Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 742
Filter
1.
Säo Paulo med. j ; 140(6): 781-786, Nov.-Dec. 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1410228

ABSTRACT

ABSTRACT BACKGROUDS: Child and Adolescent Psychosocial Care Centers (Centros de Atenção Psicossocial, CAPSI) are dedicated centers for persistent psychiatric disorders, which provide an individualized therapeutic approach based on extra-hospital services. OBJECTIVES: We aimed to describe the clinico-epidemiological profiles of the patients seeking interventions at the CAPSIs. DESIGN AND SETTING: A cross-sectional study was conducted in two CAPSI in São Bernardo do Campo, SP, Brazil. One CAPSI is dedicated to the treatment of alcohol- and drug-related disorders, and the other to the treatment of other mental disorders. METHODS: In July 2017, we reviewed all active medical records of these two CAPSI, and collected the patients information including sex, race, education, type of referral, initial complaints, psychiatric diagnoses, and medication utilization. RESULTS: Of the 233 patients, 69.5% were male and 42.5% lived with their immediate family. Most of the patients were referred from other health services. Complaints on admission included agitation and aggressive behavior (30.9%). Autism spectrum disorder (ASD) was the most prevalent diagnosis (46.8%), followed by depressive disorder (13.8%). Of the patients, 81.5% were on regular medical follow-up and 70.3% were on a single medication only. CONCLUSION: Aggression complaints are the most prevalent in CAPSI, and diagnoses of ASD and psychotic disorders are more common. This situation differs from most CAPSI that present school complaints as the most prevalent, in which diagnoses of attention-deficit/hyperactivity disorder and conduct disorders are likely to be more frequent. The epidemiological profile of each CAPSI should guide the implementation of human and structural resources targeting the most prevalent complaints and diagnoses.

2.
Rev. Hosp. Ital. B. Aires (2004) ; 42(3): 158-162, sept. 2022.
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1396917

ABSTRACT

Las nuevas estrategias, que incluyen el diagnóstico y el tratamiento tempranos, el enfoque de tratamiento dirigido a un objetivo, la remisión como ese objetivo principal del tratamiento, la participación de los pacientes en las decisiones terapéuticas, junto con el desarrollo de nuevos tratamientos efectivos, han cambiado las expectativas de los reumatólogos y de los pacientes con enfermedades reumáticas. Todavía existen, sin embargo, importantes desafíos tales como la seguridad a largo plazo de los tratamientos actuales y poder escoger tratamientos más individualizados y eficaces, de forma tal de elegir el mejor tratamiento para cada paciente. El futuro, como en el resto de la medicina, probablemente sea la prevención del desarrollo de enfermedades reumáticas. Discutiremos estos temas en esta revisión. (AU)


New strategies, including early diagnosis and treatment, targeted therapy, remission as the main objective of treatment, patient involvement in therapeutic decision-making, and the development of new effective therapies, have changed the expectations of rheumatologists and patients with rheumatic diseases.There are still serious challenges, such as the long-term safety of current treatments and the ability to make more individualized and effective treatments to choose the best treatment for each patient. The future, as that of the whole of medical science, will probably lie in preventing the development of rheumatic diseases. We will discuss these issues in this review. (AU)


Subject(s)
Humans , Rheumatic Diseases/diagnosis , Rheumatic Diseases/prevention & control , Rheumatic Diseases/drug therapy , Patient Participation , Remission Induction/methods , Early Diagnosis , Precision Medicine/trends , Pharmacovigilance , Early Goal-Directed Therapy/methods
3.
Psicol. Caribe ; 39(2): 3-3, mayo-ago. 2022. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1406362

ABSTRACT

Resumen. Si bien la investigación sobre la metacognición y los estilos cognitivos es sólida para cualquier campo solo, pocas investigaciones han abordado los dos juntos. Además, ningún estudio hasta la fecha ha examinado objetivos más específicos relacionados con aspectos específicos de la metacognición, como la habilidad de monitoreo y su relación con el estilo cognitivo. Por lo tanto, el presente estudio investigó medidas de confianza, rendimiento y precisión para tres tipos de juicios metacognitivos (predicción, concurrente y postdicción) y tres tipos diferentes de preguntas metacognitivas: preguntas sobre la tarea, preguntas sobre uno mismo y preguntas en diferentes momentos (antes, durante y después) y cómo se relacionan con el estilo cognitivo (dependiente del campo, intermedio, independiente del campo) en una muestra de 57 estudiantes universitarios colombianos. Los resultados revelaron que había diferencias en la precisión y el sesgo del monitoreo metacognitivo en función del estilo cognitivo, y que estos hallazgos fueron similares entre los diferentes momentos y entre los juicios metacognitivos. Con respecto al estilo cognitivo, aquellos con un estilo cognitivo intermedio o independiente del campo informaron una mayor precisión de monitoreo y menos sesgo que las personas con un estilo dependiente del campo. Se discuten las implicaciones para la investigación, la teoría y la práctica.


Abstract. While research on metacognition and cognitive styles is robust for either field alone, few studies have broached the two together. In addition, no studies to date have examined finer-grained objectives related to specific aspects of metacognition such as monitoring skill and its relation to cognitive style. Thus, the present study investigated confidence, performance, and accuracy measures for three types of metacognitive judgments (prediction, concurrent and postdiction) and three different types of metacognitive questions-questions about the task, questions about the self, and questions at different moments (before, during, and after)-and how these are related to cognitive style (field dependent, intermediate, field independent) in a sample of 57 Colombian university students. Results revealed that there were differences in metacognitive monitoring accuracy and bias as a function of cognitive style, and that these findings were similar both between different moments and across metacognitive judgments. Regarding cognitive style, those with an intermediate or field independent cognitive style reported greater monitoring accuracy and less bias than individuals with a field dependent style. Implications for research, theory, and practice are discussed.

4.
Gac. méd. Méx ; 158(3): 160-166, may.-jun. 2022. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1404832

ABSTRACT

Resumen La medicina de precisión en algunas enfermedades es una realidad; respalda el desarrollo de métodos diagnósticos certeros y específicos, de nuevas drogas y moléculas. Nuestro equipo de investigación en México, conformado por investigadores clínicos y biomédicos, desde hace 20 años realiza de forma gratuita el diagnóstico mutacional del gen RET y su relación con el cáncer medular de tiroides y la neoplasia endocrina múltiple (NEM) 2 y 3. Las variantes patogénicas de RET en la población mexicana coinciden con los datos reportados: la mayoría con 634/NEM2 y 918/NEM3. Actualmente se están desarrollando nuevos métodos de nanobiotecnología para este tipo de determinaciones, de tal forma que puedan obtenerse resultados más rápidos, simples, sensibles y específicos aplicables en todo tipo de laboratorio.


Abstract Precision medicine is a reality in some diseases; it supports the development of accurate and specific diagnostic methods, new drugs and molecules. Our research team in Mexico, made up of clinical and biomedical researchers, has been performing free RET gene mutational diagnosis for medullary thyroid cancer and multiple endocrine neoplasia (MEN) 2 and 3 for 20 years. RET pathogenic variants in the Mexican population are consistent with reported data: most common mutations are 634/NEM2 and 918/NEM3. Currently, new nanobiotechnology methods are being developed for this type of determination in order to obtain faster, simpler, more sensitive and specific results applicable in all types of laboratories.

5.
Arq. neuropsiquiatr ; 80(5): 455-461, May 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1383881

ABSTRACT

ABSTRACT Background: Hemorrhagic transformation (HT) is a complication in ischemic strokes, regardless of use of reperfusion therapy (RT). There are many predictive scores for estimating the risk of HT. However, most of them include patients also treated with RT. Therefore, this may lead to a misinterpretation of the risk of HT in patients who did not undergo RT. Objective: We aimed to review published predictive scores and analyze their accuracy in our dataset. Methods: We analyzed the accuracy of seven scales. Our dataset was derived from a cohort of 1,565 consecutive patients from 2015 to 2017 who were admitted to a comprehensive stroke center. All patients were evaluated with follow-up neuroimaging within seven days. Comparison of area under the curve (AUC) was performed on each scale, to analyze differences between patients treated with recombinant tissue plasminogen activator (tPA) and those without this treatment. Results: Our dataset provided enough data to assess seven scales, among which six were used among patients with and without tPA treatment. HAT (AUC 0.76), HTI (0.73) and SEDAN (0.70) were the most accurate scores for patients not treated with tPA. SPAN-100 (0.55) had the worst accuracy in both groups. Three of these scores had different cutoffs between study groups. Conclusions: The predictive scores had moderate to fair accuracy for predicting HT in patients treated with tPA. Three scales were more accurate for predicting HT in patients not treated with tPA. Through standardizing these characteristics and including more patients not treated with RT in a large multicenter series, accurate predictive scores may be created.


RESUMO Background: Transformação hemorrágica (TH) é uma complicação frequente no acidente vascular cerebral (AVC) isquêmico independente do uso de terapia de reperfusão (TR). Diversos escores preditivos de TH foram elaborados. Entretanto, a maioria desses escores incluíram pacientes submetidos a TR — o que pode levar à má interpretação do risco de TH nos pacientes não submetidos a TR. Objetivo: Nosso objetivo é revisar escores preditivos já publicados e analisar a sua acurácia em nossa amostra. Métodos: Analisamos a acurácia de sete escores. Nosso banco foi criado de uma coorte de 1.565 pacientes consecutivos, admitidos entre 2015 e 2017 em um centro avançado de AVC. Os pacientes realizaram neuroimagem de controle em até sete dias. Uma comparação entre áreas abaixo da curva/característica de operação do receptor (AUC) foi realizada, analisando-se as diferenças entre grupos de pacientes tratados ou não com ativador de plasminogênio tecidual recombinante (tPA). Resultados: Nosso banco de dados proporcionou informação suficiente para avaliar sete escores, dos quais seis foram aplicados em pacientes tratados ou não com tPA. HAT (AUC 0,76), HTI (0,73) e SEDAN (0,70) foram os escores mais acurados em pacientes não tratados com tPA. SPAN-100 (0,55) teve a pior acurácia nos grupos. Três desses escores apresentaram diferentes valores de corte entre os grupos. Conclusões: Os escores apresentaram de boa a moderada acurácia na predição de TH em pacientes tratados com tPA. Três escores foram mais acurados em pacientes não tratados com tPA. A parametrização dessas características e a inclusão de mais pacientes não tratados com TR em um estudo multicêntrico poderia levar a escores mais acurados.

6.
Medisan ; 26(2)abr. 2022.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1405794

ABSTRACT

RESUMEN El control interno de calidad en el laboratorio clínico es una actividad especializada que monitoriza la calidad de los procesos y resultados, a la vez que permite aceptar o rechazar las corridas analíticas de las diferentes determinaciones. A tales efectos, se presentan los elementos de una guía práctica incluida en un software, diseñada con el objetivo de perfeccionar el control interno de la calidad en dichos laboratorios, donde se definen los principios y conceptos claves del tema, los procedimientos y su secuencia, los requisitos de calidad, las reglas de control, los cálculos estadísticos, la interpretación de los resultados, así como algunos de los indicadores novedosos y necesarios para asegurar la calidad.


ABSTRACT The internal control of quality in the clinical laboratory is a specialized activity that monitors the quality of the processes and results at the same time that it allows to accept or to reject the analytic runs on the different determinations. To such effects, the elements of a practical guide included in a software are presented, designed with the objective of perfecting the internal control of the quality in these laboratories, where the principles and key concepts of the topic, procedures and their sequence, requirements of quality, control rules, statistical calculations, the interpretation of the results are defined, as well as some of the novel and necessary indicators to assure the quality.

7.
Rev. Odontol. Araçatuba (Impr.) ; 43(1): 24-30, jan.-abr. 2022. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1361646

ABSTRACT

Introdução: As próteses parciais removíveis são alternativas amplamente utilizadas na reabilitação oral de pacientes parcialmente desdentados. Na atualidade os implantes dentais têm sido indicados para tratamento de pacientes edêntulos em associação com próteses parciais removíveis convencionais. Objetivo: Relatar um caso clínico utilizando uma prótese parcial removível convencional associada a implantes osseointegrados em paciente portador de Classe I de Kennedy. Relato de Caso: Paciente N.A.A.S., sexo feminino, 65 anos, procurou atendimento clínico no Instituto de Estudos da Saúde (IES) para reabilitação protética das arcadas dentais superior e inferior. A sua queixa principal era "dificuldade de mastigação". A paciente apresentava prótese total removível insatisfatória na maxila e não utilizava nenhum tipo de prótese dentária na mandíbula, que se apresentava parcialmente edêntula. O tratamento realizado foi a confecção de uma prótese total na arcada superior. Na arcada inferior foram inseridos dois implantes de hexágono externo nas regiões correspondentes às áreas dos dentes 34 e 44, após quatro meses a prótese parcial removível convencional foi confeccionada e incorporada aos implantes osseointegrados utilizando o sistema de retenção do tipo attachments Equator. Conclusão: Os resultados revelaram que a técnica de associação da prótese parcial removível convencional aos implantes osseointegrados demonstrou ser uma opção viável de tratamento com capacidade de devolver a função, a estética e manter a integridade dos dentes e tecidos periodontais(AU)


Introduction: Removable partial dentures are alternatives widely used in the oral rehabilitation of partially edentulous patients. Currently, dental implants have been indicated for the treatment of edentulous patients in association with conventional removable partial dentures. Objective: To report a clinical case using a conventional removable partial denture associated with osseointegrated implants in a patient with Kennedy Class I. Case Report: Patient N.A.A.S., female, 65 years old, sought clinical care at the Institute of Health Studies (HEI) for prosthetic rehabilitation of the upper and lower dental arches. His main complaint was "chewing difficulty". The patient had unsatisfactory removable total prosthesis in the maxilla and did not use any type of dental prosthesis in the mandible, which was partially edentulous. The treatment performed was the manufacture of a total prosthesis in the upper arch. In the lower arch, two external hexagon implants were inserted in the regions corresponding to the tooth areas 34 and 44, after four months the conventional removable partial denture was made and incorporated into the osseointegrated implants using the equator attachments retention system. Conclusion: The results revealed that the technique of associating conventional removable partial dentures with osseointegrated implants proved to be a viable treatment option with the ability to restore function, aesthetics and maintain the integrity of teeth and periodontal tissues(AU)


Subject(s)
Humans , Female , Aged , Dental Implantation, Endosseous , Denture, Partial, Removable , Dental Implants , Dental Prosthesis Design , Esthetics, Dental , Bone-Anchored Prosthesis
8.
Arq. neuropsiquiatr ; 80(2): 192-207, Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364363

ABSTRACT

ABSTRACT Background: Neuropsychiatric disorders are a significant cause of death and disability worldwide. The mechanisms underlying these disorders include a constellation of structural, infectious, immunological, metabolic, and genetic etiologies. Advances in next-generation sequencing techniques have demonstrated that the composition of the enteric microbiome is dynamic and plays a pivotal role in host homeostasis and several diseases. The enteric microbiome acts as a key mediator in neuronal signaling via metabolic, neuroimmune, and neuroendocrine pathways. Objective: In this review, we aim to present and discuss the most current knowledge regarding the putative influence of the gut microbiome in neuropsychiatric disorders. Methods: We examined some of the preclinical and clinical evidence and therapeutic strategies associated with the manipulation of the gut microbiome. Results: targeted taxa were described and grouped from major studies to each disease. Conclusions: Understanding the complexity of these ecological interactions and their association with susceptibility and progression of acute and chronic disorders could lead to novel diagnostic biomarkers based on molecular targets. Moreover, research on the microbiome can also improve some emerging treatment choices, such as fecal transplantation, personalized probiotics, and dietary interventions, which could be used to reduce the impact of specific neuropsychiatric disorders. We expect that this knowledge will help physicians caring for patients with neuropsychiatric disorders.


RESUMO Antecedentes: Os transtornos neuropsiquiátricos são uma importante causa de morte e invalidez no mundo. Os mecanismos subjacentes a esses transtornos incluem uma constelação de etiologias estruturais, infecciosas, imunológicas, metabólicas e genéticas. Avanços nas técnicas de sequenciamento do DNA têm demonstrado que a composição do microbioma entérico é dinâmica e desempenha um papel fundamental não apenas na homeostase do hospedeiro, mas também em várias doenças. O microbioma entérico atua como mediador na sinalização das vias metabólica, neuroimune e neuroendócrina. Objetivo: Apresentar os estudos mais recentes sobre a possível influência do microbioma intestinal nas diversas doenças neuropsiquiátricas e discutir tanto os resultados quanto a eficácia dos tratamentos que envolvem a manipulação do microbioma intestinal. Métodos: foram examinadas algumas das evidências pré-clínicas e clínicas e estratégias terapêuticas associadas à manipulação do microbioma intestinal. Resultados: os táxons-alvo foram descritos e agrupados a partir dos principais estudos para cada doença. Conclusões: Entender a fundo a complexidade das interações ecológicas no intestino e sua associação com a suscetibilidade a certas doenças agudas e crônicas pode levar ao desenvolvimento de novos biomarcadores diagnósticos com base em alvos moleculares. Além disso, o estudo do microbioma intestinal pode auxiliar na otimização de tratamentos não farmacológicos emergentes, tais como o transplante de microbiota fecal, o uso de probióticos e intervenções nutricionais personalizadas. Dessa forma, terapias alternativas poderiam ser usadas para reduzir o impacto dos transtornos neuropsiquiátricos na saúde pública. Esperamos que esse conhecimento seja útil para médicos que cuidam de pacientes com diversos transtornos neuropsiquiátricos.


Subject(s)
Humans , Gastrointestinal Microbiome/physiology
9.
Article in Chinese | WPRIM | ID: wpr-936414

ABSTRACT

@#With the arrival of the era of big data, increasing attention has been drawn to the application of artificial intelligence (AI) in the medical field. AI has many advantages, such as objectivity, accuracy, minimal invasiveness, time savings and high efficiency. Therefore, the combination of AI with dental diagnosis and treatment can help dentists improve work efficiency and save medical resources, offering potential significant benefits for dental application. At present, AI has been gradually integrated into prosthodontics, oral and maxillofacial surgery, orthodontics, endodontics and periodontics. The AI system can realize automatic tooth preparation, automatic tooth arrangement and implantology. Deep learning can be used to assist in diagnosing maxillary sinus inflammation, predicting the complications of tooth extraction and improving the accuracy of osteotomy. The AI system can also provide significant clues for the diagnosis, treatment and prognosis of oral and maxillofacial tumors. The breakthrough brought by AI in cephalometric and the assessment of facial attractiveness of patients has promoted the development of intelligent and personalized orthodontic treatment. Deep learning and analysis of medical images also promote the accuracy of root canal therapy as well as the diagnosis and treatment of periodontal diseases. AI technology has realized the leap from digitalization to automation and intelligence in oral diagnosis and treatment, and its application potential in the oral field should not be underestimated. Based on the concepts of AI, this paper will focus on the application of artificial intelligence in various oral clinical fields and briefly introduce its advantages, problems and future.

10.
Protein & Cell ; (12): 316-335, 2022.
Article in English | WPRIM | ID: wpr-929165

ABSTRACT

Recent advances in genome editing, especially CRISPR-Cas nucleases, have revolutionized both laboratory research and clinical therapeutics. CRISPR-Cas nucleases, together with the DNA damage repair pathway in cells, enable both genetic diversification by classical non-homologous end joining (c-NHEJ) and precise genome modification by homology-based repair (HBR). Genome editing in zygotes is a convenient way to edit the germline, paving the way for animal disease model generation, as well as human embryo genome editing therapy for some life-threatening and incurable diseases. HBR efficiency is highly dependent on the DNA donor that is utilized as a repair template. Here, we review recent progress in improving CRISPR-Cas nuclease-induced HBR in mammalian embryos by designing a suitable DNA donor. Moreover, we want to provide a guide for producing animal disease models and correcting genetic mutations through CRISPR-Cas nuclease-induced HBR in mammalian embryos. Finally, we discuss recent developments in precise genome-modification technology based on the CRISPR-Cas system.


Subject(s)
Animals , CRISPR-Cas Systems/genetics , DNA/genetics , Embryo, Mammalian/metabolism , Endonucleases/metabolism , Gene Editing , Mammals/metabolism
11.
Article in English | WPRIM | ID: wpr-929042

ABSTRACT

Cancer is the leading cause of death worldwide. Drugs play a pivotal role in cancer treatment, but the complex biological processes of cancer cells seriously limit the efficacy of various anticancer drugs. Autophagy, a self-degradative system that maintains cellular homeostasis, universally operates under normal and stress conditions in cancer cells. The roles of autophagy in cancer treatment are still controversial because both stimulation and inhibition of autophagy have been reported to enhance the effects of anticancer drugs. Thus, the important question arises as to whether we should try to strengthen or suppress autophagy during cancer therapy. Currently, autophagy can be divided into four main forms according to its different functions during cancer treatment: cytoprotective (cell survival), cytotoxic (cell death), cytostatic (growth arrest), and nonprotective (no contribution to cell death or survival). In addition, various cell death modes, such as apoptosis, necrosis, ferroptosis, senescence, and mitotic catastrophe, all contribute to the anticancer effects of drugs. The interaction between autophagy and these cell death modes is complex and can lead to anticancer drugs having different or even completely opposite effects on treatment. Therefore, it is important to understand the underlying contexts in which autophagy inhibition or activation will be beneficial or detrimental. That is, appropriate therapeutic strategies should be adopted in light of the different functions of autophagy. This review provides an overview of recent insights into the evolving relationship between autophagy and cancer treatment.


Subject(s)
Antineoplastic Agents/therapeutic use , Apoptosis , Autophagy/physiology , Humans , Necrosis/drug therapy , Neoplasms/therapy
12.
Article in English | WPRIM | ID: wpr-928842

ABSTRACT

BACKGROUND@#There are only limited numbers of reviews on the association of maternal-child genetic polymorphisms and environmental and lifestyle-related chemical exposure during pregnancy with adverse fetal growth. Thus, this article aims to review: (1) the effect of associations between the above highlighted factors on adverse fetal growth and (2) recent birth cohort studies regarding environmental health risks.@*METHODS@#Based on a search of the PubMed database through August 2021, 68 epidemiological studies on gene-environment interactions, focusing on the association between environmental and lifestyle-related chemical exposure and adverse fetal growth was identified. Moreover, we also reviewed recent worldwide birth cohort studies regarding environmental health risks.@*RESULTS@#Thirty studies examined gene-smoking associations with adverse fetal growth. Sixteen maternal genes significantly modified the association between maternal smoking and adverse fetal growth. Two genes significantly related with this association were detected in infants. Moreover, the maternal genes that significantly interacted with maternal smoking during pregnancy were cytochrome P450 1A1 (CYP1A1), X-ray repair cross-complementing protein 3 (XRCC3), interleukin 6 (IL6), interleukin 1 beta (IL1B), human leukocyte antigen (HLA) DQ alpha 1 (HLA-DQA1), HLA DQ beta 1 (HLA-DQB1), and nicotinic acetylcholine receptor. Fetal genes that had significant interactions with maternal smoking during pregnancy were glutathione S-transferase theta 1 (GSTT1) and fat mass and obesity-associated protein (FTO). Thirty-eight studies examined the association between chemical exposures and adverse fetal growth. In 62 of the 68 epidemiological studies (91.2%), a significant association was found with adverse fetal growth. Across the studies, there was a wide variation in the analytical methods used, especially with respect to the genetic polymorphisms of interest, environmental and lifestyle-related chemicals examined, and the study design used to estimate the gene-environment interactions. It was also found that a consistently increasing number of European and worldwide large-scale birth cohort studies on environmental health risks have been conducted since approximately 1996.@*CONCLUSION@#There is some evidence to suggest the importance of gene-environment interactions on adverse fetal growth. The current knowledge on gene-environment interactions will help guide future studies on the combined effects of maternal-child genetic polymorphisms and exposure to environmental and lifestyle-related chemicals during pregnancy.


Subject(s)
Alpha-Ketoglutarate-Dependent Dioxygenase FTO , Female , Fetal Development , Gene-Environment Interaction , Humans , Life Style , Maternal Exposure/adverse effects , Polymorphism, Genetic , Pregnancy
13.
Chinese Journal of Orthopaedics ; (12): 365-373, 2022.
Article in Chinese | WPRIM | ID: wpr-932844

ABSTRACT

Objective:To introduce the concept and procedure of CTA guided precision flap surgery and report the preliminary clinical application.Methods:The theory of CTA guided precision flap surgery is: based on CTA high-throughput data, comprehensively evaluate the wound and potential donor sites, and select the best plan for wound repair. This article reviews 177 patients treated under the guidance of CTA guided precision flap surgery from August 2014 to December 2018. Among them, 131 were males and 46 were females; they were 7-72 years old, with an average age of 39.5 years. The tissue defects were: 74 cases of foot and ankle, 64 cases of wrist, 15 cases of calf, 11 cases of forearm and upper arm, 7 cases of thigh and perineum, 5 cases of face and neck, and 1 case of abdomen. The size of the defect was 2 cm×1 cm to 65 cm×50 cm. The recipient and donor sites were assessed based on CTA guided precision flap surgery, then choose the optimal flap to repair the defect. The flap types, outcomes and complications were recorded. The visual analogue scale (VAS), British Medical Research Council sensory rating scale, and revascularization assessments of digital replantation standard by Hand Surgery Branch of Chinese Medical Association was used to assess clinical results.Results:All flaps were uneventfully harvested as planned according to the CTA guided precision flap surgery concept.A total number of 181 flaps were harvested, including 125 free flaps and 56 pedicled flaps. The flap area rangedfrom 4 cm×3 cm to 40 cm×8 cm. After surgery, 165 cases were survival completely, 7 cases were total necrosis, 9 cases were partial necrosis. A total of 174 cases of flaps survived. The mean follow-up was 9.2 months (range, 6-60 months). After surgery 53 flaps were bulky, and 7 cases with other complications.At the last follow-up, only 6 patients had mild pain, the VAS score was 1-3. The sensation of the flaps recovered partially. According to the British Medical Research Council sensory rating scale: 68 cases were grade S2 and 106 cases were grade S3. According to the revascularization assessments of digital replantation standard by Hand Surgery Branch of Chinese Medical Association, 171 cases were excellent and 3 cases were good.Conclusion:The concept of precision flap surgery based on CTA can effectively guide flap surgery and achieve precise wound repair.

14.
Article in Chinese | WPRIM | ID: wpr-932726

ABSTRACT

Hepatocellular carcinoma (HCC) is common in China. Most patients are at advanced stages of HCC at diagnosis, with short survival outcomes and poor prognosis. It is a major disease that seriously affects the health of many people. In recent years, the medical community has attempted to prolong survival and improve quality of life of patients by using multidisciplinary treatments. Immune checkpoint inhibitors, when combined with antiangiogenic targeted drugs, have achieved encouraging results in treatment of advanced hepatocellular carcinoma. This paper focuses on the issues of using salvage surgery after conversion of initially unresectable to resectable HCC by immune checkpoint inhibitors combined with antiangiogenic targeted drugs in treatment of advanced hepatocellular carcinoma, and makes a prediction on the prospect of this therapy protocol in treatment of these patients.

15.
Article in Chinese | WPRIM | ID: wpr-932620

ABSTRACT

With aligned MR registration, the MR-Linac provides superior soft tissue resolution for prostate cancer. No fiducial markers or electromagnetic transponders insertion is needed to guarantee high-precision radiotherapy. The highly-recommended Adapt-To-Shape (ATS) workflow can resolve all the problems encountered during prostate cancer radiotherapy, including prostate volume changes and adjacent organs motion, both inter-fractionally and intra-fractionally. With all the above advantages, MR-Linac performs outstandingly than conventional linac in prostate cancer RT delivery, and probably helps us to reduce the CTV-PTV margin safely in the near future. Nevertheless, it is difficult to implement the ATS workflow in clinical practice. In this article, the standard ATS workflow for prostate cancer was summarized based on our own experience.

16.
Journal of Chinese Physician ; (12): 179-183, 2022.
Article in Chinese | WPRIM | ID: wpr-932039

ABSTRACT

Diabetes is a group of clinical syndromes with multiple causes and pathologies resulting from multiple factors. Different types of diabetes have different intrinsic types and complex clinical phenotypes according to genetics, immunology, metabolism, and clinical characteristics. Latent autoimmune diabetes in adults and ketosis-prone diabetes are the manifestation of clinical heterogeneity among different types of diabetes. High clinical heterogeneity gradually obscures the classic differences between diabetes types and leads to the emergence of new forms of diabetes. The high heterogeneity of diabetes poses challenges to the accurate classification of diabetes mellitus. It has significance in the prediction, prevention, diagnosis, and treatment of the disease for us to have a deep understanding of the clinical consequences of heterogeneity within and between different diabetes types.

17.
Article in Chinese | WPRIM | ID: wpr-931464

ABSTRACT

Objective:To construct a precision teaching platform based on quality feedback, and to explore its application effect on the teaching of practice nursing students in the operating room.Methods:A total of 179 nursing students who interned in the operating room of Zhongshan Hospital Affiliated to Xiamen University from January 2018 to January 2019 were selected as the control group, while 157 nursing students who interned in this hospital operating room from February 2019 to February 2020 were selected as the research group. The control group adopted the traditional clinical teaching mode, while the research group adopted the teaching mode of precision teaching platform based on quality feedback. The assessment results of basic theoretical knowledge and operation skills after the internship were compared between the two groups of students, and their critical thinking ability before and after the internship, the comprehensive evaluation on them by surgeons after the internship and the satisfaction of interns with teaching were compared. SPSS 25.0 was used for t test and chi-square test. Results:After internship, the examination results of basic theoretical knowledge and operation skills in the research group were higher than those in the control group ( P<0.05). There was no significant difference in critical thinking ability between the two groups before internship. After internship, the critical thinking ability of the two groups were both significantly improved, and this ability of the research group improved more significantly than that of the control group ( P< 0.05). After the internship, the surgeon's comprehensive evaluation on the nursing students in the research group was higher than that in the control group, and the difference was statistically significant ( P<0.05). The total satisfaction rate of nursing students with teaching in the research group was significantly higher than that in the control group [93.63%(147/157) vs. 85.47%(153/179)], and the difference was statistically significant ( P<0.05). Conclusion:The application of precision teaching platform based on quality feedback in the teaching of practice nursing students in the operating room can significantly improve the learning effect of student nurses, improve their critical thinking ability and clinical comprehensive work ability, and improve their satisfaction with teaching.

18.
Article in Chinese | WPRIM | ID: wpr-930934

ABSTRACT

Objective:To investigate the clinical efficacy of precise hepatectomy for the treatment of recurrent unilateral hepatolithiasis and prognostic factors.Methods:The retrospec-tive case-control study was conducted. The clinicopathological data of 166 patients with recurrent unilateral hepatolithiasis who were treated by precise hepatectomy in the First Affiliated Hospital of Anhui Medical University from January 2015 to January 2021 were collected. There were 51 males and 115 females, aged (58±12)years. Observation indicators: (1)diagnosis and classification; (2) surgical and intraoperative situations; (3) postoperative situations; (4) follow-up; (5) analysis of prognostic factors. Follow-up was conducted using the outpatient examination and telephone inter-view to detect final stone clearance or recurrence and survival of patients up to August 2021. Patients with T-tube were performed T-tube cholangiography or choledochoscopy to evaluate the final stone clearance rate at postoperative week 8. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages. Univariate and multi-variate analyses were conducted using the Logistic regression model. Results:(1) Diagnosis and classifica-tion: 166 patients were diagnosed as hepatolithiasis by preoperative imaging examination and intraoperative evaluation, including 134 cases with common bile duct stones. Of the 166 patients, 115 cases had stones located in the left lobe of liver and 51 cases had stones located in the right lobe of liver. There were 111 cases with bile pigment stones, 31 cases with cholesterol stones, 24 cases with mixed type of stones. There were 9 cases classified as Tsunoda type Ⅰ, 89 cases as Tsunoda type Ⅱ, 65 cases as Tsunoda type Ⅲ, 3 cases as Tsunoda type Ⅳ. There were 12 cases classified as type Ⅰ, 99 cases as type Ⅱ, 47 cases as type Ⅲ, 8 cases as type Ⅳ according to Japanese classification in 2001. All the 166 patients were classified as type Ⅰ based on Chinese classification. According to the classification of author team, 166 patients were classified as type Ⅱ. (2) Surgical and intra-operative situations: 119 of 166 patients had liver lobe or segment atrophy. All the 166 patients underwent precise hepatectomy combined with different methods of drainage, of which 28 cases underwent left hemihepatectomy, 11 cases underwent right hemihepatectomy, 1 case underwent liver resection of segment Ⅰ, 5 cases underwent liver resection of segment Ⅱ, 5 cases underwent liver resection of segment Ⅲ, 8 cases underwent liver resection of segment Ⅳ (left medial lobe), 3 cases underwent liver resection of segment Ⅴ, 2 cases underwent liver resection of segment Ⅵ, 2 cases underwent liver resection of segment Ⅷ, 68 cases underwent liver resection of segment Ⅱ and Ⅲ (left lateral lobe), 3 cases underwent liver resection of segment Ⅴ and Ⅵ, 6 cases underwent liver resection of segment Ⅴ and Ⅷ (right anterior lobe), 21 cases underwent liver resection of segment Ⅵ and Ⅶ (right posterior lobe), 1 case underwent liver resection of segment Ⅱ, Ⅲ and Ⅳa, 1 case underwent liver resection of segment Ⅴ, Ⅵ and Ⅶ, 1 case underwent liver resection of segment Ⅰ, Ⅱ, Ⅲ and Ⅳ. For biliary drainage methods of 166 patients, 120 patients received T-tube external drainage, 23 cases received choledochojejunostomy, 23 cases received choledochojejunostomy combined with T-tube external drainage. The original cholangiojejunal anastomotic stenosis was found and reconstructed in 10 patients. The operation time was (258±87)minutes and intraopera-tive blood transfusion rate was 16.87%(28/166) of 166 patients. All the 166 patients underwent fiber choledochoscopy, showing 77 cases with normal function of Oddi sphincter, 38 cases with disorder, 40 cases with dysfunction. There were 11 patients undergoing choledochojejunostomy who were not evaluate the function of Oddi sphincter. There were 21.69%(36/166)of patients with intra-hepatic biliary stricture. One hundred and forty-nine of 166 patients were conducted bile culture, showing the positive rate as 75.17%(112/149). There were 22 cases cultured multiple kinds of bacteria. The most common bacterium was Escherichia coli (43 cases), followed by Pseudomonas aeruginosa (12 cases), Klebsiella pneumoniae (9 cases), Klebsiella oxytoca (7 cases), Enterococcus faecium (7 cases). (3) Postoperative situations. The postoperative complication rate of 166 patients was 16.87%(28/166). In the 8 patients with serious complications of Clavien-Dindo grade Ⅲ, 6 cases were performed thoracocentesis or abdominocentesis for effusion, 1 case was stopped bleeding under gastroscopy for stress ulcerbleeding, 1 case was performed surgery for adhesive intestinal obstruction. Two patients with septic shock of Clavien-Dindo grade Ⅳ were converted to intensive care unit for treatment and discharged after recovery. There were 13 patients with biliary leakage, 10 patients with pulmonary infection, 6 cases with incision infection, which were improved after conservative treatments. There was no perioperative death. The instant stone clearance rate of 166 patients was 81.93%(136/166). The duration of postoperative hospital stay of 166 patients was (11±6)days. (4) Follow-up: 166 patients were followed up for (37±17)months. The final stone clearance rate and stone recurrence rate of 166 patients were 94.58%(157/166) and 16.87%(28/166), respectively. According to Terblanche classification of prognosis, there were 91, 36, 25, 14 cases of grade Ⅰ, Ⅱ, Ⅲ, Ⅳ in 166 patients, respectively. Five of the 166 patients underwent intrahepatic secondary malignancy in which 4 cases died. (5) Analysis of prognostic factors: results of univariate analysis showed that biliary culture, the number of previous surgeries, immediate stone clearance, final stone clearance were related factors affecting the prognosis of precise hepatectomy in patients with recurrent unilateral hepatolithiasis ( odds ratio=2.29, 7.48, 2.69, 4.52, 95% confidence interval as 1.09?4.85, 2.80?19.93, 1.16?6.25, 1.15?17.77, P<0.05). Results of multivariate analysis showed that the number of previous surgeries ≥3 was an independent risk factor affecting the prognosis of precise hepatectomy in patients with recurrent unilateral hepato-lithiasis ( odds ratio=6.05, 95% confidence interval as 2.20?16.62, P<0.05). Conclusions:Precise hepatectomy is safe and effective for the treatment of patients with recurrent unilateral hepato-lithiasis. The number of previous surgeries ≥3 is an independent risk factor affecting the prognosis of precise hepatectomy in patients with recurren t unilateral hepatolithiasis.

19.
Article in Chinese | WPRIM | ID: wpr-930925

ABSTRACT

Tumor recurrence and metastasis after liver transplantation (LT) remains one of the most important factors that affect the outcome of LT for hepatocellular carcinoma (HCC). The diagnosis and treatment strategies in the era of precision medicine, including utilizing multi-omics, high-throughput gene sequencing analysis, big data and artificial intelligence to select the biomarkers which can accurately predict the prognosis after LT, evaluating the immune status comprehensively, inducing immune tolerance, providing effective prevention for patients at a high risk of recurrence with sensitive antitumor drugs and attaching importance to individualized treatment for recurrence and metastasis, may further improve the outcome of LT. Combined with experience and review of relevant research articles, the authors elaborate perioperative diagnosis and treatment strategies of LT for HCC, aiming to promote the application of precision medicine in the field of LT.

20.
Article in Chinese | WPRIM | ID: wpr-930914

ABSTRACT

Biliary surgery has a long history. Since the Renaissance era, countless predece-ssors began to understand the biliary ducts, developed from cholecystectomy to extrahepatic bile duct exploration, and made significant progress. Academician Zhiqiang Huang firstly applied hepatectomy to the treatment of complex hepatolithiasis, and developed biliary surgery from extrahepatic bile duct to intrahepatic bile duct. The establishment and maturity of the "Precision biliary surgery technology system" marks the era of "segment" in biliary surgery. However, due to the many uncertainties of the concept and technology in the entire diagnosis and treatment process, biliary surgery is still one of the most complicated areas in abdominal surgery, and the prognosis is in urgent need of improvement. In the future, biliary surgery will make a breakthrough from the current hepatic segment to molecular level. Surgeons will cooperate with experts in various fields, make medical decisions based on big data and artificial intelligence, and perform more precise surgeries.

SELECTION OF CITATIONS
SEARCH DETAIL