emergency department overcrowding in the tertiary level A hospitals / 中华急诊医学杂志

Objective To investigate the current status of overcrowding in emergency departments of Tertiary level A hospitals in order to discover and analyze key factors limiting the performance efficiency of staff to raise a suggestion of improvements.Methods The data regarding the distribution of the total number of available beds and total number of patients registered were collected from 19 tertiary level A hospitals to construct a regression model correlating variables including number of patients waiting,time of appointment and number of patients delivered by ambulances.The national grading system of crowdedness for emergency departments was used to estimate the NEDOCS_ BJ value for Beijing Friendship Hospital.Results Statistical analyses of key factors hampering the work efficiency and correlation between ESI triage and clinical decisions revealed overcrowding in the emergency department in a pattern across hospitals and time periods.The extent of overcrowding can be alleviated by way of increase in performance efficiency.Conclusions The proposed improvements regarding the hierarchical medical system,the development of treatment plans,and working procedure were recommended.

Prescripción de antibioticoterapia por vía parenteral en un servicio de cirugía general de Santiago de Cuba / Parenteral antibiotic therapy prescription in a general surgery service of Santiago de Cuba

Se realizó un estudio analítico y transversal, del tipo indicación-prescripción de medicamentos, de 254 pacientes atendidos en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, de enero a mayo de 2016, con vistas a analizar la prescripción de antibióticos de administración parenteral por parte del personal médico de esta área. En la serie las infecciones resultaron más frecuentes en el sexo masculino (53,1 por ciento y en los grupos etarios de 45 a 64 años (42,1 por ciento). Asímismo, predominó el criterio de aplicar terapia antimicrobiana empírica (71,7 por ciento) y en general, las indicaciones correspondieron a la amikacina 144 (25,2 por ciento), 121 al metronidazol (21,2 por ciento) y 118 a la penicilina cristalina (20,7 por ciento); por otra parte, los gérmenes patógenos más aislados en el Servicio fueron la Escherichia coli, la Klebsiella, el enterobacter y el estafilococo coagulasa positivo.

An analytic and cross-sectional study, of the indication-prescription medications type, of 315 patients assisted in the General Surgery Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba, from January to May, 2016, aimed at analyzing the prescription of parenteral antibiotics on the part of the medical staff of this area. In the series the infections were most frequent in the male sex (53,1 percent) and in the 45 to 64 years group (42,1 percent). Also, the criterion of applying antimicrobians empirically prevailed (71,7 percent) and in general, indications corresponded to amikacin 144 (25,2 percent), 121 to metronidazole (21,2 percent), and 118 to crystalline penicillin (20,7 percent); on the other hand, the most isolated pathogens in the Service were Escherichia coli, Klebsiella, enterobacter and positive coagulase staphylococcus.

Nasoenteral tube: factors associated with delay between indication and use in emergency services / Sonda Nasogástrica: factores asociados al delay entre indicación y uso en Servicio de Urgencia / Sonda Nasoenteral: fatores associados ao delay entre indicação e uso em Emergência

ABSTRACT Objective: to know the time between indication and use of a nasoenteral tube (NET) and factors associated with delays. Method: A prospective cohort study that followed adults in a Brazilian emergency department, since the indication of the use of a NET, evaluating clinical variables and the work process. The Generalized Estimated Equations model was adopted to identify factors associated with the delays in each stage of the process. Results: the time between indication and use of NET was 573 (IQR: 3601,093) minutes, in 150 insertions of NET. Insertions in patients who previously did not use it; delays in the medical, nutrition, and nursing care routine; use of mechanical ventilation; noradrenaline; and fasting were factors for longer time before the use of the tube. Conclusion: the time between indication and use of NET was high, exceeding 10 hours in half of the cases. Factors related to the clinical condition of the patient and to the care management would contribute to delays.

RESUMEN Objetivo: conocer el tiempo entre indicación y uso de sonda nasogástrica (SNG) y factores asociados a demoras. Método: cohorte prospectivo que observó adultos en Servicio de Urgencia brasileño, desde indicación hasta uso de la SNG, evaluándose variables clínicas del proceso de trabajo. Se adoptó modelo de Ecuaciones de Estimación Generalizada para identificar factores asociados a demoras en cada etapa del proceso. Resultados: el tiempo entre indicación y uso de SNG fue 573 (IQR=360α1093) minutos, en 150 inserciones de SNG. Las inserciones en pacientes que no la utilizaban previamente, demoras en rutina de atención médica, de nutrición y enfermería, uso de ventilación mecánica, noradrenalina y ayuno, constituyeron factores de demora hasta uso de la sonda. Conclusión: el tiempo entre indicación y uso de SNG fue elevado, superando las 10 horas en mitad de los casos. Factores relacionados a condiciones clínicas del paciente y a gestión de atención contribuyeron a las demoras.

RESUMO Objetivo: conhecer o tempo entre indicação e uso da sonda nasoenteral (SNE) e fatores associados a atrasos. Método: coorte prospectiva que acompanhou adultos de uma Emergência brasileira, desde a indicação ao uso da SNE, avaliando-se variáveis clínicas e do processo de trabalho. Adotou-se o modelo de Equações de Estimações Generalizadas para identificar fatores associados a atrasos em cada etapa do processo. Resultados: o tempo entre indicação e uso da SNE foi 573 (IQR: 360-1093) minutos, em 150 inserções de SNE. Inserções em pacientes que anteriormente não a utilizavam, retardos na rotina assistencial médica, da nutrição e enfermagem, uso de ventilação mecânica, noradrenalina e jejum foram fatores para maior tempo até o uso da sonda. Conclusão: o tempo entre indicação e uso de SNE foi elevado, excedendo 10 horas em metade dos casos. Fatores relacionados às condições clínicas do paciente e à gestão da assistência contribuiriam para atrasos.

The progress of interventional therapy time and influential factors in patients with ST-segment elevation myocardial infarction / 天津医药

Acute myocardial infarction is one of the most severe diseases that cause higher incidence and mortality. It is important to take effective clinical measures to improve the prognosis. Shortening the time of treatment is controllable in clinical work, which plays a key role in limiting and reducing the myocardial infarction size. This article summarized the interventional therapy time and influential factors in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention, providing the basis for clinical application.

Assistência ao paciente com síndrome coronariana aguda segundo indicadores de qualidade / La atención al paciente con síndrome coronario agudo según los indicadores de calidad / Health care for patients with acute coronary syndrome according to quality indicators

RESUMO Objetivo: avaliar a assistência intra-hospitalar ao paciente com Síndrome Coronariana Aguda segundo indicadores de qualidade. Método: longitudinal, quantitativo, realizado entre novembro de 2012 e março de 2013 com 94 pacientes, por meio de entrevistas e prontuários. Resultados: 39,4% tiveram angina instável, 60,6% infarto do miocárdio, sendo 34% com supra de ST. Tiveram óbito pacientes com escore de TIMI e GRACE superiores a 4 e 140 (p<0,05). A admissão em unidade de cuidados intensivos foi 2,1%, avaliação da fração de ejeção do ventrículo esquerdo em 83,0%, AAS em 24 horas de admissão em 77,8%, estatinas em 72,7%, inibidor da enzima conversora de angiotensina em 62,8%, aconselhamento antitabágico 53,3% e reperfusão oportuna 62,5%. Submeteram-se a estratégia invasiva em 24h 12,0% e, acima de 72h, 50,0%. O tempo porta-ECG foi de 68,3±104,3 min e porta-balão de 122±54,5 min. Conclusão: são necessários protocolos assistenciais para uniformização da prática e melhora destes indicadores.

RESUMEN Objetivo: evaluar la atención en el hospital para los pacientes con síndrome coronario agudo según los indicadores de calidad. Método: estudio cuantitativo longitudinal realizado entre noviembre de 2012 y marzo de 2013 con 94 pacientes a través de entrevistas y registros médicos. Resultados: el 39,4% tenían angina inestable, el 60,6% tenían infarto de miocardio y el 34% con elevación del ST. Los pacientes con puntuación TIMI y GRACE superior a 4 y 140 (p <0,05) murieron. Ingreso en la unidad de cuidados intensivos fue de 2,1%, la evaluación de la fracción de eyección ventricular izquierda en el 83,0%, la aspirina dentro de las 24 horas de ingreso en el 77,8%, estatinas en el 72,7%, la enzima convertidora de la angiotensina en un 62,8%, consejería anti-tabaco a 53,3% y la reperfusión oportuna en el 62,5%. El total de 12,0% de los pacientes fueron sometidos a la estrategia invasiva dentro de las 24 horas, y el 50,0% por encima de las 72 horas. El tiempo puerta ECG fue de 68,3 ± 104,3 min y puerta-balón de 122 ± 54,5 min. Conclusión: los protocolos de atención son necesarios para la normalización de la práctica y mejorar estos indicadores.

ABSTRACT Objective: to assess in-hospital care for patients with Acute Coronary Syndrome according to quality indicators. Method: a longitudinal quantitative study was performed between November 2012 and March 2013 with 94 patients, including interviews and medical records. Results: a total of 39.4% of patients had unstable angina and 60.6% had myocardial infarction, of which 34% had ST segment elevation. Patients with TIMI and GRACE scores higher than four and 140 (p<0.05) respectively died. Admission to the intensive care unit totaled 2.1%; assessment of left ventricular (LV) ejection fraction, 83.0%; ASA within 24 hours of admission, 77.8%; statins, 72.7%; angiotensin-converting enzyme inhibitor, 62.8%; anti-smoking counseling, 53.3%; and timely reperfusion, 62.5%. Of all participants, 12.0% underwent an invasive strategy in 24h and 50.0% in 72h. Door-to-ECG time was 68.3±104.3 min and door-to-balloon time, 122±54.5 min. Conclusions: health care protocols are required to standardize practice and improve these indicators.

Clinical Observations on Acupoint Application in Dog Days and Coldest Days of Winter for the Prevention and Treatment of ;Child Asthma / 上海针灸杂志

Objective To investigate the efficacies of different times and frequencies of acupoint application in preventing and treating child asthma of spleen-lung qi deficiency type. Method Sixty children with asthma of spleen-lung qi deficiency type were randomly allocated to dog days, dog days reinforcement, coldest days and coldest days reinforcement groups for treatment by acupoint application. The therapeutic effects were evaluated using the TCM symptom score as the observation indicator in the four groups after three months of treatment. Result The TCM symptom score decreased significantly in the four groups at the follow-up after three months of treatment (P<0.05). The main effect of treatment time was marked (F=17.04, P<0.05). The main effect of treatment frequency was marked (F=8.17, P<0.05). Conclusion Different times and frequencies of acupoint application both decrease the TCM symptom score in children with asthma. The therapeutic effect is better in dog days than in three nine-day period after the winter solstice. An increase in treatment frequency influences the therapeutic effect obviously. The therapeutic effect is best in the dog days reinforcement group.

Evaluation of In-Vitro Efficacy of Active Ingredients in Dentifrice Used for Different Treatment Times / 치위생과학회지

The purpose of this study was to evaluate the in-vitro efficacy of the active ingredients of dentifrice following treatment time. The whitening effect was evaluated by a change in lightness value relative to the contact time of hydrogen peroxide, by using artificially stained hydroxyapatite discs. The anti-calculus effect was assessed based on the amount of calcium eluted from the human dental calculus by sodium pyrophosphate. Remineralization was evaluated by the Vickers hardness test following the application of sodium fluoride to bovine enamel. In order to view dentinal tubules occlusion, the formation of insoluble calcium salts by bovine dentin specimens was observed using scanning electron microscopy. Change in lightness value (ΔL) was 5.50±1.51 after 1 min of treatment, 5.73±0.43 after 3 min, 8.64±0.24 after 10 min, 18.93±0.76 after 30 min, and 27.35±0.54 after 60 min. The amount of calcium eluted from the human dental calculus was 4.23±0.14 ppm after 1 min of treatment, 4.51±0.04 ppm after 3 min, 12.12±0.16 ppm after 10 min, 17.85±0.81 ppm after 30 min, and 25.15±0.32 ppm after 60 min. The Vickers hardness change value (ΔVHN) was 1.96±1.44 after 1 min, 1.52±1.06 after 3 min, 9.06±0.15 after 10 min, 10.83±5.13 after 30 min, and 12.55±2.09 after 60 min. Partial dentinal tubules occlusion was observed at 10 min and complete occlusion was evident at 60 min. In summary, the use of patch type dentifrices for 10, 30, or 60 min were 1.57 to 8.26 times more effective than using the paste type dentifrices for 1 to 3 min. Based on these findings, it is reasonable to expect that the use of patch type dentifrices for 10 min would lead to remineralization, anti-calculus and dentinal tubules occlusion effects, and that use for 30 min would result in a whitening effect.

Relations between timing of treatment in stanford B acute aortic dissection vascular repair and prognosis / 中国基层医药

Objective To investigate clinical relevance of the acute Stanford B aortic dissection vascular repair time for treatment and prognosis.Methods A retrospective clinical data of our hospital treated 1 10 cases of vascular repair of acute aortic dissection type Stanford B were analyzed according to the onset to treatment time.They were divided into three groups:group A (onset to treatment time of 7 days),group B (onset to treatment time 14) and group C (onset to treatment time than 14 days);the three groups were observed after aortic repair status and prognosis related indicators.Results The true lumen false lumen diameter and maximum diameter ratio in group A was the largest (1.8 ±0.5),which was significantly higher than that of group B and group C (1.3 ±0.3)and (1.3 ± 0.2),the difference was statistically significant (F=7.352,P<0.05).Ratio of preoperative minimum true lumen diameter and the maximum diameter of the false lumen,ratio of postoperative maximum true lumen diameter and the maximum diameter of the false lumen were associated with the onset of the endovascular repair time,showed a negative correlation (r=-0.452,-0.281,all P<0.05).postoperative complication rate of group A was 12.8%,complica-tion rate of group B was 29.5%,complication rate of group C was 33.3%,data of group A was significantly lower than those of group B and group C,the difference were statistically significant (χ2 =4.024,4.721,all P<0.05).group A died three cases,group B had 1 patient died and in group C there was no deaths.Hospital stay and hospital costs of group A were significantly lower than those of group B and group C,the difference werestatistically significant (F=4.125,7.375,all P<0.05).Conclusion As soon as possible to implement acute aortic dissection stanford B aortic vascular repair could better improve outcomes,and reduce the cost of hospitalization and treatment.At the same time, it can reduce the incidence of complications and improve clinical safety.