Prioritization of Patients with Abnormal Breast Findings in the Alerta Rosa Navigation Program to Reduce Diagnostic Delays

IntroductionIn Mexico, there are considerable health system delays in the diagnosis and treatment initiation of women with breast cancer. Alerta Rosa is a navigation program in Nuevo Leon that aims to reduce barriers that impede the timely management of these patients.Patients and MethodsSince December 2017, women who registered to receive medical evaluations by Alerta Rosa were stratified based on their clinical characteristics into three priority groups (“Red,” “Yellow,” and “Green”). According to the category assigned, patients were scheduled imaging studies and medical appointments with breast specialists on a preferential basis.ResultsUp until December 2019, 561 patients were scheduled for medical evaluations. Of them, 59% were classified as “Red,” 25% “Yellow,” and 16% “Green” priority. The median time from stratification to first medical evaluation was 4, 6, and 7 days, respectively (p = .003). Excluding those who had a prior breast cancer diagnosis, 21 patients were diagnosed by Alerta Rosa, with the initial “Red” priority classification demonstrating a sensitivity of 95% (95% confidence interval [CI], 75.1%–99.9%) and specificity of 42% (95% CI, 37.1%–47.1%) for breast cancer. The median time elapsed from initial patient contact to diagnosis and treatment initiation was 16 days and 39 days, respectively. The majority (72%) of patients were diagnosed at an early stage (0–II).ConclusionThis patient prioritization system adequately identified women with different probabilities of having breast cancer. Efforts to replicate similar triage systems in resource‐constrained settings where screening programs are ineffective could prove to be beneficial in reducing diagnostic intervals and achieving early‐stage diagnoses.Implications for PracticeLow‐ and middle‐income countries such as Mexico currently lack the infrastructure to achieve effective breast cancer screening and guarantee prompt access to health care when required. To reduce the disease burden in such settings, strategies targeting early detection are urgently needed. Patient navigation programs aid in the reduction of health system intervals and optimize the use of available resources. This article presents the introduction of a triage system based on initial patient concern. Appointment prioritization proved to be successful at reducing health system intervals and achieving early‐stage diagnoses by overcoming barriers that impede early access to quality medical care.     

An electronic travel guide for visually impaired – vehicle board recognition system through computer vision techniques

Abstract

Purpose: In the context of assistive technology, mobility takes the meaning of “moving safely, gracefully, and comfortably”.The aim of this article is to provide a system which will be a convenient means of navigation for the Visually Impaired people, in the public transport system.

Method: A blind regular commuter who travels by public transport facility finds difficulty in identifying the vehicle that is nearing the stop. Hence, a real-time system that dynamically identifies the nearing vehicle and informs the commuters is necessary. This paper proposes such a system namely the “Vehicle Board Recognition System” (VBRS). Computer Vision techniques such as segmentation, object recognition, text detection and optical character recognition are utilized to build the system, which will detect, analyze, derive and communicate the information to the passengers.

Results: Thanks to the rapid development in technology, there are several navigation systems both hand held and wearable, available to help visually impaired (VI) people move comfortably both indoor and outdoor. Many blind people are not comfortable in using these devices or they are not affordable for them. Thus the proposed system gives them the comfort of navigation.

Conclusion: This system can be installed in the bus stop to assist the Visually Impaired, from externally rather than their hand held or wearable assistive devices.

• Implications for rehabilitation

• This proposed system will help the visually impaired to

• ensure secure navigation

• be independent of the others

• develop self confidence.

• overcome the training, affordability of wearable/ handheld devices.

     

经典名方物质基准研制的关键技术分析

中药经典名方开发已成为当下中医药界研究的热点之一,而其中经典名方物质基准的成功研制对于整个中药经典名方的申报极为关键。经典名方物质基准既是检测经典名方制剂质量的基准,同时又需反映整方的物质基础。中药成分众多而复杂,单成分的、化药式的研发与质量控制模式难以适用于整体药用的中药制剂的开发,亟需开辟一条中药专属的研发模式。以目前已有的现代科学技术,笔者建议将中药的遗传多态性、提取动力学、指纹图谱总量统计矩(相似度)法、超分子"印迹模板"等结合应用于经典名方物质基准的研制,探讨中药经典名方物质基准的质量控制技术,以期全面、准确地阐明药材-饮片-物质基准的成分群量值的传递规律,为推进中药经典名方的研制进程提供参考。     

Versatile applicability of a grid-based CYP3A4 Template to understand the interacting mechanisms with the small-size ligands; part 3 of CYP3A4 Template study

Modes of interactions of small ligands with CYP3A4 have been defined using the Template established in our previous studies (DMPK. 34: 113–125 2019 and 34 351–364 2019). Interactions of polyaromatic hydrocarbons such as benzo[a]pyrene, pyrene and dibenzo[a,j]acridine were refined with the idea of Right-side movement of ligands at Rings A and B of Template. Expected formation of metabolites from the placements faithfully matched with experimentally observed sites of their metabolisms and also with preferred orders of regio-isomeric metabolite abundances in recombinant CYP3A4 system. In comparison of CYP3A4-ligand data with the placements on simulations, a futile sitting of non-substituted and free rotatable phenyl structures was suggested as a cause of poor oxidations of the phenyl parts of CYP3A4 ligands. These data were in turn indicative of the role of the rotation-ceasing action for the function. Typical inhibitors, ketoconazole, nicardipine, mibefradil and GF-I-1 shared mutuality on their sittings, in which the inhibitor molecules hold a CYP3A4 residue from dual sides on Template. In addition, clotrimazole would be stuck between facial- and rear-side walls of CYP3A4 and interact with ferric iron through nitrogen atom of the imidazole part. These data offered structural bases of CYP3A4-inhibitory actions of ligands.     

Intraoperative three-dimensional navigation for surgical treatment of osteoid osteoma in the foot and ankle – A series of 14 cases

BackgroundThe surgical treatment for osteoid osteoma (OO) in the foot and ankle is challenging. It is difficult to locate the lesion and the anatomy is crowded by sensitive structures. The purpose of this study was to describe the outcomes of navigated mini open-intralesional curettage (NMIC) or navigated minimally invasive radiofrequency ablation (NMRFA) in treating these lesions.MethodsAll patients who underwent surgery for OO in the foot and ankle between 2015 and 2020 were included. O-arm navigation was used in All procedures. The choice of NMIC versus NMRFA was made by the surgeon according to the location of the lesion and its proximity to sensitive anatomic structures.ResultsFourteen patients were included. Ten were operated by NMRFA and 4 by NMIC. All patients’ symptoms related to OO resolved following a single procedure. Average AOFAS score increased by 18.7 (P < .001). Three patients had the following complications: pathologic fracture, superficial infection and transient deep peroneal nerve sensory loss.ConclusionNavigated surgical treatment of OO in the foot and ankle is accurate, efficient and safe.     

基于超分子“印迹模板”理论探讨中药升降浮沉

在前期提出超分子化学对中药四性理论特殊影响的基础上,进一步分析中药升降浮沉的历史沿革、研究概况,并运用超分子"印迹模板"理论对中药"升降浮沉"理论进行解析,提出对中药"升降浮沉"的评价方法。人体与中药均是印迹模板印迹作用的聚集体,在印迹模板作用规律下,不同类型的中药成分与人体的靶点通过"锁-钥"关系以非共价键结合,中药客体超分子通过键的作用可纠正人体主体超分子在自识别、自组织、自组装、自复制过程时发生的寒热、气机失调。人体具备抵抗外界病邪侵袭的能力,有赖于其气机"升降出入"的正常;中药具有"升降浮沉"的性能并能祛除病疾,有赖于其能调整人体气机紊乱,或顺应气机、祛邪外出以增强机体免疫的能力。基于此,在分析中药"升降浮沉"药理作用的基础上,探究其物质基础,并建立中药"升降浮沉"的评价方法,通过超分子印迹模板理论对中药升降浮沉进行剖析,揭示其科学内涵,推动中药药性理论不断创新。     

Guided biopsy of osseous pathologies in the jaw bone using a 3D-printed,tooth-supported drilling template

Suspicious radiological findings in the jaw bone require histopathological examination for the confirmation of a diagnosis. As pathologies in this region are difficult to reach or are in close proximity to relevant anatomical structures, e.g. tooth roots or nerves, they often represent a challenge. Such factors may adversely affect the predictability of the surgical outcome of a biopsy of the osseous tissues. This technical note introduces a novel method for performing a digitally planned, guided biopsy. For this purpose, a cone beam computed tomography scan and an intraoral scan are superimposed using specific planning software. The resulting three-dimensionally printed, tooth-supported drilling template is designed for a trephine biopsy. It allows a precise, minimally invasive approach, with an exact three-dimensional determination of the biopsy location prior to surgery. The risk of devitalization of the neighbouring teeth or possible damage to the nerve structures can be minimized. Furthermore, a small access flap can be sufficient. In summary, the method of bone biopsy presented here allows high precision and greater predictability for biopsy sampling and is minimally invasive for the patient.