• 文章类型: Journal Article
    这篇综述探讨了人工智能(AI)对修复性牙科的变革影响。通过讨论诊断过程,治疗计划,图像分析,口腔修复术,和材料/生物材料研究,这项研究强调了人工智能在优化精度和效率方面的作用。它强调个性化的材料选择,加速生物材料研究,和支持AI的临床工作流程,以增强患者的预后。审查的结论是对挑战的见解,伦理考虑,和未来的趋势,强调人工智能驱动的修复牙科持续创新所需的协作努力。
    This review explores the transformative impact of artificial intelligence (AI) on restorative dentistry. By discussing the diagnostic processes, treatment planning, image analysis, prosthodontics, and material/biomaterial research, this study highlights the role of AI in optimizing precision and efficiency. It emphasizes personalized material selection, accelerated biomaterial research, and AI-enabled clinical workflows for enhanced patient outcomes. The review concludes with insights into the challenges, ethical considerations, and future trends, emphasizing the collaborative efforts needed for continued innovation in AI-driven restorative dentistry.
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  • 文章类型: Journal Article
    为了评估力量和条件对舞蹈人群身体素质和审美能力的影响的证据,三个电子数据库(PubMed,Scopus,搜索SPORTDiscus)(直到2022年9月)符合以下标准的研究:(i)年龄>16岁的舞者;(ii)结构化的力量和条件干预;(iii)以身体素质和美学能力作为结果指标。通过系统评价工具“QualSyst”评估纳入研究的方法学质量和偏倚风险。对森林地块的效应大小(Hedges\'g)的荟萃分析探讨了强度和条件干预措施的影响。36项研究符合纳入标准,被纳入本综述。荟萃分析表明力量和调理显着(p<0.05)改善了下半身力量(g=0.90,95%CI:0.53-1.27),上身强度(g=0.98,95%CI:0.39-1.57),下体强度(g=1.59,95%CI:0.97-2.22),和灵活性(g=0.86,95%CI:0.05-1.66)。发现力量和调理干预措施可有效改善舞者的身体素质,建议他们参加其他课程,以增强整体健身并最终提高舞蹈表演。建议未来强度和条件干预研究应包括样本量计算,从特定舞蹈类型和技能水平招募参与者,以评估力量和条件如何影响舞蹈表演。
    To assess the evidence for the effect of strength and conditioning on physical qualities and aesthetic competence in dance populations, three electronic databases (PubMed, Scopus, SPORTDiscus) were searched (until September 2022) for studies that met the following criteria: (i) dancers aged >16 years; (ii) structured strength and conditioning intervention; and (iii) with physical qualities and aesthetic competence as outcome measures. Methodological quality and risk of bias of the included studies were assessed through the systematic review tool \"QualSyst\". Meta-analyses of effect sizes (Hedges\' g) with forest plots explored the effects of the strength and conditioning interventions. Thirty-six studies met the inclusion criteria and were included in this review. Meta-analysis indicated strength and conditioning significantly (p < 0.05) improved lower body power (g = 0.90, 95% CI: 0.53-1.27), upper body strength (g = 0.98, 95% CI: 0.39-1.57), lower body strength (g = 1.59, 95% CI: 0.97-2.22), and flexibility (g = 0.86, 95% CI: 0.05-1.66). Strength and conditioning interventions were found to be effective at improving physical qualities in dancers, recommending their participation in additional sessions to enhance overall fitness and ultimately dance performance. It is recommended that future strength and conditioning intervention research should include sample size calculations, with participants recruited from a specific dance genre and skill level in order to evaluate how strength and conditioning influences dance performance.
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  • 文章类型: Journal Article
    神经肌肉疾病患者在围手术期特别容易发生肺部和心脏并发症,或药物副作用。这些风险可能包括通气不足,吸入性肺炎,潜在心肌病恶化,心律失常,肾上腺功能不全,长时间的神经肌肉阻滞,与体温调节有关的问题,横纹肌溶解症,恶性高热,或长时间的机械通气。可以在每个围手术期实施干预以减轻这些风险。仔细的术前评估可能有助于识别风险因素,以便启动适当的干预措施。包括心脏病学咨询,肺功能检查,开始无创通气,或采取预防措施。重要的术中问题包括定位,气道和麻醉管理,和足够的通风。术后期间可能需要纠正电解质异常,用药物控制分泌物,手动或机械咳嗽辅助,避免重新插管的风险,明智的疼痛控制,和适当的药物管理。这项审查的目的是提高对这一弱势群体的特殊手术挑战的认识,并指导临床医生进行可能导致良好手术效果的各种评估和干预措施。
    Patients with neuromuscular diseases are particularly vulnerable in the perioperative period to the development of pulmonary and cardiac complications, or medication side effects. These risks could include hypoventilation, aspiration pneumonia, exacerbation of underlying cardiomyopathy, arrhythmias, adrenal insufficiency, prolonged neuromuscular blockade, issues related to thermoregulation, rhabdomyolysis, malignant hyperthermia, or prolonged mechanical ventilation. Interventions at each of the perioperative stages can be implemented to mitigate these risks. A careful pre-operative evaluation may help identify risk factors so that appropriate interventions are initiated, including cardiology consultation, pulmonary function tests, initiation of noninvasive ventilation, or implementation of preventive measures. Important intraoperative issues include positioning, airway and anesthetic management, and adequate ventilation. The postoperative period may require correction of electrolyte abnormalities, control of secretions with medications, manual or mechanical cough assistance, avoiding the risk of reintubation, judicious pain control, and appropriate medication management. The aim of this review is to increase awareness of the particular surgical challenges in this vulnerable population, and guide the clinician on the various evaluations and interventions that may result in a favorable surgical outcome.
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  • 文章类型: Journal Article
    与快速性心律失常不同,这在怀孕期间很常见,关于孕产妇心动过缓的数据很少。我们的目标是描述特征,相关条件,以及产后发生心动过缓的妇女的预后。
    我们对2012年1月至2020年5月因产妇心动过缓而转诊至不列颠哥伦比亚省妇女医院产科医学服务机构的患者进行了回顾性图表回顾。
    包括24例产后心动过缓患者(年龄34.2±4.8岁;心率40.4±8.1次/分钟;血压131/72mmHg)。窦性心动过缓(79.2%)是最常见的节律。呼吸困难(29.4%)和胸痛(23.5%)是常见症状。心动过缓的平均消退时间为3.6±3.8天。可能解释心动过缓的相关条件是先兆子痫(54.1%),基本(16.7%),药物(8.3%),和神经轴麻醉(8.3%)。
    孕产妇心动过缓是一种罕见的疾病,会使产后复杂化。这通常是自我限制的,大多数只需要临床观察。
    UNASSIGNED: Unlike tachyarrhythmias, which are common in pregnancy, there is a paucity of data regarding maternal bradycardias. Our objective was to describe the characteristics, associated conditions, and prognosis of women who develop bradycardia post-partum.
    UNASSIGNED: We conducted a retrospective chart review of patients referred to the Obstetrical Medicine service at British Columbia Women\'s Hospital from January 2012 to May 2020 for post-partum maternal bradycardia.
    UNASSIGNED: Twenty-four patients with post-partum bradycardia were included (age 34.2  ±  4.8 years; heart rate 40.4  ±  8.1 beats per minute; blood pressure 131/72 mm Hg). Sinus bradycardia (79.2%) was the most common rhythm. Dyspnea (29.4%) and chest pain (23.5%) were common symptoms. Mean time to resolution of bradycardia was 3.6  ±  3.8 days. Associated conditions potentially explaining the bradycardia were preeclampsia (54.1%), underlying (16.7%), medications (8.3%), and neuraxial anesthesia (8.3%).
    UNASSIGNED: Maternal bradycardia is an uncommon condition complicating the post-partum period, that is generally self-limiting, with the majority only require clinical observation.
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  • 文章类型: Journal Article
    背景:氯胺酮,作为麻醉剂,已考虑终止癫痫持续状态(SE);然而,由于病情的紧迫性和严重性,目前,国际上尚无评价氯胺酮治疗超难治性癫痫持续状态疗效的随机对照试验.同样,文献中似乎缺乏解决这一主题的系统评论。因此,本系统综述旨在探讨氯胺酮终止超难治性癫痫持续状态的有效性和安全性.
    方法:我们对PubMed进行了系统搜索,EMBASE,和WebofScience数据库。排除与超难治性癫痫持续状态研究无关的手稿,用非英语出版的手稿也是如此。使用MINORS标准评估质量评估和偏倚风险。由于数据不适合进行荟萃分析,数据提取仅限于定性综合。
    结果:从电子数据库检索的782项研究中,11符合纳入标准。其中,10项研究是回顾性的,1项研究是前瞻性的。纳入的患者数据来自研究人员各自医院的病例登记处。在所有纳入的研究中,与未接受氯胺酮治疗的超难治性癫痫持续状态患者相比,氯胺酮的给药显著缩短了癫痫持续状态的持续时间,并显示出更高的安全性.此外,早期给予氯胺酮与改善治疗结局相关.所有研究的偏倚风险被认为是低的。
    结论:本系统综述提示氯胺酮可能是治疗超难治性癫痫持续状态的可行选择。然而,鉴于超难治性癫痫持续状态的关键性质,临床医生应优先考虑其终止,而不是评估特定药物的疗效,确保患者安全仍然至关重要。如果在现实世界的医疗环境中可行,未来的研究应集中于设计随机对照试验,以观察氯胺酮的具体疗效和作用机制.在考虑将氯胺酮作为超难治性癫痫持续状态的一线治疗之前,需要仔细验证。
    BACKGROUND: Ketamine, as an anesthetic, has been considered for terminating status epilepticus (SE); however, due to the urgency and severity of the condition, there are currently no randomized controlled trials internationally assessing the efficacy of ketamine for treating super-refractory status epilepticus. Similarly, there appears to be a lack of systematic reviews addressing this topic in the literature. Therefore, this systematic review aims to explore the effectiveness and safety of ketamine for terminating super-refractory status epilepticus.
    METHODS: We conducted a systematic search on PubMed, EMBASE, and Web of Science databases. Manuscripts unrelated to the research on super-refractory status epilepticus were excluded, as were manuscripts published in non-English languages. The quality assessment and risk of bias were evaluated using the MINORS criteria. Data extraction was limited to qualitative synthesis due to the unsuitability of the data for meta-analysis.
    RESULTS: Out of 782 studies retrieved from electronic databases, 11 met the inclusion criteria. Among them, 10 studies were retrospective, and 1 study was prospective. Patient data for inclusion were sourced from the case registries of the researchers\' respective hospitals. Across all included studies, the administration of ketamine significantly reduced the duration of status epilepticus and demonstrated higher safety compared to patients not receiving ketamine treatment for super-refractory status epilepticus. Additionally, early administration of ketamine correlated with improved treatment outcomes. The risk of bias across all studies was deemed low.
    CONCLUSIONS: This systematic review suggests that ketamine may be a feasible treatment option for super-refractory status epilepticus. However, given the critical nature of super-refractory status epilepticus, clinicians should prioritize its termination over evaluating the efficacy of specific medications, ensuring patient safety remains paramount. If feasible in real-world medical settings, future research should focus on designing randomized controlled trials to observe the specific efficacy and mechanisms of ketamine. Careful validation is necessary before considering ketamine as a first-line treatment for super-refractory status epilepticus.
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  • 文章类型: Journal Article
    头颈部肿瘤切除后的骨缺损可导致显著的功能和美学缺陷。最佳重建方法的选择取决于几个因素,例如缺陷的大小,肿瘤的位置,病人的健康和外科医生的经验。如今,重建金标准由使用钛板进行骨合成的血管重建骨肌皮瓣或骨肌皮瓣代表。常用的供体部位是腓骨,髂骨,和肩胛骨外侧/肩胛骨角。近年来,计算机辅助设计(CAD)/计算机辅助制造(CAM)系统彻底改变了重建领域,随着立体光刻模型的引入,其次是虚拟计划软件和3D打印板和假体。这项技术在准确性方面表现出了出色的可靠性,精确性和可预测性,导致更好的手术结果,减少手术时间和降低并发症发生率。缺点是成本高,实施时间和规划适应性差。这些问题正在为开发用于规划和3D打印的“内部”实验室找到部分解决方案。当今使用CAD/CAM技术的有力适应症是下颌骨或上颌骨全部或次全缺损的重建以及二次骨重建。
    Bone defects following resections for head and neck tumours can cause significant functional and aesthetic defects. The choice of the optimal reconstructive method depends on several factors such as the size of the defect, location of the tumour, patient’s health and surgeon’s experience. The reconstructive gold standard is today represented by revascularised osteo-myocutaneous or osteomuscular flaps with osteosynthesis using titanium plates. Commonly used donor sites are the fibula, iliac crest, and lateral scapula/scapular angle. In recent years, computer-aided design (CAD)/computer assisted manufacturing (CAM) systems have revolutionised the reconstructive field, with the introduction of stereolithographic models, followed by virtual planning software and 3D printing of plates and prostheses. This technology has demonstrated excellent reliability in terms of accuracy, precision and predictability, leading to better operative outcomes, reduced surgical times and decreased complication rates. Among the disadvantages are high costs, implementation times and poor planning adaptability. These problems are finding a partial solution in the development of “in house” laboratories for planning and 3D printing. Strong indications for the use of CAD/CAM technologies today are the reconstruction of total or subtotal mandibular or maxillary defects and secondary bone reconstructions.
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  • 文章类型: Journal Article
    降血糖药和麻醉技术的同时使用已被证明可以减轻没有糖尿病的危重患者的应激性高血糖。从而有助于提高患者的治疗效果。应激性高血糖,以急性疾病或生理压力导致的血糖水平升高为特征,经常表现在经历危重疾病的患者中。这种情况与发病率增加有关,住院时间延长,和死亡率上升。这篇综述旨在介绍和严格评估用于缓解应激性高血糖的各种降血糖药和麻醉技术。强调继续研究以全面确定这些方法的安全性和有效性的必要性,这将促进他们更广泛的融合。
    The concurrent utilization of hypoglycemic agents and anesthetic techniques has been demonstrated to mitigate stress hyperglycemia in critically ill patients without diabetes, thereby contributing to enhanced patient outcomes. Stress hyperglycemia, characterized by elevated blood glucose levels as a result of acute illness or physiological stress, frequently manifests in patients experiencing critical illness. This condition has been linked to augmented morbidity, protracted hospitalization durations, and elevated mortality rates. This review aims to introduce and critically assess various hypoglycemic agents and anesthetic techniques employed to alleviate stress hyperglycemia, emphasizing the necessity for continued research to comprehensively ascertain the safety and efficacy of these approaches, which will facilitate their broader integration.
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  • 文章类型: Systematic Review
    脂肪团,皮肤形貌的感知变化,主要存在于富含脂肪组织的身体区域,如臀部,臀部,大腿,和腹部。与普遍的信念相反,脂肪团的病因和病理生理学尚未得到充分证实或普遍同意。对脂肪团的实际病因缺乏了解直接影响了选择合适的治疗方法,这些治疗方法可以解决该病症的美学和炎症方面的问题。各种治疗方法,包括电流等电物理因子,射频,超声,和光生物调节,已经过测试。然而,许多研究的方法学质量令人怀疑,使确定脂肪团的有效治疗方法变得复杂。在这项研究中,我们对利用电物理药物治疗脂肪团的临床研究进行了系统评价.
    方法:我们采用了PICO(人口,干预,control,和结果)制定我们的搜索策略并建立纳入/排除标准的过程。我们搜索了五个数据库:Medline,中央,Scopus,丁香花,还有PEDro,在2001年至2021年7月之间进行的研究中,涉及使用电物理药物进行脂肪团治疗。为了确保系统性和指导研究选择,我们遵守系统评价和荟萃分析(PRISMA)指南的首选报告项目。
    结果:我们最初的搜索产生了556篇文章:379来自Medline,159来自中央,和18来自丁香。在应用我们的纳入标准后,仅剩下32项研究。其中,通过QualSyst工具,只有2例(6.2%)被评估为具有强大和良好的方法.
    结论:我们的研究结果表明,关于使用电物理药物治疗脂肪团的临床研究的证据质量仍然低于标准。需要进一步研究可靠的实验设计和更精确的评估技术。虽然我们的研究没有反驳用于脂肪团治疗的技术的有效性,它强调需要额外的精心设计的试验。
    Cellulite, a perceived alteration in skin topography, is predominantly found in adipose tissue-rich body regions such as the hips, buttocks, thighs, and abdomen. Contrary to common belief, the etiology and pathophysiology of cellulite are not well-established or universally agreed upon. This lack of understanding about the actual etiology of cellulite directly influences the selection of suitable treatments that can address both the aesthetic and inflammatory aspects of the condition. Various treatment methods, including electrophysical agents like electric currents, radiofrequency, ultrasound, and photobiomodulation, have been tested. However, the questionable methodological quality of many studies complicates the determination of effective treatments for cellulite. In this study, we conducted a systematic review of clinical studies that utilized electrophysical agents in cellulite treatment.
    METHODS: We employed the PICO (population, intervention, control, and outcome) process to develop our search strategy and establish inclusion/exclusion criteria. We searched five databases: Medline, Central, Scopus, Lilacs, and PEDro, for studies conducted between 2001 and July 2021 that involved cellulite treatment with electrophysical agents. To ensure systematicity and guide study selection, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.
    RESULTS: Our initial search yielded 556 articles: 379 from Medline, 159 from Central, and 18 from Lilacs. After applying our inclusion criteria, only 32 studies remained. Of these, only two (6.2%) were evaluated as having strong and good methodology via the QualSyst tool.
    CONCLUSIONS: Our findings indicate that the quality of evidence from clinical studies on the use of electrophysical agents for cellulite treatment remains subpar. Further studies with robust experimental designs and more precise assessment techniques are necessary. While our study does not refute the effectiveness of the techniques used for cellulite treatment, it underscores the need for additional well-designed trials.
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  • 文章类型: Journal Article
    背景:如今,多模式癌症治疗导致早期乳腺癌的存活率很高,基于皮瓣的显微外科乳房重建已变得安全可靠,随着逐渐增加的需求,因为其耐用和美观的结果。这项研究旨在探讨不同的皮瓣成形和嵌入技术对患者报告的结果测量(PROMs)的影响,这些结果测量与基于腹部皮瓣的乳房重建中的美学结果有关。方法:系统评价筛查Pubmed,Cochrane图书馆和WebofScience的原始文章报告襟翼插图策略,同时在美学结果上提供PROM。结果:在确定的319项研究中,六人符合纳入标准。这些研究根据患者的形态描述了不同的皮瓣旋转选择,不同的插图平面,避免监测皮肤桨,并提示较高的皮瓣与乳房切除术质量比与较好的美学效果相关。在两项比较研究中,根据PROMs(BREAST-Q,李克特量表)和独立观察者判断,使用新描述的技术观察到更高的患者满意度和更好的美学效果。结论:强调乳房形状和对称性方面的美学结果,提供个性化的皮瓣插图方法,考虑到对侧乳房的形状和体积,结果满意度得分较高。
    Background: Nowadays, multimodal cancer therapy results in very high survival rates of early-stage breast cancer and microsurgical flap-based breast reconstruction has become safe and reliable, with gradually increasing demand because of its durable and aesthetically pleasing results. This study aimed to explore the impact of different flap shaping and inset techniques on patient-reported outcome measures (PROMs) with regard to the aesthetic result in abdominal flap-based breast reconstruction. Methods: A systematic review was performed screening Pubmed, Cochrane Library and Web of Science for original articles reporting flap inset strategies, concomitantly providing PROMs on the aesthetic result. Results: Of 319 studies identified, six met the inclusion criteria. The studies described different flap rotation options according to the patient\'s morphology, different inset planes, and avoidance of the monitoring skin paddle, and suggested that a higher flap-to-mastectomy mass ratio was associated with better aesthetic results. In two comparative studies, according to the PROMs (BREAST-Q, Likert scale) and independent observer judgement, both higher patient satisfaction and superior aesthetic results were observed with the newly described techniques. Conclusions: Emphasis on the aesthetic outcome in terms of breast shape and symmetry, providing an individualized approach of flap inset, considering the contralateral breast\'s shape and volume, results in higher satisfaction scores.
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  • 文章类型: Systematic Review
    面部移植已成为严重毁容患者的最后一种重建选择,已成为临床现实。迄今为止,临床结局仍不清楚.本文的目的是分析面部移植(FT)的结果,并根据短期和长期结果确定FT的风险和收益。在PubMed进行了电子文献检索,EMBASE和Cochrane中央对照试验登记册(CENTRAL)数据库,以捕获2005年至2021年与FT结果有关的所有相关记录。列入条款是根据预先定义的列入和排除标准决定的。迄今为止,共进行了48次FT。共有90项研究符合资格标准,并被纳入结果分析。根据48例病例中的每一例进行分析,并将结果分为短期(<36个月)和长期(>36个月)结果。主要结果包括患者和移植物存活,次要结果包括功能,手术翻修事件,免疫学,医疗并发症,美学,社会心理和生活质量。死亡率,感染和恶性肿瘤的发病率仍然很高,患者应充分了解潜在的危及生命的并发症。FT在短期和长期改善生活质量和社会心理恢复等结果。结果在同行评审期刊中报告不足。
    Facial transplantations have become a clinical reality as the last reconstructive option in severely disfigured patients. To date, clinical outcomes remain unclear. The purpose of this paper was to analyse the outcomes in facial transplantation (FT) and determine the risks and benefits of FT based on short- and long-term outcomes. An electronic literature search was performed across PubMed, EMBASE and the Cochrane Central Register for Controlled Trials (CENTRAL) databases to capture all the relevant records relating to outcomes in FTs from 2005 to 2021. Articles for inclusion were decided upon pre-defined inclusion and exclusion criteria. A total of 48 FTs has been performed to date. A total of 90 studies met the eligibility criteria and were included in the outcome analysis. Studies were analysed based on each of the 48 cases and outcomes categorised into short-term (<36 months) and long-term (>36 months) outcomes. Primary outcomes included patient and graft survival and secondary outcomes included functional, surgical revision events, immunological, medical complications, aesthetics, psychosocial and quality of life. Mortality rate, infection and malignancy incidence remain high, and patients should be fully informed of the potential life-threatening complications. FTs improve outcomes such as quality of life and psychosocial recovery in the short- and long-term. Outcomes remain under-reported in peer-review journals.
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