Medicine Format Research Articles

Research on modelling vestibular rehabilitation decision based on machine learning

Objective:To evaluate the effect of the support vector machine（SVM） and artificial neutral network（ANN） on the treatment choice of vestibular rehabilitation. Method:Total scores COMP and three ratios of sensory analysis: somatosensory（SOM）, visual（VIS）, vestibular（VEST） from the sensory organization test（SOT）, and physical score（DHI-P）, emotional score（DHI-E）, functional score（DHI-F） from the dizziness handicap inventory（DHI） were chosen as input of SVM and ANN, rehabilitation program as output. According to the data source of the literatures, we constructed simulation database used as the sample set to conduct model training, and part of the clinical data was used to train the model accuracy. Result:After trainings, the accuracy rate of ANN model was 52.3%, and that of SVM model was 83.4%. The error mainly comes from the serious overlap of each score data interval under the three diagnostic schemes, which easily leads to the misclassification of boundary sample points, which is also a difficult problem to overcome in clinical diagnosis. Conclusion:Vestibular rehabilitation decision based SVM is more accurate than ANN. The use of machine learning to assist decision-making of vestibular rehabilitation scheme has important prospective reference significance in promoting clinical medical informatization and improving medical quality.

Construction and Application of Regional Medical Information Sharing System Based on Big Data

With the popularization of network application and the rapid development of electronic science, big data technology is constantly maturing and widely used in various fields. For the continuous development of regional medical informatization in China, based on the concept of big data technology and regional medical information data sharing, this paper adopts big data to improve the quality and efficiency of medical information service so as to realize the reasonable distribution and sharing of medical resources and provide references for medical service innovation in China.

John Wiltshire, Frances Burney and the doctors: Patient narratives, then and now (United Kingdom: Cambridge University Press, 2019)

This review essay examines the emergence of the patient narrative or "pathography" in the late eighteenth and early nineteenth century in relation to the great cultural, epistemological, and ethical transformations that enabled the formation of modern medicine. John Wiltshire's book provides an historical overview of this complex process, as well as laying the basis for a contemporary critique of some of its key assumptions.

Patient Counseling Through the Pelvicalyceal-shaped Labyrinth: In Search of an Easy Understanding of the Upcoming Stone Removal: A Pilot Study

ObjectiveTo investigate the impact of a mobile application (app) displaying a visualization of the internal anatomy of the pelvicalyceal systemPCS and of kidney stones on patient understanding of their affected kidney anatomy and their upcoming percutaneous nephrolithotripsy (PCNL). Materials and methodsOne-hundred patients who required PCNL were included in this study, and all patients were nonrandomly distributed into 2 groups: counseled using only 3D-reconstructed computed tomography (CT) images (group 1) or using only the “InsKid” app (group 2). Patient data were obtained from CT scans as Digital Imaging and Communications in Medicine format and converted into stereolithography (STL) format. All patients completed the questionnaire after counseling, and the results were compared between groups. ResultsPatients from group 2 better understood the anatomy of their affected kidney by 53%; awareness regarding their stone location was better by 32%; the steps of planned surgery, as well as possible complications, were more transparent for patients using the app by 24% and 56%, respectively. The number of patients who were dissatisfied with the mobile counseling dropped by 70%. The average duration of consultation with the 3D reconstruction of CT images was 10.9 ± 0.6 min, while counseling using our program reliably led to a reduction in this duration (7.3 ± 0.5 min). ConclusionThe InsKid app is a freely available, easy-to-use educational software that improves patient counseling without considerable financial expense or long waiting periods for use.

Horseshoe crab trace fossils from the Upper Cretaceous Two Medicine Formation of Montana, USA, and a brief review of the xiphosurid ichnological record

AbstractA locality in the Upper Cretaceous Two Medicine Formation of Montana preserves abundant and variable horseshoe crab tracks and trails of the ichnotaxon Kouphichnium isp. These specimens span six morphologies differing in track form and trail configuration. These differences likely reflect variations in track-maker locomotion and behavior, substrate consistency, epichnial versus hypichnial preservation, and undertrack versus true tracks. Several tracks preserve the first clear appendage impressions for an extinct horseshoe crab. This discovery adds new information to the fossil horseshoe crab diversity in the Cretaceous Period. Trackway dimensions, such as the external width across the pusher legs or of the prosomal drag mark, provide information on the track-maker size. Most trackways correspond with crabs 9–14 cm wide; the abundance but limited size range of the traces suggests the large assemblage corresponds to a mating aggregation. The trace fossil record of xiphosurids indicates that throughout their history, horseshoe crabs inhabited both marine and nonmarine settings. They were definitively present in freshwater habitats from the lower Carboniferous through at least the Paleogene. Horseshoe crab trace abundance is highest from the upper Carboniferous through the Jurassic and likely reflects two factors: true upper Carboniferous taxonomic diversity and a preponderance of suitable sites for trackway preservation in the Late Triassic and Jurassic. Cretaceous traces are uncommon, and this Two Medicine locality is the first occurrence of horseshoe crab traces in the Late Cretaceous worldwide. Overall, track abundance and diversity would seem to correspond well with the reported horseshoe crab body fossil record.

A new terrestrial trace fossil Feoichnus martini n. isp. from the Upper Cretaceous Two Medicine Formation (USA)

AbstractA new trace fossil, Feoichnus martini new ichnospecies, from the Two Medicine Formation is here described. This ichnotaxon is reported from the upper Campanian deposits of the Egg Mountain locality (Montana) and consists of a hemispherical to hemiellipsoidal structure with a truncated upper edge, and a regular, rounded lower edge marked by a lined border composed of stained layers. The trace maker likely impregnated the border using organic fluids. The simple lined wall observed in F. martini n. isp. suggests that the structure was produced by an invertebrate soil-dwelling organism, likely an insect. Specimens are preserved as casts in calcitic Inseptisols alongside an abundant vertebrate fossil record composed by dinosaurian and nondinosaurian fossil remains, dinosaur eggs and nest structures, and pervasive insect bioturbation. Feoichnus martini n. isp. represents an additional, minor component of the impoverished Celliforma ichnofacies reported at Egg Mountain and expands the paleogeographical distribution of the ichnogenus Feoichnus Krause et al., 2008 to the Upper Cretaceous deposits of Montana, USA.UUID: http://zoobank.org/7c1a5026-7f27-4f12-a9fb-1eb8daa93baf

The use of the three-dimensional printed segmented collapsible model of the pelvicalyceal system to improve residents' learning curve.

The aim of the present study was to determine the effectiveness of the use of the three-dimensional (3D) printed segmented collapsible model of the pelvicalyceal system (PCS) to improve the learning curve of the residents. 3D printed models based on computed tomography (CT) images of 10 patients with a staghorn stone were developed. Used images of patients were obtained from CT scans in Digital Imaging and Communications in Medicine format. The area of interest was extracted and saved in stereolithography format. Further, the bioengineer performed virtual segmentation corresponding to the level of each calyces group that was defined by an experienced urologist. The final stage was the printing of each separated detail. Special questionnaire for evaluating the effectiveness of 3D models during both the examination of PCS anatomy and planning percutaneous nephrolithotomy was invented. The determination of the anterior and posterior calyces of the upper group was improved by 61% and 69%, the difference in the determination of the calyces of the middle group was 60% and 51%, and the answers regarding the number of the anterior and posterior calyces of the lower group became better by 67% and 74%, respectively (p<0.001). The ability to select the optimal calyx for the primary and the second access became better by 60% and 55%, respectively (p<0.001). 3D printed segmented collapsible model of the PCS is promising for the improvement of the learning curve of residents and enables to optimize their clinical education, as well as compensate for their lack of experience.

A semi-automated machine-learning based workflow for ellipsoid zone analysis in eyes with macular edema: SCORE2 pilot study

To develop a semi-automated, machine-learning based workflow to evaluate the ellipsoid zone (EZ) assessed by spectral domain optical coherence tomography (SD-OCT) in eyes with macular edema secondary to central retinal or hemi-retinal vein occlusion in SCORE2 treated with anti-vascular endothelial growth factor agents. SD-OCT macular volume scans of a randomly selected subset of 75 SCORE2 study eyes were converted to the Digital Imaging and Communications in Medicine (DICOM) format, and the EZ layer was segmented using nonproprietary software. Segmented layer coordinates were exported and used to generate en face EZ thickness maps. Within the central subfield, the area of EZ defect was measured using manual and semi-automated approaches via a customized workflow in the open-source data analytics platform, Konstanz Information Miner (KNIME). A total of 184 volume scans from 74 study eyes were analyzed. The mean±SD area of EZ defect was similar between manual (0.19±0.22 mm2) and semi-automated measurements (0.19±0.21 mm2, p = 0.93; intra-class correlation coefficient = 0.90; average bias = 0.01, 95% confidence interval of limits of agreement -0.18-0.20). A customized workflow generated via an open-source data analytics platform that applied machine-learning methods demonstrated reliable measurements of EZ area defect from en face thickness maps. The result of our semi-automated approach were comparable to manual measurements.

A new, transitional centrosaurine ceratopsid from the Upper Cretaceous Two Medicine Formation of Montana and the evolution of the 'Styracosaurus-line' dinosaurs.

Ceratopsids are among the most ubiquitous dinosaur taxa from the Late Cretaceous terrestrial formations of the Western Interior of North America, comprising two subfamilies, Chasmosaurinae and Centrosaurinae. The Two Medicine Formation of northwestern Montana has produced numerous remains of centrosaurine dinosaurs, which represent three taxa previously considered valid: Rubeosaurus ovatus, Einiosaurus procurvicornis and Achelousaurus horneri. Here, we reassess the previous referral of specimens to Rubeousaurus ovatus and demonstrate that this taxon is represented solely by its holotype specimen, which was first diagnosed as Styracosaurus ovatus. One of the specimens previously referred to ‘Rubeosaurus’ ovatus instead represents a new eucentrosauran centrosaurine taxon diagnosed here, Stellasaurus ancellae gen. et sp. nov. Stellasaurus expresses a unique combination of eucentrosauran centrosaurine characters, including an elongate nasal horncore, diminutive supraorbital horncores, and a parietal bearing straight, elongate P3 processes, semi-elongate P4 processes and non-elongate P5, P6 and P7 processes. Within the stratigraphic succession of Eucentrosaura, Stellasaurus occurs intermediate to Styracosaurus albertensis and Einiosaurus, and likewise reflects intermediate morphology. Assessed within the stratigraphic, geographical, taphonomic, ontogenetic and phylogenetic framework of Unified Frames of Reference, we fail to reject the hypothesis that Stellasaurus ancellae represents a transitional taxon within an anagenetic lineage of eucentrosauran centrosaurines.

Research on the characteristics of the formation and inheritance of Lei's medicine in Quzhou from the perspective of regional medicine

Lei's medicine is the main school of traditional Chinese medicine in Quzhou, Zhejiang Province. It originated from Xin'an medical school. It has been passed on for more than 200 years, but it is still lack of in-depth study. From the perspective of regional medicine, combined with the regional characteristics of Quzhou, absorbing the research results of local social history and environmental history, starting with the historical materials such as Lei's medical works, local chronicles literature and so on, the school characteristics are summarized as: the formation of "treatment in accordance with three types of disease causes" , the academic inheritance of "inheriting the past and integrating the present" , the inheritance mode of "multiple integration" , the cultural connotation of "combining medicine with Confucianism" , and the school characteristics of "integration and innovation" . The purpose of this paper is to provide reference for the research of academic schools and the inheritance of traditional Chinese medicine.

The proangiogenic effects of extracellular vesicles secreted by dental pulp stem cells derived from periodontally compromised teeth

BackgroundAlthough dental pulp stem cells (DPSCs) isolated from periodontally compromised teeth (P-DPSCs) have been demonstrated to retain pluripotency and regenerative potential, their use as therapeutics remains largely unexplored. In this study, we investigated the proangiogenic effects of extracellular vesicles (EVs) secreted by P-DPSCs using in vitro and in vivo testing models.MethodsPatient-matched DPSCs derived from periodontally healthy teeth (H-DPSCs) were used as the control for P-DPSCs. Conditioned media (CMs) derived from H-DPSCs and P-DPSCs (H-CM and P-CM), CMs derived from both cell types pretreated with the EV secretion blocker GW4869 (H-GW and P-GW), and EVs secreted by H-DPSCs and P-DPSCs (H-EVs and P-EVs) were prepared to test their proangiogenic effects on endothelial cells (ECs). Cell proliferation, migration, and tube formation were assessed using the Cell Counting Kit-8 (CCK-8), transwell/scratch wound healing, and Matrigel assays, respectively. Specifically, quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) and western blot analysis were used to examine the expression levels of angiogenesis-related genes/proteins in ECs in response to EV-based incubation. Finally, a full-thickness skin defect model was applied to test the effects of EVs on wound healing and new vessel formation.ResultsBoth H-CM and P-CM promoted EC angiogenesis, but the proangiogenic effects were compromised when ECs were incubated in H-GW and P-GW, wherein the EV secretion was blocked by pretreatment with GW4869. In EV-based incubations, although both H-EVs and P-EVs were found to enhance the angiogenesis-related activities of ECs, P-EVs exerted a more robust potential to stimulate EC proliferation, migration, and tube formation. In addition, P-EVs led to higher expression levels of angiogenesis-related genes/proteins in ECs than H-EVs. Similarly, both P-EVs and H-EVs were found to accelerate wound healing and promote vascularization across skin defects in mice, but wounds treated with P-EVs resulted in a quicker healing outcome and enhanced new vessel formation.ConclusionsThe findings of the present study provide additional evidence that P-DPSCs derived from periodontally diseased teeth represent a potential source of cells for research and therapeutic use. Particularly, the proangiogenic effects of P-EVs suggest that P-DPSCs may be used to promote new vessel formation in cellular therapy and regenerative medicine.

G-Code Generator from Bone DICOM CT with Cloud

A three dimensional (3D) medical image can provide a sense of reality for a doctor. A 3D printer can transform a 3D image into a 3D object, which provides communication between the doctor and his/her patients. One step to make the 3D object is to generate the g-code using a software. However, the existing software for creating the g-code still uses the user interface (a manual process). This study aims to generate g-code from Digital Imaging and Communications in Medicine (DICOM) format in Computerized Tomography (CT) through the cloud. The g-code generator is implemented using Phyton version 3 and runs on a computer using Linux (Ubuntu 18.4) as the operating system. The computer specification is intel core i9-9900K with motherboard Gigabyte Z390 Aorus Elite and graphic card Gigabyte GV-N208TGAMING OC11GC (memory 11GB). The medical image object is a bone that comprises craniofacial bone and thoracic vertebra, taken from multi-slice CT in DICOM format. The g-code file is suitable for a specific 3D printer. The performance criteria are the transferred data and visual shape comparison between the output from InVesalius 3.1 software and 3D printer (manually). The justification of the visual shape match from three radiology doctors for craniofacial bone and a thoracic vertebra is approximately 100% matching.

Tracking Knowledge Evolution in Cloud Health Care Research: Knowledge Map and Common Word Analysis.

BackgroundWith the continuous development of the internet and the explosive growth in data, big data technology has emerged. With its ongoing development and application, cloud computing technology provides better data storage and analysis. The development of cloud health care provides a more convenient and effective solution for health. Studying the evolution of knowledge and research hotspots in the field of cloud health care is increasingly important for medical informatics. Scholars in the medical informatics community need to understand the extent of the evolution of and possible trends in cloud health care research to inform their future research.ObjectiveDrawing on the cloud health care literature, this study aimed to describe the development and evolution of research themes in cloud health care through a knowledge map and common word analysis.MethodsA total of 2878 articles about cloud health care was retrieved from the Web of Science database. We used cybermetrics to analyze and visualize the keywords in these articles. We created a knowledge map to show the evolution of cloud health care research. We used co-word analysis to identify the hotspots and their evolution in cloud health care research.ResultsThe evolution and development of cloud health care services are described. In 2007-2009 (Phase I), most scholars used cloud computing in the medical field mainly to reduce costs, and grid computing and cloud computing were the primary technologies. In 2010-2012 (Phase II), the security of cloud systems became of interest to scholars. In 2013-2015 (Phase III), medical informatization enabled big data for health services. In 2016-2017 (Phase IV), machine learning and mobile technologies were introduced to the medical field.ConclusionsCloud health care research has been rapidly developing worldwide, and technologies used in cloud health research are simultaneously diverging and becoming smarter. Cloud–based mobile health, cloud–based smart health, and the security of cloud health data and systems are three possible trends in the future development of the cloud health care field.

The Craniosynostosis Puzzle: New Simulation Model for Neurosurgical Training

Neurosurgical training usually requires long hours for hands-on procedures, making it difficult for inexperienced surgeons to quickly learn in an error-proof environment. The objective of this study was to propose a puzzle-like new model for neurosurgical education that simulates craniosynostosis correction (scaphocephaly type) using Renier's H technique. A model of a 3-dimensional (3D) anatomic simulator for craniosynostosis training is presented and evaluated. The cranial model was created using 1-mm computed tomography scan images from patients with scaphocephaly in the Digital Imaging and Communications in Medicine format. This information was processed using an algorithm to generate a 3D biomodel in resin. The puzzle model and its variable training models were assessed qualitatively by a team of expert neurosurgeons. Next, the model was applied in trainees and was evaluated using specific questionnaires. Experts and trainees evaluated the model. The mean number of attempts without errors was 2.3 ± 0.675, for 1 error was 2.2 ± 0.918, and for 2 errors was 1.3 ± 0.707. The mean score of the simulator was 9.2 ± 0.421. Twelve residents (second evaluation) answered the questionnaire with a positive assessment of diagnosis capabilities, appropriateness of the model, time commitment, adequate environment, reliable 3D reconstruction, and teaching method. Three participants had used a 3D simulator previously, and the simulator was evaluated obtaining a 9.9final average (range, 0-10). The puzzle may be a complementary tool for surgical training. It allows several degrees of immersion and realism, offering symbolic, geometric, and dynamic information with 3D visualization. It provides additional data to support the practice of complex surgical procedures without exposing real patients to undue risk.

Technical Note: A digital reference object representing Hoffman's 3D brain phantom for PET scanner simulations.

Physical and digital phantoms play a key role in the development and testing of nuclear medicine instrumentation and processing algorithms for clinical and research applications, including neuroimaging using positron emission tomography (PET). We have developed and tested a digital reference object (DRO) version of the original segmented magnetic resonance imaging (MRI) data used for the three-dimensional (3D) PET brain phantom developed by Hoffman et al., which is used as the basis of a commercially available physical test phantom. The DRO was constructed by subdividing the MRI image planes the original phantom was based on to create equal-thickness slices and re-labeling voxels. The digital data was then embedded in a PET Digital Imaging and Communications in Medicine format and tested for compliance. We then tested the DRO by comparing it to computed tomography (CT) images of the physical phantom summed to form composite slices with axial extent similar to the DRO, but with a factor of two better in-slice resolution. For composite slices, 91% of voxels were labeled in full agreement, 5% of the voxels were 50-75% accurate, and the remaining 4% of voxels had 25% or less agreement. This DRO can be used as an input for PET scanner simulation studies or for comparing simulations to measured Hoffman phantom images.

Managing moral risks in medical insurance from the perspective of development of medical informatization

The subject of this research is the methods of managing moral risks from the perspective of development of medical informatization, which allows maintain efficiency of medical insurance and lowering medical expenses. The authors meticulously examine the problem of growing medical expenses in China, concept of moral risk in medical insurance, as well as causes for emergence of moral risk in medical insurance. Analysis is conducted on the history of development of medical informatization and functionality of information system of medical insurance in China. The question as raised on application of general information system of gathering vast amounts of intersecting data in medical insurance. The article employs method of scientific cognition of theoretical and empirical levels. The theoretical base for this research is comprised of works of Chinese and foreign scholars on the issues of moral risks in medical insurance. The scientific novelty consists in development of a moral risk management model in medical insurance on the background of informatization of medical service. A conclusion is made that moral risks in medical insurance are tightly connected with the asymmetry of information in subjects of insuring. Medical informatization became a very important means for moral risk management in medical insurance and has great prospects for increasing efficiency of the work of medical facilities.

Design and Analysis of Customized Fixation Plate for Femoral Shaft.

In the recent years, several techniques have been used to treat femur diaphyseal fracture. Among all the traditional fixation techniques, unstable fixation remains the biggest challenge for orthopedists. Researchers have recommended new approaches to deal with diaphyseal femur fracture. However, solely few had been successful in getting some better results. In the present work, a methodology comprising of design and finite-element analysis of a counter fit customized fixation plate has been suggested to provide a stable fixation. In the present work, reverse engineering (RE) approach has been invoked to create a 3D model of a fresh fractured femur diaphysis bone using the computed tomography (CT) scan data available in digital imaging and communications in medicine (DICOM) format. To provide stable fixation, a counter fit customized fixation plate at medial side has been designed and simulated under static physiological loading conditions for three different biocompatible materials, viz., titanium alloy (Ti6Al4V), stainless steel (SS-316L), and cobalt-chromium-molybdenum alloy (Co-Cr-Mo). Static stress distribution and deformation analysis of the clinical setup have been performed for the aforementioned materials. It has been observed that the stresses and deformation developed in all the materials are quite low. It implies that customized fixation plates will provide stable fixation resulting in improved fracture union. The proposed work will assist the medical practitioners regarding the design and analysis of customized implants. This will reduce the post surgical failures and residual pain due to non-union fractured region.

Brazilian Journal of Medical Education and the Health of Transgender People

Abstract: Introduction: This research aims to understand the current knowledge on the health of the transgender population in the Brazilian Journal of Medical Education. Historically, the formation in medicine was consolidated in the Cartesian discourses: the figure of the white man, heterosexual and cisgender. Method: This is a qualitative and retrospective research, which also aims to problematize the medical education and the importance of Queer Studies. A documental analysis was carried out to identify the content in the conceptual constructs of the documents published between 2008 and 2017. The content analysis method according to Bardin was then chosen. Results: The methodological management indicated four categories for study: knowledge about the sexuality of medical students; gender as a research variable; gender and education; training and sexuality. Conclusion: The analyzed material indicates the lack of publications on the health of people whose gender identity is considered as dissident. The need for editorial opening is pointed out, with the purpose of providing visibility to the demands of the transgender population in the journal, aiming to broaden the discussions on the integral health of the LGBTTQIA+ population during graduation.

Brazilian Journal of Medical Education and the Health of Transgender People

Abstract: Introduction: This research aims to understand the current knowledge on the health of the transgender population in the Brazilian Journal of Medical Education. Historically, the formation in medicine was consolidated in the Cartesian discourses: the figure of the white man, heterosexual and cisgender. Method: This is a qualitative and retrospective research, which also aims to problematize the medical education and the importance of Queer Studies. A documental analysis was carried out to identify the content in the conceptual constructs of the documents published between 2008 and 2017. The content analysis method according to Bardin was then chosen. Results: The methodological management indicated four categories for study: knowledge about the sexuality of medical students; gender as a research variable; gender and education; training and sexuality. Conclusion: The analyzed material indicates the lack of publications on the health of people whose gender identity is considered as dissident. The need for editorial opening is pointed out, with the purpose of providing visibility to the demands of the transgender population in the journal, aiming to broaden the discussions on the integral health of the LGBTTQIA+ population during graduation.

Effects of five levels of noise reduction applied to indirect digital radiography on diagnostic accuracy of external apical root resorption

Radiologic diagnosis of external apical root resorption (EARR) is clinically important. Noise might disrupt this diagnosis. Therefore, we assessed the efficacy of noise reduction on periapical indirect digital radiography. This in vitro study as performed on 792 radiographs. A total of 66 single-rooted premolars were inserted in dried hemimandibles of sheep and fixed with modeling wax. Digital images were obtained using the parallel technique. The storage phosphor plates were processed in the DIGORA Optime scanner. The resulting images were sent to a computer using the Scanora software for radiographic analysis. The teeth were removed from the mandible, and artificial EARR defects were simulated. Afterward, the indirect digital radiographs were obtained at the same condition of the baseline. Five levels of noise reduction were applied. All images were saved in Digital Imaging and Communications in Medicine format and monitored by two observers twice over 2 weeks. Data were analyzed statistically using Cochran and McNemar tests (α = 0.05). The highest sensitivity rate was found in the baseline group (0.99), and the lowest sensitivity was related to the "four-time noise reduction" method (0.91). The highest specificity rate was in the "five-times noise reduction" method (0.88) and the lowest specificity was associated with "one-time noise reduction" method (0.71). There was no statistical difference between images with/without noise reduction enhancement with varied gradation levels in terms of diagnostic accuracies of EARR (P > 0.05). Application of noise reduction procedure in Scanora software might have no effect on the accuracy of EARR diagnosis.