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1.
目的 在肺癌微波消融治疗中探究基于CT的三维数字化导航技术的应用价值。方法 回顾性分析我院收治的92例肺癌患者,随机进行三维数字化导航微波消融或传统CT引导下微波消融,分为三维导航组和传统组,依据肿瘤位置、大小(最大径差值≤2 mm)及微波消融条件不同两两配对,共46对,比较2组手术时间、微波针穿刺次数、CT剂量指数、术中并发症发生率、术后病灶控制情况。结果 三维导航组与传统组的手术时间分别为(30.07 ± 6.36)min、(47.20 ± 9.65)min、穿刺次数分别为(1.72 ± 0.69)次、(7.13 ± 3.00)次、CT剂量指数分别为(11.16 ± 2.20)mGy、(26.67 ± 8.72)mGy、术中并发症发生率分别为10.87%、34.78%,以上3个指标三维导航组均低于传统组,三维导航组治疗有效率(93.48%)高于传统组(71.74%),差异均有统计学意义(P < 0.05)。结论 CT引导下利用三维数字化导航技术行肺癌微波消融治疗,使介入穿刺手术的操作更加精准安全。  相似文献   
2.
Introduction and objectivesIonizing radiation exposure in catheter ablation procedures carries health risks, especially in pediatric patients. Our aim was to compare the safety and efficacy of catheter ablation guided by a nonfluoroscopic intracardiac navigation system (NFINS) with those of an exclusively fluoroscopy-guided approach in pediatric patients.MethodsWe analyzed catheter ablation results in pediatric patients with high-risk accessory pathways or supraventricular tachycardia referred to our center during a 6-year period. We compared fluoroscopy-guided procedures (group A) with NFINS guided procedures (group B).ResultsWe analyzed 120 catheter ablation procedures in 110 pediatric patients (11 ± 3.2 years, 70% male); there were 62 procedures in group A and 58 in group B. We found no significant differences between the 2 groups in procedure success (95% group A vs 93.5% group B; P = .53), complications (1.7% vs 1.6%; P = .23), or recurrences (7.3% vs 6.9%; P = .61). However, fluoroscopy time (median 1.1 minutes vs 12 minutes; P < .0005) and ablation time (median 96.5 seconds vs 133.5 seconds; P = .03) were lower in group B. The presence of structural heart disease was independently associated with recurrence (P = .03).ConclusionsThe use of NFINS to guide catheter ablation procedures in pediatric patients reduces radiation exposure time. Its widespread use in pediatric ablations could decrease the risk of ionizing radiation.  相似文献   
3.
The aim of this retrospective study was to investigate the accuracy of dynamic navigation for the placement of intentionally tilted implants in the posterior maxilla. The study included 12 patients with edentulism or continuous multiple tooth loss, who had 48 implants inserted under dynamic navigation guidance in the posterior maxilla. Twenty-four implants near maxillary sinuses were intentionally tilted. The average platform deviation was 1.3 ± 0.4 mm (range 0.8–2.3 mm), apex deviation was 1.1 ± 0.5 mm (range 0.2–2.3 mm), and axis deviation was 3.1 ± 1.0° (range 1.8–6.7°). The other 24 implants were axially positioned. The average platform deviation was 1.5 ± 0.5 mm (range 0.7–3.1 mm), apex deviation was 1.3 ± 0.7 mm (range 0.5–3.1 mm), and axis deviation was 3.2 ± 1.5° (range 1.5–7.7°). There was no significant difference in platform deviation, apex deviation, or axis deviation between the tilted implants and implants in the axial position (P > 0.05). This analysis indicates that a dynamic navigation system can be used as a method of guidance to place intentionally tilted implants as accurately as axially positioned implants in the posterior maxilla, thereby preventing damage to the maxillary sinuses and the need to graft bone.  相似文献   
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5.
Patient navigation is a strategy for overcoming barriers to reduce disparities and to improve access and outcomes. The aim of this umbrella review was to identify, critically appraise, synthesize, and present the best available evidence to inform policy and planning regarding patient navigation across the cancer continuum. Systematic reviews examining navigation in cancer care were identified in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), Epistemonikos, and Prospective Register of Systematic Reviews (PROSPERO) databases and in the gray literature from January 1, 2012, to April 19, 2022. Data were screened, extracted, and appraised independently by two authors. The JBI Critical Appraisal Checklist for Systematic Review and Research Syntheses was used for quality appraisal. Emerging literature up to May 25, 2022, was also explored to capture primary research published beyond the coverage of included systematic reviews. Of the 2062 unique records identified, 61 systematic reviews were included. Fifty-four reviews were quantitative or mixed-methods reviews, reporting on the effectiveness of cancer patient navigation, including 12 reviews reporting costs or cost-effectiveness outcomes. Seven qualitative reviews explored navigation needs, barriers, and experiences. In addition, 53 primary studies published since 2021 were included. Patient navigation is effective in improving participation in cancer screening and reducing the time from screening to diagnosis and from diagnosis to treatment initiation. Emerging evidence suggests that patient navigation improves quality of life and patient satisfaction with care in the survivorship phase and reduces hospital readmission in the active treatment and survivorship care phases. Palliative care data were extremely limited. Economic evaluations from the United States suggest the potential cost-effectiveness of navigation in screening programs.  相似文献   
6.
正颌手术后髁突移位可导致患者复发以及出现颞下颌关节症状。为减少术后髁突移位,众多髁突定位技术运用于临床中。旨探讨髁突定位技术预防术后出现关节症状及复发的有效性,本文回顾近20年内国内外正颌术中髁突定位技术的相关文献,经文献归纳发现,定位技术以稳定术前髁突位置为最终目的,可分为非计算机辅助和计算机辅助定位技术。目前计算机辅助设计与制造髁突定位装置(computer?aided de?sign/computer?aided manufacturing condylar positioning devices,CAD/CAM CPDs)定位效果最佳,由牙支持式与骨支持式导板组成。其余各技术定位效果由高到低排序:CAD/CAM钛板定位>手法定位>计算机辅助导航系统>影像定位系统。各定位技术的精准度可达到与髁突术前位置相差1~2 mm与1°~2°,有效预防术后复发以及关节症状,为不同级别的外科医生和不同难度的病例提供临床参考。该领域仍缺乏大样本和长时间随访的随机对照试验。未来需进一步研究,以优化现今髁突定位技术,提升其临床实际效用及开拓新型定位技术。  相似文献   
7.
目的:观察"眠三针"配合重复经颅磁刺激(r TMS)改善缺血性脑卒中后失眠的临床疗效。方法:选取2019年1—12月在广东三九脑科医院康复训练中心就诊的缺血性脑卒中后失眠患者60例,随机分为治疗组与对照组,每组30例。对照组予重复经颅磁刺激治疗,治疗组在对照组基础上增加"眠三针"(四神针、三阴交、内关)针刺。每天治疗1次,治疗4周。治疗前后记录患者的血清5-羟色胺(5-HT)水平、匹兹堡睡眠质量指数评分、阿森斯失眠量表评分,并进行疗效评定。结果:治疗1个疗程后,两组患者血清5-HT水平均较治疗前上升,且治疗组上升更明显,两组患者匹兹堡睡眠质量指数评分、阿森斯失眠量表评分均较治疗前降低,且治疗组比对照组下降更明显,两组比较,差异均有统计学意义(P<0.05)。治疗组有效率为86.67%(26/30),对照组为73.33%(22/30),两组比较,差异有统计学意义(P<0.05)。结论:"眠三针"配合重复经颅磁刺激可有效提高脑卒中失眠患者的睡眠质量。  相似文献   
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9.
《Journal of endodontics》2021,47(10):1651-1656
IntroductionThis study aimed to evaluate substance loss and the time required for access cavity preparation (ACP) using the conventional freehand method (CONV) versus a miniaturized dynamic navigation system of real-time guided endodontics (RTGE) in an in vitro model using 3-dimensional–printed teeth.MethodsNine human anterior maxillary teeth were selected and micro–computed tomographic scanned. Root canals were virtually reduced to 2 mm below the cementoenamel junction. The teeth were digitally duplicated and mirrored to yield 6 different models with 6 single-rooted teeth each. The models were 3-dimensionally printed using radiopaque resin and consecutively mounted on a dental mannequin for ACP. Two operators with 12 and 2 years of clinical experience, respectively, received 6 models (36 teeth) each and performed ACP on half of the models using RTGE (after digital planning) and CONV on the other half 2 weeks later. The time was recorded. Postoperative substance loss was measured by cone-beam computed tomographic imaging. The differences in time and substance loss between the methods and operators were evaluated by the t test.ResultsOverall, substance loss was significantly lower with RTGE than CONV (mean = 10.5 mm3 vs 29.7 mm3), but both procedures took a similar time per tooth (mean = 195 vs 193 seconds). Operator 1 (more experienced) achieved significantly less substance loss than operator 2 with CONV (mean = 19.9 vs 39.4 mm3) but not with RTGE (mean = 10.3 vs 10.6 mm3).ConclusionsRTGE is a practicable, substance-sparing method performed in comparable time as CONV. Moreover, RTGE seems to be independent of operator experience.  相似文献   
10.
Zygomatic implants (ZIs) are used for the oral rehabilitation of patients with maxillectomy defects as an alternative to extensive bone grafting surgeries. New technologies such as computer-assisted navigation systems can improve the accuracy and safety of ZI placement. The intraoral anchorage of fiducial markers necessary for navigation registration is not possible in the case of a severe maxillary defect and lack of residual bone. This technical note presents a novel extraoral registration method for a dynamic navigation system guiding ZI placement in patients with maxillectomy defects. Titanium microscrews were inserted in the mastoid process, supraorbital ridge, and posterior zygomatic arch as registration markers. The mean fiducial registration error (FRE) was 0.53 ± 0.20 and the deviations between the planned and placed ZIs were 1.56 ± 0.54 mm (entry point), 1.87 ± 0.63 mm (exit point), and 2.52 ± 0.84° (angulation). The study results indicate that the placement of fiducial markers at extraoral sites can be used as a registration technique to overcome anatomical limitations in patients after maxillectomy, with a clinically acceptable registration accuracy.  相似文献   
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