Tiroidectomía endoscópica transoral por vía vestibular: TOETVA

Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) is a novel technique that allows the thyroid to be approached without visible scars, as it is performed through a natural orifice. It was first described and developed in Asia where due to sociocultural reasons neck scars are considered a stigma. This technique, as we now nowadays, and its preliminary results, were first reported by Angkoon Anuwong in August 2015 at the International Association of Endocrine Surgeons (IAES) world surgery congress held in Bangkok.Here we present the TOETVA approach, step-by-step, in order it could be safely replicated, aiming also it can be spread within the therapeutic framework of endocrine surgery. However, it is important to remark that, as happens in most of remote approaches, it is only suitable for a small percentage of patients.     

Registro español de marcapasos. XIX informe oficial de la Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología (2021)

Introduction and objectivesThis document includes cardiac pacing activity performed in Spain in 2021: figures for implanted devices, demographic and clinical factors, characteristics of the implanted material, and remote monitoring data.MethodsThe European Pacemaker Patient Card, the CardioDispositivos.es online platform, the centers’ own databases and the data provided by the supplier companies are used as sources of information.Results17.360 procedures were registered from 95 hospitals, which represents 43% of the activity. The implantation rates of conventional and resynchronization pacemakers were 822 and 31 units per million population, respectively. 652 leadless pacemakers were implanted. The mean age of implantation is high (78.8 years), and atrioventricular block is the most frequent electrocardiographic abnormality. Dual-chamber pacing mode predominated, nonetheless single-chamber pacing was performed in 19% of patients in sinus rhythm, mainly in the elderly. 28.5% of implanted conventional pacemakers and 56,2% of low-energy resynchronization pacemakers were included in the remote monitoring program.ConclusionsIn 2021 the number of conventional pacemakers increased by 8.3% and resynchronizers by 18.9%, despite the decrease in low-energy resynchronization, probably attributable to the development of physiological pacing. Leadless pacemakers increased by 25%. The expansion of remote monitoring continued, consolidating as a fundamental follow-up method.     

远程管理下儿童膀胱功能障碍基础行为治疗依从性现况调查及其影响因素分析

目的 基于微信平台远程管理模式，探讨儿童膀胱功能障碍基础行为治疗依从性及其影响因素，为制定提高治疗依从性的干预措施提供参考依据。 方法 采用自制问卷对2021年9月至2022年2月在成都市妇女儿童中心医院就诊的膀胱功能障碍患儿及其家长开展问卷调查，并基于微信平台进行基础行为治疗远程管理和随访。调查内容包括患儿的一般情况、疾病相关情况、治疗预期目标、患儿家长对儿童膀胱功能障碍相关知识的知晓情况，以及对治疗实施满4周后患儿治疗依从性的评价。采用SPSS 22.0软件，分析儿童膀胱功能障碍基础行为治疗依从性现状及其影响因素，检验水准为α=0.05。 结果 研究最终纳入174例膀胱功能障碍患儿，平均年龄5.87±2.02岁，其中男性113例，女性61例，治疗依从率为59.20%（103/174）。t检验显示，患儿家长的首诊知识问卷得分与患儿治疗依从性有关（t=8.105，P＜0.001）；多因素logistic回归分析显示，首诊知识问卷得分（与＞10分相比，≤10分:OR=6.432，95%CI:3.150~13.135，P<0.001）、儿童日常主要照顾人类型（与日常照顾人为父母相比，日常照顾人为祖辈或保姆:OR=2.897，95%CI:1.283~6.543，P=0.011）是影响治疗依从性的危险因素。 结论 基于微信平台远程管理，可获得较好的儿童膀胱功能障碍基础行为治疗依从性。在管理各阶段应持续创新健康教育形式，加强健康教育力度，提高患儿及其照顾者对疾病相关知识的掌握程度。     

Compressed sensing with signal averaging for improved sensitivity and motion artifact reduction in fluorine‐19 MRI

Fluorine‐19 (¹⁹F) MRI of injected perfluorocarbon emulsions (PFCs) allows for the non‐invasive quantification of inflammation and cell tracking, but suffers from a low signal‐to‐noise ratio and extended scan time. To address this limitation, we tested the hypotheses that a ¹⁹F MRI pulse sequence that combines a specific undersampling regime with signal averaging has both increased sensitivity and robustness against motion artifacts compared with a non‐averaged fully sampled pulse sequence, when both datasets are reconstructed with compressed sensing. As a proof of principle, numerical simulations and phantom experiments were performed on selected variable ranges to characterize the point spread function of undersampling patterns, as well as the vulnerability to noise of undersampling and reconstruction parameters with paired numbers of x signal averages and acceleration factor x (NAx ‐AFx ). The numerical simulations demonstrated that a probability density function that uses 25% of the samples to fully sample the k‐space central area allowed for an optimal balance between limited blurring and artifact incoherence. At all investigated noise levels, the Dice similarity coefficient (DSC) strongly depended on the regularization parameters and acceleration factor. In phantoms, the motion robustness of an NA8‐AF8 undersampling pattern versus NA1‐AF1 was evaluated with simulated and real motion patterns. Differences were assessed with the DSC, which was consistently higher for the NA8‐AF8 compared with the NA1‐AF1 strategy, for both simulated and real cyclic motion patterns (P < 0.001). Both strategies were validated in vivo in mice (n = 2) injected with perfluoropolyether. Here, the images displayed a sharper delineation of the liver with the NA8‐AF8 strategy than with the NA1‐AF1 strategy. In conclusion, we validated the hypotheses that in ¹⁹F MRI the combination of undersampling and averaging improves both the sensitivity and the robustness against motion artifacts.     

The effect of remotely delivered lifestyle interventions on cognition in older adults without dementia: A systematic review and meta-analysis

Up to 40% of dementias may be preventable via risk factor modification. This inference has motivated the development of lifestyle interventions for reducing cognitive decline. Typically delivered to older adults face-to-face, the COVID-19 pandemic has necessitated their adaptation for remote delivery. We systematically reviewed randomized controlled trials of remotely delivered lifestyle interventions (≥4 weeks duration and delivered >50% remotely), for adults aged ≥ 60 without dementia, examining effects on objective cognitive measures. Comparators were active (face-to-face or remote) or passive. Ten studies (n = 2967) comprising multidomain (k = 4), physical activity (k = 3) or psychosocial (k = 3) remote interventions were included. Data were synthesized using robust variance estimation meta-analysis. The pooled estimate comparing the effect of remote interventions versus comparators on cognition was not significant (g=−0.02; 95%CI [−0.14, 0.09]; p = .66); subgroup analyses by type of intervention or comparator also yielded non-significant effects. Most studies had low risk of bias. Current evidence to support remote lifestyle interventions is limited. Included studies were conducted pre-pandemic, and evaluated individual, rather than group interventions. Future studies may exploit the greater digital connectivity of older people since the pandemic. Group formats, more frequently efficacious than individual interventions in face-to-face dementia prevention trials, may be a rational approach for future remote trials.     

“医随”远程随访模型在减少乳腺良性肿瘤日间手术并发症中的应用

目的探讨“医随”远程随访模式在减少乳腺良性肿瘤日间手术术后并发症中的应用。方法 选取2019 年1 月～2020 年1 月在我院治疗的日间手术患者798 例为研究对象，分为对照组（399 例）和观察组（399 例）。对照组进行常规出院宣教；观察组在对照组基础上应用“医随”远程随访模式平台实施医护联合远程随访。两组均随访至术后1 周，比较两组术后并发症发生率、疾病康复知识知晓率、复诊依从率及解除胸壁加压包按时率。结果 两组术后并发症（尿频、尿急、尿痛、麻木、肌肉僵硬、抽搐、焦虑、血肿）发生率差异无统计学意义；观察组术后并发症（术口乙级红肿、出血、中度疼痛、恶心、胸闷、皮肤骚痒、水泡）发生率低于对照组，差异有统计学意义（P＜0.05）；观察组疾病康复知识知晓率、复诊依从率及解除胸壁加压包按时率均高于对照组，差异有统计学意义（P＜0.05）。结论 “医随”远程随访模式能有效减少乳腺良性肿瘤日间手术并发症的发生，提高患者生活质量，值得推广。     

基于虚拟现实技术的放疗CT模拟定位远程培训系统研发

目的 研发一种基于虚拟现实技术的放疗CT模拟定位的远程培训系统,探索一种医学培训的新方法。方法 使用3DMax与Maya进行3D建模,Unity3D引擎开发3D虚拟操作及交互系统;Java的SpringMvc架构作为系统后台服务,MySQL作为后台数据库系统;并将用户分为教师和学员两种角色,模式分为教学与考核模式。结果 系统功能涵盖CT模拟定位全过程,主要包括患者信息管理、CT模拟定位机认知、体位固定技术、CT定位扫描、处理突发事件等模块。自2018年投入使用以来,运行稳定,系统浏览量达14 920人次,培训通过率为86.66%。与传统培训相比,培训效率明显提升,并获得一致好评。结论 远程培训系统能有效提升学员的临床实践能力、人文关怀能力,具有良好的自主性、共享性、创新性。目前系统已上线且推广性较强,应用前景广阔。     

PARP7 negatively regulates the type I interferon response in cancer cells and its inhibition triggers antitumor immunity

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Dysregulation in nucleic acid‐sensing pathway genes is associated with cancer patients’ prognosis

The innate immune system, the first line of defense against pathogens, is activated by nucleic acids from microbial invaders that are recognized by nucleic acid‐sensing receptors. Recent evidence affirms the ability of these receptors to respond to nucleic acids released by damaged cancer cells. The innate immune system is also involved in cancer immunosurveillance, and could be modulated for devising effective antitumor therapies by targeting nucleic acid‐sensing pathways. A systematic, comprehensive analysis of dysregulation in nucleic acid‐sensing pathways in cancer is required to fully understand its role. Based on multidimensional data of The Cancer Genome Atlas pan‐cancer cohort, we revealed that upregulation of cytosolic DNA‐sensing genes like AIM2 and CGAS was common in tumor tissues. We used 15 genes in the nucleic acid‐sensing pathway to cluster all tumor patients into 2 subgroups and found that the subgroup with higher expression of nucleic acid‐sensing pathway genes was associated with poorer prognosis across cancer types. However, in homologous recombination deficient patients, the nucleic acid recognition activated subgroup was associated with better prognosis, which confirms the therapeutic effect of nucleic acid recognition. This study contributes to a better understanding of the functions and mechanisms of nucleic acid recognition in cancer, lays the foundation for new therapeutic strategies, and enlarges the scope of development of new drugs.