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Ductal carcinoma in situ of the breast (DCIS) most commonly manifests as asymptomatic calcifications at mammography. The most common manifestation of MRI is nonmass enhancement. The ultrasound mainly presents as a hypoechoic irregular hypervascular mass without posterior features. Core-needle biopsy is a commonly used method for preoperative diagnosis of DCIS. Due to differences in needle type and sample size, there is a certain degree of pathological upgrading of the lesion. In recent years, there has been controversy over the diagnosis and treatment of DCIS. With the development of breast disease diagnostic technology, advances in digital breast tomography, artificial intelligence, and radiomics are expected to help DCIS management and address issues such as overdiagnosis.
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Reviewing important clinical trials in the field of arrhythmia in 2023,involving atrial fibrillation,pacing,and other aspects.Both the CIRDA-DOSE study and the EARLY-AF study affirmed the efficacy of cryoballoon ablation in treating atrial fibrillation,alter its progression to persistent atrial fibrillation.The MANIFEST-PF study examined the success rate and safety of pulse field ablation in atrial fibrillation,and the ADVENT study also confirmed its safety and effectiveness not inferior to conventional thermal ablation.In the LBBAP study,LBBAP reduced the occurrence of sustained VT/VF and new-onset atrial fibrillation compared to BVP.For patients with a high right ventricular pacing burden and reduced ejection fraction in pacemakers or ICDs,the BUDAPEST CRT upgrade study affirmed the benefits of upgrading to CRT-D.The DANPACE Ⅱ study showed that minimizing atrial pacing in patients with sinus node dysfunction does not reduce the incidence of atrial fibrillation.The IDE study demonstrated the safety of Aveir DR dual-chamber leadless pacemaker at 3 months post-operation,providing reliable atrial pacing and atrioventricular synchrony.The iSUSI study is a registry study of subcutaneous implantable cardioverter-defibrillators,finding similar inappropriate and appropriate shock rates in patients with and without heart failure.
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Health consumption upgrading is an important way to benefit residents'livelihood,protect health and promote the construction of healthy China.It analyzes the practical foundation and development dilemma of China's health consumption upgrading in the new period through literature and logical analysis,and puts forward strategies to alleviate the dilemma.It concludes that in the new period,China's health consumption upgrading has the practical foundation of significant effect of health poverty alleviation policies,continuous upgrading of national health consumption concepts,and continuous emergence of health science and technology innovations,but also faces the development dilemmas of unstable health market order,insufficient supply of health products,insufficient application of health science and technology,and lack of deep cultivation of health literacy.Accordingly,the following strategies are proposed to alleviate the difficulties:strengthen top-level design to create a new"environment"for health consumption;promote diversified participation to meet the new"demand"for health consumption;strengthen technology-driven to build a new"industry"for health consumption;and cultivate health literacy.Cultivating health literacy and cultivating new"potential"for healthy consumption.
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RESUMEN Introducción: la enfermera que se desempeña en los consultorios de la Atención Primaria de Salud, asume la responsabilidad de propiciar una atención integral al familiar encargado del cuidado del enfermo oncológico. Objetivo: diseñar una propuesta de superación para el perfeccionamiento de la actuación de la enfermera en la atención integral a la familia con enfermo oncológico. Materiales y métodos: se efectuó una investigación de desarrollo en la Facultad de Ciencias Médicas de Matanzas Dr. Juan Guiteras Gener, durante el curso 2018-2019. Se utilizó una muestra de 23 enfermeras de los consultorios de la atención primaria del municipio de Matanzas. Se analizaron los documentos que avalan su desempeño profesional. Se diseñó una encuesta dirigida a la identificación de las necesidades de aprendizaje y una guía de observación para caracterizar el modo de actuación del profesional de Enfermería. Se aplicaron entrevistas a supervisoras y directivos. Resultados: el análisis de las encuestas aplicadas a la muestra seleccionada y las observaciones realizadas a las actividades en el hogar, permitieron detectar las necesidades de aprendizaje para el perfeccionamiento de la atención integral a la familia con enfermo oncológico. Las entrevistas realizadas a supervisoras y directivos corroboraron la necesidad de la propuesta. Conclusiones: se diseñó un curso de posgrado para el perfeccionamiento de la actuación de los profesionales de la Enfermería, relacionado con el cuidado integral a la familia con enfermos oncológicos en la Atención Primaria de Salud (AU).
ABSTRACT Introduction: the nurse who works in the primary health care consultations assumes the responsibility of providing comprehensive care to the relative who takes care of oncological patients. Objective: to design a proposal of upgrading to improve the performance of the nurse in the comprehensive care to the family with an oncological patient. Materials and methods: a development research was conducted in the Faculty of Medical Sciences Dr. Juan Guiteras Gener, of Matanzas, during the school year 2018-2019. The sample was 23 nurses from the primary health care offices of the municipality of Matanzas. The documents that support their professional performance were analyzed. A survey was designed to identify learning needs and also an observation guide to characterize the performance of the nursing professional. Interviews were conducted with supervisors and managers. Results: the analysis of the surveys applied to the chosen sample and the observations made to the activities carried out at home, made it possible to determine the learning needs for the improvement of the comprehensive care to the families with oncological patients. Interviews with supervisors and managers confirmed the necessity of the proposal. Conclusions: a postgraduate course was designed for the improvement of nursing professionals' performance, aimed to the comprehensive care to families with oncological patients in the primary health care (AU).
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Humans , Male , Female , Professional Training , Family Nurse Practitioners/education , Patients , Comprehensive Health Care/methods , Family Nurse Practitioners/psychology , Neoplasms/nursingABSTRACT
Objective:To evaluate narrow band imaging-magnifying endoscopy (NBI-ME) for the further assessment of lesions of low-grade intraepithelial neoplasia (LGIN) in the gastric biopsy.Methods:Data of 180 patients who underwent NBI-ME before endoscopic submucosal dissection (ESD) for biopsy of gastric LGIN at the First Affiliated Hospital of Soochow University from January 2017 to October 2020 were analyzed retrospectively. Taking the pathological results after ESD as the gold standard, the sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy of NBI-ME in predicting the pathological upgrading of gastric LGIN lesions after ESD were calculated, and the receiver operator characteristic (ROC) curve was drawn.Results:Among 180 gastric LGIN lesions, 115 (63.89%) were pathological upgraded and 65 (36.11%) were not after ESD. There were 10 missed diagnoses, 19 misdiagnoses, and 151 correct diagnoses in NBI-ME examination before ESD. The sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy of NBI-ME in predicting the pathological upgrading of gastric LGIN lesions after ESD were 91.3% (105/115), 70.8% (46/65), 84.7% (105/124), 82.1%(46/56) and 83.9% (151/180), respectively. The area under the ROC curve was 0.810 (95% CI: 0.737-0.883). Conclusion:Further NBI-ME examination of gastric LGIN lesions diagnosed by biopsy pathology can accurately predict whether the lesions have pathological upgrading after ESD, which is of important guiding significance for the patients to choose the treatment strategy of further follow-up or endoscopic resection.
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El Programa Nacional y Normas de procedimiento para la Prevención y Control de la Tuberculosis en Cuba de 2013 constituye la guía de trabajo cotidiana del personal de salud para el manejo de la enfermedad. Este necesita ser actualizado para adecuarse a las nuevas condiciones y retos que plantea la tuberculosis a tono con las experiencias nacionales y las recomendaciones internacionales las cuales buscan estandarizar la atención. Deben modificarse términos en la clasificación de casos, incorporar nuevos métodos diagnósticos (imagenológicos, inmunológicos y genotípicos) y fundamentalmente en el tema de tratamiento con la incorporación de nuevas drogas, esquemas terapéuticos y la reorganización de los fármacos según su efectividad(AU)
The 2013 National Program and Rules of Procedure for the Prevention and Control of Tuberculosis in Cuba constitutes the daily work guide of health personnel for the management of the disease. This Program and Rules of Procedure needs to be updated to meet the new conditions and challenges posed by tuberculosis in line with local experiences and international recommendations seeking to standardize care. Modificatins are needed for terms of case classification, new diagnostic methods need to be included (imaging, immunological and genotypic) and basically on the subject of treatment with the integration of new drugs, therapeutic forms and the reorganization of drugs according to their effectiveness(AU)
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Humans , Male , Female , Tuberculosis/prevention & control , Health Programs and Plans/standards , CubaABSTRACT
OBJECTIVE:To design and upgrade the finished infusion label in P IVAS of Hefei Binhu hospital ,so as to improve the safety and effectiveness of intravenous medication. METHODS :By investigating the experience and suggestions about the use of infusion labels by pharmacists and clinical nurses in PIVAS ,taking clear ,concise,focused,rational layout ,comprehensive information as improving principle ,the infusion label was designed and upgraded. The effect of upgrading were evaluated by the recognition rate of label scanning ,scanning time and rate on label (94 701,113 759 groups,respectively),and the correct rate , time and rate of drug delivery checking in 30 days before and after upgrading ,as well as satisfaction degree ,which made among PIVAS pharmacists (30),nurses(50)and patients (49). RESULTS :The upgraded label simplified part of the content and optimized the layout structure ,removed redundant content ,focused on the patient safety information that nurses needed to pay attention to when checking ,and added the marking of infusion sequence and precautions. By changing the barcode into two-dimensional code and adding hidden display function ,more information about drugs and rational drug use related to the infusion of patients was provided. Compared with original label ,after upgrading ,the recognition rate of new label scanning increased from 99.27% to 99.96%,the scanning time reduced from 3 518.75 s/d to 2 110.10 s/d,and the scanning rate increased from 0.57 group/s to 0.95 group/s;the correct rate of drug delivery checking increased from 99.73% to 99.91%,the time of drug delivery checking decreased from 5 423.55 s/d to 4 818.85 s/d,and the speed of drug delivery checking increased from 0.36 group/s to 0.41 group/s. The satisfaction degree of pharmacists ,nurses and patients were increased from 70.00% to 93.33%,from 62.00% to 90.00%,from 20.40% to 89.80%,respectively. CONCLUSIONS:The design and upgrading of infusion labels can improve the working efficiency of staff ,and improve the quality of pharmaceutical care and nursing care , and satisfaction, promote the improvement on the safety and effectiveness of intravenous medication for patients.
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Objective To evaluate the risk factors of postoperative upgrade to pT3a of cT1 renal cell carcinoma,and to establish a nomogram prediction model to improve the ability of predicting locally advanced renal cell carcinoma and provide a reference for clinical surgical decision-making.Methods Clinical data of 1 376 patients with cT1 (diameter ≤ 7 cm) renal tumor hospitalized for surgery from January 2010 to December 2016 were retrospectively analyzed.There were 979 males and 397 females,with the mean age of (57.65 ± 10.92) years.The mean body mass index (BMI) was (25.47 ± 3.27) kg/m2 and the average tumor size was (4.02 ±1.52) cm.There were 711 tumors on the left and 665 on the right.There were 363 cases with clinical symptoms,567 patients with smoking history,732 cases with history of chronic disease.There were 289 cases with tumor necrosis,636 cases with tumor protrusion,822 cases with irregular tumor,and 738 cases with renal sinus compression.Partial nephrectomy and radical nephrectomy were performed in 396 cases and 980 cases respectively.Mann-whitney U test and chi-square test were used for univariate analysis,logistic regression analysis was used for multivariate analysis to analyze the predictors of upgrading,R software was used to construct the nomogram predictive model,C-index was used to evaluate the model discrimination,and calibration curve method was used to evaluate the consistency of the model.Results Postoperative pathology of total 1 376 cases showed that there were 1 195 cases of clear cell carcinoma of kidney,48 cases of papillary cell carcinoma,57 cases of chromophobe cell carcinoma,and 76 cases of other types.Among the 1 376 patients with cT1 renal tumor,75 patients were upgraded to pT3a,accounting for 5.5% of all patients.Univariate analysis showed that the patients who upgraded to pT3a were older [(63.08 ± 10.17) years old and (57.34 ± 10.88) years old],and the tumor length and diameter were larger [(5.24 ± 1.35) cm and (3.95 ± 1.51) cm].Patients with clinical symptoms [46.7% (35/75) vs.25.2% (328/1 301)],patients with CT indication of tumor necrosis [40.0% (30/25 975) vs.19.9% (259/1 301)],patients with irregular tumor contour [73.3% (55/76 775) vs.59.0% (767/1 301)],and patients with radical nephrectomy were higher [(92.1% (70/91 075) vs.70% (910/ 1 301)].All the differences were statistically significant (P <0.01).Multivariate analysis showed that the independent predictors of upgrading were age (OR =1.046,P <0.001),larger tumor (OR =1.504,P <0.001),clinically symptom (OR =2.153,P =0.004),irregular tumor profile (OR =2.466,P =0.002),and tumor necrosis on CT (OR =2.588,P < 0.001).The C-index was 0.808,the calibration curve of forecasting curve with the standard curve fit was good,and the prediction of renal cancer are better in predict consistency.Conclusions Based on the five preoperative predictors,including age,tumor size,clinical presence or absence of symptoms,tumor profile,and whether or not the tumor necrosis indicated by CT,this study developed a nomogram of cT1 renal cancer upgrade to pT3a.This nomogram has a good statistical significance,and this model can provide prognosis consultation for patients and provide reference for doctors to make decisions before treatment.
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Objective@#To evaluate the risk factors of postoperative upgrade to pT3a of cT1 renal cell carcinoma, and to establish a nomogram prediction model to improve the ability of predicting locally advanced renal cell carcinoma and provide a reference for clinical surgical decision-making.@*Methods@#Clinical data of 1 376 patients with cT1 (diameter ≤ 7 cm) renal tumor hospitalized for surgery from January 2010 to December 2016 were retrospectively analyzed. There were 979 males and 397 females, with the mean age of (57.65±10.92) years. The mean body mass index (BMI) was (25.47±3.27) kg/m2 and the average tumor size was (4.02±1.52) cm. There were 711 tumors on the left and 665 on the right. There were 363 cases with clinical symptoms, 567 patients with smoking history , 732 cases with history of chronic disease. There were 289 cases with tumor necrosis, 636 cases with tumor protrusion, 822 cases with irregular tumor , and 738 cases with renal sinus compression. Partial nephrectomy and radical nephrectomy were performed in 396 cases and 980 cases respectively. Mann-whitney U test and chi-square test were used for univariate analysis, logistic regression analysis was used for multivariate analysis to analyze the predictors of upgrading, R software was used to construct the nomogram predictive model, C-index was used to evaluate the model discrimination, and calibration curve method was used to evaluate the consistency of the model.@*Results@#Postoperative pathology of total 1 376 cases showed that there were 1 195 cases of clear cell carcinoma of kidney, 48 cases of papillary cell carcinoma, 57 cases of chromophobe cell carcinoma, and 76 cases of other types. Among the 1 376 patients with cT1 renal tumor, 75 patients were upgraded to pT3a, accounting for 5.5% of all patients. Univariate analysis showed that the patients who upgraded to pT3a were older [(63.08±10.17) years old and (57.34±10.88) years old], and the tumor length and diameter were larger [(5.24±1.35) cm and (3.95±1.51) cm]. Patients with clinical symptoms [46.7% (35/75) vs. 25.2%(328/1 301)], patients with CT indication of tumor necrosis [40.0%(30/25 975) vs. 19.9% (259/1 301)], patients with irregular tumor contour [73.3%(55/76 775) vs. 59.0%(767/1 301)], and patients with radical nephrectomy were higher [(92.1% (70/91 075) vs. 70%(910/1 301)]. All the differences were statistically significant (P<0.01). Multivariate analysis showed that the independent predictors of upgrading were age (OR=1.046, P<0.001), larger tumor (OR=1.504, P<0.001), clinically symptom (OR=2.153, P=0.004), irregular tumor profile (OR=2.466, P=0.002), and tumor necrosis on CT (OR=2.588, P<0.001). The C-index was 0.808, the calibration curve of forecasting curve with the standard curve fit was good, and the prediction of renal cancer are better in predict consistency.@*Conclusions@#Based on the five preoperative predictors, including age, tumor size, clinical presence or absence of symptoms, tumor profile, and whether or not the tumor necrosis indicated by CT, this study developed a nomogram of cT1 renal cancer upgrade to pT3a. This nomogram has a good statistical significance, and this model can provide prognosis consultation for patients and provide reference for doctors to make decisions before treatment.
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Recommendations for managing clinically localized prostate cancer are structured around clinical risk criteria, with prostate biopsy (PB) Gleason score (GS) being the most important factor. Biopsy to radical prostatectomy (RP) specimen upgrading/downgrading is well described, and is often the rationale for costly imaging or genomic studies. We present simple, no-cost analyses of clinical parameters to predict which GS 6 and GS 8 patients will change to GS 7 at prostatectomy. From May 2006 to December 2012, 1590 patients underwent robot-assisted radical prostatectomy (RARP). After exclusions, we identified a GS 6 cohort of 374 patients and a GS 8 cohort of 91 patients. During this era, >1000 additional patients were enrolled in an active surveillance (AS) program. For GS 6, 265 (70.9%) of 374 patients were upgraded, and the cohort included 183 (48.9%) patients eligible for AS by the Prostate Cancer Research International Active Surveillance Study (PRIAS) standards, of which 57.9% were upgraded. PB features that predicted a >90% chance of upgrading included ≥ 7 cores positive, maximum foci length ≥ 8 mm in any core, and total tumor involvement ≥ 30%. For GS 8, downgrading occurred in 46 (50.5%), which was significantly higher for single core versus multiple cores (80.4% vs 19.6%, P = 0.011). Biochemical recurrence (BCR) occurred in 3.4% of GS 6 upgraded versus 0% nonupgraded, and in GS 8, 19.6% downgraded versus 42.2% nondowngraded. In counseling men with clinically localized prostate cancer, the odds of GS change should be presented, and certain men with high-volume GS 6 or low-volume GS 8 can be counseled with GS 7-based recommendations.
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Recommendations for managing clinically localized prostate cancer are structured around clinical risk criteria, with prostate biopsy (PB) Gleason score (GS) being the most important factor. Biopsy to radical prostatectomy (RP) specimen upgrading/downgrading is well described, and is often the rationale for costly imaging or genomic studies. We present simple, no-cost analyses of clinical parameters to predict which GS 6 and GS 8 patients will change to GS 7 at prostatectomy. From May 2006 to December 2012, 1590 patients underwent robot-assisted radical prostatectomy (RARP). After exclusions, we identified a GS 6 cohort of 374 patients and a GS 8 cohort of 91 patients. During this era, >1000 additional patients were enrolled in an active surveillance (AS) program. For GS 6, 265 (70.9%) of 374 patients were upgraded, and the cohort included 183 (48.9%) patients eligible for AS by the Prostate Cancer Research International Active Surveillance Study (PRIAS) standards, of which 57.9% were upgraded. PB features that predicted a >90% chance of upgrading included ≥ 7 cores positive, maximum foci length ≥ 8 mm in any core, and total tumor involvement ≥ 30%. For GS 8, downgrading occurred in 46 (50.5%), which was significantly higher for single core versus multiple cores (80.4% vs 19.6%, P = 0.011). Biochemical recurrence (BCR) occurred in 3.4% of GS 6 upgraded versus 0% nonupgraded, and in GS 8, 19.6% downgraded versus 42.2% nondowngraded. In counseling men with clinically localized prostate cancer, the odds of GS change should be presented, and certain men with high-volume GS 6 or low-volume GS 8 can be counseled with GS 7-based recommendations.
Subject(s)
Humans , Male , Middle Aged , Biopsy , Neoplasm Grading/statistics & numerical data , Neoplasm Recurrence, Local/pathology , Prostate/surgery , Prostate-Specific Antigen/blood , Prostatectomy , Prostatic Neoplasms/surgery , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Objective To compare the pathological results between preoperative gastroscopy samples and postoperative samples of endoscopic resection from patients with gastric intraepithelial neoplasia, and further investigate the risk factors of pathological upgrading. Methods A retrospective analysis was performed on the data of 371 patients with gastric intraepithelial neoplasia confirmed by biopsy and undergoing endoscopic resection from January 2012 to December 2014 in Nanjing Drum Tower Hospital. The preoperative and postoperative pathological results were compared, and the risk factors for pathological upgrading after operation were analyzed. Results Among 371 patients, 173 and 198 cases were diagnosed as low-grade intraepithelial neoplasia ( LGIN ) and high-grade intraepithelial neoplasia ( HGIN ) , respectively, by preoperative endoscopic biopsy. By postoperative pathology of endoscopic resection, 113 ( 65. 3%) of 173 LGIN cases kept the diagnosis, while 46 ( 26. 6%) of 173 cases were upgraded to HGIN, and 10 ( 5. 8%) of 173 cases were finally upgraded to gastric cancer. The upgrade rate was 32. 4%(56/173). In the HGIN group, 107 ( 54. 0%) of 198 HGIN patients had the same diagnosis after endoscopic resection, 78 ( 39. 4%) of 198 cases were upgraded to cancer. Multivariate regression analysis showed that diameter of larger than 2 cm (P=0. 008), proximal stomach location (P=0. 011), mucosal surface redness ( P=0. 000 ) , and surface depression or ulcer ( P=0. 003 ) were independent factors of pathological upgrading for postoperative samples. Conclusion Preoperative biopsy for the diagnosis of gastric intraepithelial neoplasia has a certain misdiagnosis rate. More attentions should be paid on the lesion which is larger than 2 cm in diameter, located in the proximal stomach, or mucosa with red surface, depression or ulcer. Postoperative pathological examination can help to clarify the nature of the lesion.
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Objective:To discuss the necessity of upgrade and verification laboratory information management system( LIMS) in drug control institutes. Methods:LIMS was upgraded and validated in a laboratory. Results:The upgrade and verification of LIMS en-sured the primitiveness and accuracy of laboratory date, and improved the work efficiency. Conclusion:The application of LIMS sys-tem ensures the reliability of the date and is of great significance to the development of drug testing organizations.
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Objective:To create a convenient, quick and personalized upgrade application (APP) based on current Pocket Shengjing hospital mobile medical APP.Methods: To establish the best suitable mobile terminal APP to patient by using smartphone and mobile internet technique.Result: A series of new function, such as appointed register at any time before diagnosis, anticipated waiting time during diagnosis, enquiry of detection after diagnosis, different kind of payment during diagnosis, healthy information net among family members and effective control for broken appointment of patient, were achieved by the upgrade mobile medical APP. It also can optimize the process of diagnosis, reduce waiting time, increase outpatient service effective and improve satisfaction of patient for outpatient serviceConclusion: The upgrade mobile medical APP is a more practical and convenience software, and it can improve medical treatment process and provide convenient condition for medical service based on the perspective of patient.
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Objective To explore the lived study feeling and experience of nursing upgrade students during blended learning model so as to provide the evidence of reforming teaching model of nursing educators.Methods Phenomenological research of qualitative research was used.Four focus groups,25 upgrade nursing students were interviewed in-depth.Results Six themes were sublimated:relief the contradiction between work and study,promote communication in double interaction,improve self-learning ability,improve selfconfidence as learning controllability,online courses lack a sense of belonging,lack of skills support.Conclusions Blended learning model meets students,needs,provides students with personalized learning and improves comprehensive quality.However,the development of blended learning model in China is in the primary stage,we should combine conditions and reference foreign experience to develop it.
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Objective To discuss the timing of surgery, operation strategy and technique of upgrading chronically right ventricle-paced heart failure patients to cardiac resynchronization therapy. Methods Six chronically right ventricle-paced heart failure patients underwent surgery of upgrading to CRT in our department between March 2009 to February 2014. The clinical characteristics, surgical techniques and follow-up data were retrospectively analyzed. Results Six patients, including single-chamber pacemaker (VVI) 2 cases, dual-chamber pacemaker (DDD) 4 cases, were successfully complete the upgrade operation, no complications. In two cases which original pacemaker pockets were on the left, the left ventricular electrodes were implanted through the left subclavian vein, without subcutaneous tunnel. In 4 cases which original pacemaker pockets were on the right, the left ventricular electrodes implanted through the right internal jugular vein in 2 patients, running in the subcutaneous tunnel from right internal jugular vein to the right chest, while in other 2 cases, the left ventricular electrodes implanted through Left subclavian vein, running in the subcutaneous tunnel from the right chest to the left chest. There were a total of 10 primary electrode wires, the two wires were removed, the eight were continued to use. Follow-up data showed that in the postoperative 3 days, compared with admission, CRT significantly reduced the mean ORS duration(P0.05)and BNP(P0.05),while left ventricular end-diastolic diameter, ejection fraction and NYHA class no significant changes. In the postoperative 3 months, CRT significantly reduced the mean ORS duration and BNP, and increased the LV ejection fraction, left ventricular end-diastolic diameter were reduced significantly, the patients cardiac function was improved by an average of one grade of NYHA functional class. Conclusion Correct preoperative operation strategy and intraoperative operation skills is the key of upgrading chronically right ventricle-paced to cardiac resynchronization therapy,Upgrade surgery can significantly improve the synchronization of left and right ventricular contraction, improve heart function and quality of life.
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Objective To upgrade No.1 Military Medical Project from single operation to Oracle RAC to eliminate single failure of the operation system, protect medical data and lay a foundation for the following upgrade and deployment.Methods RAC software and hardware environment was constructed for database upgrade and deployment of Data Guard.Results The database was gifted with high availability and high performances, and database maintenance and upgrade could be carried out with the operation system less ceased than before.Conclusion The database is upgraded from a single-mode rigid architecture to a multi-mode elastic one, with the performances, safety and extendibility enhanced greatly.
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Objective:To discuss the test methods and the application value of detective quantum efficiency (DQE) in upgrading of DR based on flat panel detector(FPD).Methods:Combining the dose of incident X-rays with the image brought by flat panel detector. According to the international electrotechnical commission IEC 62220-1 standard method, the tungsten imaging,and combined with the relationship between the FPD and incident X-ray air kerma, using DQEPro equipment and software to calculate the result of the three different types of FPD.Results: The experiment proves that the basic performance of flat panel detector is known definitely by testing the DQE. DQE can reflect the quality of imaging performance in different types of flat-panel detector.Conclusion: The upgrading of DR based on flat panel detector and the DQE testing can be a better technical basis for DR measurement performance, then it can be ensure the quality of DR upgraded in diagnostic imaging.
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PURPOSE: To review MR imaging finding of papillary lesion identified as additional suspicious lesion on MR image in women with biopsy-proven breast cancer and to evaluate upgrading rates after subsequent surgical histopathological diagnosis. MATERIALS AND METHODS: Among 1729 preoperative MR image of women with biopsy proven breast cancer, US-guided CNB-proven 22 papillary lesions from 21 patients, which showed additional suspicious contrast enhancement other than index cancer on MR image, were subjected to the study. Some of these lesions underwent surgery, thus the comparisons between the histopathologic results were able to be compared to the results of US guided CNB. Also retrospective analysis was done for MR findings of these lesions by BI-RADS MRI lexicon. RESULTS: On MR imaging, 8 mass lesions, 7 non-mass lesions, 7 focus lesions were detected. All of the focus lesion (100%, 7/7) was diagnosed as benign lesion and showed plateau and washout pattern in dynamic MR image. After excisional biopsy, one of 9 benign papilloma (11.1%), 3 of 3 papillary neoplasm with atypia component (100%), 3 of 5 papillary neoplasm (60%) were upgraded to malignancy such as ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC). CONCLUSION: The MR images of papillary lesions diagnosed by US-guided CNB exhibit no significant differences between malignancy and benign lesion. Also 41.2% of the lesion (7/17) was upgraded after subsequent surgery. Thus all of the papillary lesions require excisional biopsy for definite diagnosis and the MR imaging, it's just not enough by itself.
Subject(s)
Female , Humans , Biopsy , Breast Neoplasms , Breast , Carcinoma, Ductal , Carcinoma, Intraductal, Noninfiltrating , Carcinoma, Lobular , Diagnosis , Magnetic Resonance Imaging , Papilloma , Retrospective StudiesABSTRACT
Al cumplirse cien años del aún vigente Informe Flexner los educadores de las ciencias de la salud de todo el mundo generaron reflexiones y nuevas metas para las mismas. Son muchos los cambios producidos desde la presentación de Abraham Flexner en 1910 pero muy importantes son los ocurridos sobre el fin del siglo XX. La aparición de las tecnologías de la información y de la comunicación fueron precipitantes. Este ensayo pretende dar muestra de la evolución y alertar que esa combinación nos obliga a los docentes a estar informados y atentos a su influencia en el ámbito de la educación superior y entender que debemos estar dispuestos a cambios personales y a brindar una mayor colaboración para producir los cambios institucionales que nos permitan entregar a la sociedad mejores egresados.
To celebrate one hundred years of the still current "Flexner report" worldwide health science educators generated reflections and new goals for them. There have been many changes since the submission of Abraham Flexner in 1910 but more important are the ones which took place at the end of the 20th century. The emergence of information and communication technologies were swift. This essay is intended to alert that that combination forces us teachers to be informed and aware of its influence in the field of higher education and understand that we must be prepared to personal changes and to provide greater collaboration to produce the institutional enabling us to deliver better graduates to society.