Background and Objectives: Lung cancer is the commonest cancer killer in the western world. Many patients have lung cancers first identified on chest radiograph (CXR). Potentially curable cancers are often missed on CXR. This study quantified the incidence of cases of lung cancer which were initially overlooked and studied the causes of delayed diagnosis. Materials and Methods: All consecutive patients discussed during a 3-month period at the local lung cancer multidisciplinary meeting (MDM) were identified. All imaging within two years prior to diagnosis of lung cancer were reviewed with its report. Any CXR examination which failed to raise the potential for lung cancer was blindly reviewed by four consultant chest radiologists. Results: 189 patients were identified from the MDM over three months. 38,049 CXRs were carried out in the trust over the same period. Of the 189 patients, 58 had previous CXRs within 2 years reported as normal. On review 27 (47%) showed an abnormality in the region of the lung subsequently shown to have cancer. 70% of lesions were central, obscured by the heart, diaphragm, clavicles or mediastinum. Conclusions: This study shows that 1 in 1,409 CXRs reported as normal harbours a visible lung cancer on retrospective review. In this group 14% of patients with lung cancer could potentially have been diagnosed earlier. Of those that had previous CXRs, 47% had abnormal CXRs reported as normal. This study qualifies the rate of missed lung cancer on CXR in clinical practice and highlights where on CXR cancers are missed.

Background and Objectives: Pediatric femoral neck fracture is a serious and disabling injury that is prone to complications. This study examined the feasibility, accuracy, and efficiency of treating the fracture through a three-dimensional (3D)-printed navigation template that was used to guide placement of cannulated screws and locking compression-pediatric hip plates (LC-PHPs). Materials and Methods: Template-guided surgeries were carried out on nine children with femoral neck fracture from 1, 2012 to 12, 2014, and the resulting data were analyzed retrospectively. From preoperative computed tomography data, a 3D model of the proximal femur and a matching navigation template were created for guiding placement of cannulated screws or LC-PHP. Finally, the template-guided operation was performed, and the outcomes were compared to those from control patients undergoing the same surgery without navigation templates (n = 10). Results: The navigation templates were found to match the individual proximal femurs well. Two to three screws were accurately inserted in the femoral neck, and the end of the fracture was successfully stabilized. Implantation of the cannulated screws or LC-PHP took an average of 13.6 and 24.5 min, respectively, whereas intraoperative X-ray was used an average of 4.2 times for the former and 5.5 times for the latter. This was compared to 37.6 and 59.6 min, and 11.4 and 15.4 X-rays, for the controls. Postoperative X-ray showed a great reduction of the femoral neck fracture. Six- to twelve-month follow-ups indicated that the fracture had healed and the function of hip joint was excellent for seven of the children and good for two (Ratliff's criteria). Conclusions: Using 3D-printed guides, accurate and effective placement of cannulated screws and LC-PHPs is realized in the femoral neck. The method reduces operation time, intraoperative bleeding, radiation exposure, and iatrogenic damage to the vasculature, femoral neck, and epiphysis.

Fuzzy nature of decision-making process in healthcare enforces technology producers and researchers to employ creative and smooth solutions. Conversion from fuzzy concepts and ideas to crisp values causes loss of precision and weakens the output decisions. A promising bundle of techniques, soft computing, is a fast developing and popular area that helps meet this creative and smooth need in healthcare. In this study, fuzzy logic (FL) application in healthcare decision-making is examined. The number of publications is rising each year related to FL application in healthcare. FL can be used as a classifier, or in a selection process of a certain type of disease, or diseased patients, or determining the risk ratio of a disease, or in a data mining algorithm, or in constructing a decision support system. This study is a descriptive study aiming to examine and explain FL applications in healthcare.

Objective: The objective of this study was to analyze the functional brain activation in acute stroke patients during motor execution (ME) and motor imagery (MI) and to discuss the association between damaged brain structure and impaired brain function in stroke patients. Methods: The functional magnetic resonance imaging technique was used to observe activation of the brain during ME/MI of the upper limbs in 12 acute stroke patients (with the left brain damage) and 12 healthy controls. Results: During ME, the stroke patients appeared to be activated more strongly than the healthy controls in the ipsilateral primary motor areas. The MI of the affected hand in the stroke patients was not significantly different from that of the healthy hand. The nonmotor areas, the angular gyrus, and the fusiform gyrus were also activated during ME/MI. Conclusion: Structural damage in the brain is associated with the activation of brain function in acute stroke patients. Ipsilateral inhibition is reduced in stroke patients during ME and the damaged brain needs to recruit more brain areas to complete the desired action due to motion difficulties resulting from brain damage. The participation of nonmotor brain areas in ME/MI indicates that cortical reorganization may contribute to the restoration of motor function following stroke. MI can be used to improve injured brain areas, helping with the rehabilitation of stroke patients.

Background and Objectives: Electronic devices such as laptops, tablets, and smartphones are commonly used in clinical clerkships, problem-based learning, and practicals. However, there is limited literature on electronic device usage in medical lectures. This study aimed to (1) assess preclinical medical students' pattern and reason for electronic device usage in lectures and (2) assess the effect of lecture content and student factors on device usage. Materials and Methods: This was a cross-sectional study from the year 1 to 3 medical students of the Li Ka Shing Faculty of Medicine, The University of Hong Kong. The data was collected through self-administrated questionnaires. The questionnaire was distributed twice to the same cohort of students, once after their basic medical science lectures, another after humanities lectures. Categorical variables were compared by Chi-squared test or Fisher's exact test; continuous variables were compared by Mann-Whitney U-test or Kruskal-Wallis H-test. Results: Five hundred and seventy-nine valid questionnaires were collected. Students spent more time on electronic devices for learning in science lectures when compared with humanities lectures (P < 0.001). In contrast, students spent more time for nonlearning purposes in humanities lectures (P < 0.001). In science lectures, the mode of admission to medical school (P < 0.05) and year of study (P < 0.001) were factors affecting the device usage. Conclusions: Lecture content, mode of admission, and year of study have a significant impact on the electronic device usage in preclinical medical lectures. Appropriate interventions are necessary to help the students make better use of their devices and decrease the time spent on nonlearning purposes, particularly in humanities lectures.

Objective: To determine the pattern and forecast visitor accession trend of two national academic journal website: Indian Journal of Community Medicine (IJCM) and Indian Journal of Public Health (IJPH) for the period 2015-2020. Materials and Methods: The visitor accession details (number of times journal issue accessed online) for the period 2000-2014 (15 years) were collected and recorded on Microsoft Excel sheet. Time series analysis was then applied on the dataset using different forecasting models to predict the future trend of accession and value of a real dataset using R software (version 3.1). Results: Both the Indian journals are managed by independent professional bodies, but IJCM journal website was made online in 2007, 3 years ahead of IJPH (2010), leading to a very high accession (a proxy indicator for volume of readership) of IJCM during this period ranging between 100,000 and 120,000 counts, and thereafter accession was noticed to be slightly higher for IJPH than IJCM. The time series sequence showed that both had similar pattern, i.e., first stage: they have initial slow rise; second stage: sudden increasing trend from 2007 to 2010 (IJCM); and 2010 to 2012 (IJPH), respectively; and third stage: Both have then a decreasing trend with superimposed seasonal fluctuations. Future predicted accession details of IJCM and IJPH for 2015-2020 by Holt-Winter fitting model suggest stagnation with online accession of journal issue ranging from 30,360 to 31,860 counts for IJPH and 20,997 to 25,581 counts for IJCM though the range of accession for IJCM (4584) was higher than IJPH (1500), thereby reflecting that IJPH will attain stagnation earlier then IJCM. Autoregressive integrated moving average model also reflected similar results. Ljung-Box test indicated that the model was found statistically correct (P = 0.825 for IJCM and P = 0.50 (IJPH), and there was no statistically significant difference between actual values and predicted values by model. For IJCM dataset, value of R² = 0.678 means that the model could explain 67.8% of the observed variation in the series, while it was able to explain 63.3% variations in IJPH series. Conclusion: To conclude within limitations, this study provides information on pattern and trend of visitor accession of public health journal website. The information unraveled from this study may further aids in planning, strengthening publication standards along with experimentation of innovative ideas to enhance visibility, global participation with a focus on retaining and enhancing journal user base.

Background and Objectives: Patient safety in hospital is an essential professional indicator that should be noticed. The thread of fires is of the most potentially dangerous risk that could harm patients and personnel. Hence, we studied operating room staff knowledge about fires, its prevention, and control, based on their specialty and their job tenure. Materials and Methods: This is a descriptive-analytical cross-sectional study. A cluster sampling method was applied, and a quota was considered for each hospital. In each cluster, samples were selected through census method. Data were collected using a three-part questionnaire and analyzed using SPSS version 17 (SPSS, Inc, Chicago, IL, USA). Results: The mean of their knowledge level about fires and its prevention was 2.71 (0.67), and control was 2.62 (0.71). In 66% of cases, the level of knowledge about fires and its prevention, and in 70% of cases, the level of knowledge about methods of fire control have been below the average (P < 0.05). As staff age increases, their level of knowledge increases as well. Hospital they are employed by, their job tenure, and their profession can affect the level of knowledge (P < 0.05). Discussion: This study shows that the staff knowledge about fires, its prevention, and control has been lower than the average limit. Due to the sensitivity of the issue, in terms of susceptibility of the environment and medical equipment for ignition, and also the safety of staff and patients, it is necessary to make facilities for development of staff knowledge, to eliminate defects of staff training by managers, and also to consider standards.

The electronic medical record (EMR) is now nearly ubiquitous in the USA. This article will review the EMR system with respect to goals, utilization, advantages compared with hand written records, as well as problems and/or disadvantages of the EMR system.

Objective: The purpose of this study was to analyze how fat distribution in the rotator cuff interval (RCI) in normal volunteer shoulders determines the coracohumeral ligament (CHL) visualization, including the CHL visualization rate, type, and thickness, using routine magnetic resonance imaging (MRI). Materials and Methods: This study prospectively analyzed 120 shoulder joints in 60 normal volunteer individuals (30 males and 30 females) using MRI to identify the fat distribution type in the RCI as well as the CHL visualization rate, type, and thickness. Results: The fat in the RCI was visualized in 110 of 120 shoulders (91.7%) while the fat in the RCI was not identifiable in 8.3% of normal volunteer shoulders. The fat distribution in the RCI was classified into five types: Type A (52.5%), Type B (26.7%), Type C (5.8%), Type D (6.7%), and Type E (8.3%). The CHL types included the horizontal type (73.3%), upsloping type (12.5%), downsloping type (5.9%), and unseen type (8.3%) (The CHL was not identifiable in 8.3% of normal volunteer shoulders). No significant difference existed for the fat distribution types in the RCI or the CHL visualization rate, types, or thickness in either different lateral shoulders or different gender shoulders, using a Chi-square test (P > 0.05). In addition, no significant correlation emerged between body mass index (23.4 ± 2.5, n = 110) and the CHL thickness (3.1 ± 1.3 mm) in normal volunteer shoulders, using the Pearson correlation test (n = 110) (r = −0.095, P> 0.05). Conclusion: MRI is a satisfactory method for determining the fat distribution in the RCI and CHL depiction in normal volunteer shoulders. The fat distribution in the RCI determines the CHL visualization, including the CHL visualization rate, type, and thickness.

Objectives: This single-center prospective, case-controlled study investigated satisfaction and esthetic results as rated by the physician and patient, respectively, by following up thirty patients with aging face, who underwent facial autologous fat grafting with platelet-rich plasma (PRP). Materials and Methods: A retrospective review of thirty patients, who were suffering from facial sagging or partial depression and requiring autologous fat grafting between February 2012 and September 2015. Photograph was taken before and 3-month after the operation. Patient and physician satisfaction was rated using visual analog scale (VAS) ranging from 1 (least satisfied) to 10 (most satisfied) 3 months after the operation. Statistical difference between the patient and physician satisfaction scores was analyzed by SPSS 17.0 software. Results: The patients' average age was 34.5 ± 1.2 years. The average VAS score of physician satisfaction was 7.9 ± 1.0, and the average VAS score of patient satisfaction was 8.0 ± 1.2. There was no statistically significant difference between the two groups in scores (P = 0.859; P > 0.05). Conclusion: There is no evidence that different donor sites or different donor-site preparation will lead to different outcomes. Multilevel injection is recommended for autologous fat injection. The high satisfaction scores indicated a good esthetic result of facial autologous fat grafting with PRP. Autologous fat as one of the popular soft tissue fillers is durable and safe. The biggest challenge is the high variation in absorption rate. PRP may lead to higher survival rate of fat and satisfaction level. The stability of survival rate of autologous fat grafting with PRP and the connection between complications and PRP technique need further study.

Objective: To fully understand the original spatial position and three-dimensional (3D) anatomical morphology of cardiac skeleton (CS), and to quickly locate its position in patient-specific computed tomography angiography (CTA) images. Materials and Methods: First, we segmented and reconstructed 3D models of CS and its attached valves with Amira software, defined valve planes based on Chinese visible human 5 (CVH5), and then computed its geometric transformation matrix and applied them in locating the valve planes in patient-specific CTA images. Results: We reconstructed a 3D CS model based on CVH5 images which keep the original spatial position and its normal anatomical appearance. The 3D structures include aortic valve annulus (AVA), mitral valve annulus, tricuspid valve annulus, pulmonary valve annulus, and its attached valves. With the relative geometric transformation matrix, we quickly located the patient-specific valve planes that are vertical to each valve in CTA images. Conclusions: CVH5 dataset can be used in reconstructing the 3D model of CS, which is difficult for clinical images, such as CT, magnetic resonance imaging, and traditional anatomical method to achieve. Our method of 3D reconstruction presents more anatomical details than clinical images and keeps the original shape and position. We can define each valve plane on the CVH5 model and show its corresponding plane in patient-specific CTA images, which can be observed on each valve plane at the same time based on the consistent reference.

Objective: To evaluate, the feasibility and efficacy of three-dimensional (3D) digital navigation, 3D design, and 3D printing in the surgical treatment of giant tumors in thoracic cavity. Patients and Methods: A 62-year-old male patient had a giant tumor in the left thoracic cavity. The tumor constricted the left lobe with the left chest wall being involved. We performed high-precision consecutive thin-sectional computed tomography (CT) scanning and obtained the 3D model of the tumor, lung, pulmonary, tracheobronchial tree, sternum, ribs, and costal cartilage with self-developed 3D image processing software. Before surgery, we also carried out digital navigation, printed out the tumor and the chest wall that is intended to be reconstructed, and developed the surgery program for the giant tumor. At the same time, 3D chest wall titanium was produced based on 3D printing. We performed giant tumor resection and sutured the titanium plate to the chest wall of the patient to repair the chest wall defect. After surgery, we performed CT scans and 3D reconstruction in order to determine the efficacy of surgical treatment. Results: The results showed that we successfully designed the repair surgery program for chest wall defect after the tumor resection. Titanium based on the 3D printing-assisted design completely fit the chest wall defect. Blood loss was significantly reduced compared to conventional titanium suture. There were fewer postoperative complications, and patient recovery was fast. Conclusion: We conclude that 3D printing-assisted resection of tumors in the thoracic cavity and chest wall reconstruction contributes to developing surgery program and performing complex thoracic surgery, which improves the efficacy of surgery, shortens the operation time, reduces the abrasion of conventional steel implant to the residual sternum, ribs, chest wall muscle and pleura, decreases the bleeding, abnormal breathing, and achieves the developmental shift to digital and personalized cardiothoracic surgery.

Objective: Smartphones have evolved from luxury to essential need items in general population nowadays. iOS by Apple, Android by Google, Windows by Microsoft and Blackberry account for the majority of smartphone operating system which are currently in use today. Materials and Methods: The present study was done among 350 students of medical, dental, nursing and physiotherapy streams to know the prevalence of smartphone use and attitude towards its use. Of the 350 students enrolled in the study, 257 completed the questionnaire with a response rate of 73.4%. Results: Out of 222, 198 had android devices, 13 had iPhones, and 11 had other operating systems including Windows and Blackberry. 191 (74.3%) of the subjects had a working email account. Conclusion: First year students have positive perception towards smartphone use and medical schools should encourage the use of medical applications among them. However, students and medical professionals should be cautious of the negative issues with smartphone use.

Objective: Transjugular intrahepatic portacaval shunt (TIPS) is a traditional and effective treatment for variceal bleeding in cirrhotic patients with portal hypertension. However, in patients with a Budd-Chiari syndrome or other unaccessible hepatic veins, a direct puncture through the inferior caval vein may be inevitable. Direct intrahepatic portacaval shunt (DIPS) also has several advantages compared with TIPS. So we are expected to explore a digitalized model of DIPS and find the suitable shunt pathway of DIPS. Materials and Methods: We chose four hundred serial sectional images from the internal jugular vein superior margin to the edge interior hepatic from Chinese Visible Human Dataset. Surface and volume reconstruction were performed by 3D Doctor 3.5 software programs(ABLE SOFTWARE). Results: We reconstructed a digitalized model including liver and relevant vessels. It can display distribution characteristics and spatial structure relationship of intrahepatic vessels from any positions and angles. Conclusion: DIPS represents a useful addition to the endovascular techniques for managing complications of portal hypertension. The model of DIPS provides a good 3D morphological reference of image diagnostics and interventional therapy for DIPS.

Objective: To investigate the treatment effects on port-wine stains (PWSs) using the red, green, and blue (RGB) color measuring and analyzing system in combination with a personal computer. Methods: Twenty patients with PWSs were evaluated both by the RGB color measuring and analyzing system and by the experienced plastic surgeons through a blind test. Then, the two treatment effects were compared. Results: The mean treatment effect was 51.6 ± 24% by RGB method, ranging from 2% to 98%, and that of the clinician evaluation was 47.13 ± 24.6%, ranging from 15% to 90%. There was no significant difference in treatment effects as evaluated by both the clinicians and the RGB measuring and analyzing system method on average (P > 0.05). The subjective clinical grades correlated well with the treatment effects obtained by the proposed computer-assisted RGB measuring and analyzing system (correlation coefficient, 0.87). Conclusions: RGB color measure and analysis system could replace clinician for the evaluation of treatment effects on PWSs and it is an easy, objective, quantitative, and cost-effective method, and can be useful for the evaluation of treatment effects on PWSs.

Objective: To assess prevalence, usage pattern, and risk of internet addiction (IA) among undergraduate students of a health institution from Delhi. Materials and Methods: A cross-sectional descriptive study was carried out during March-April 2015 using 20-item Young's IA test, a Likert scale-based interview schedule with scores ranging from 0 to 100 points with a higher score indicating greater internet dependency. Background variables included sociodemographic details, general health practices, self-assessment of mental health status, inter-personal relation (family/friends), personality type, and global satisfaction in life. The scoring pattern was analyzed in the form of low risk (score ≤49 points) and high risk (score ≥50 points) for IA. The proportion, Chi-square test, adjusted, and un-adjusted odds ratio (OR) (95% confidence interval) were computed using regression analysis. Results: Out of 202, 40.6% were MBBS students, followed by 35.6% from nursing, and 23.8% from medical lab technology stream; 68.3% were females; the mean age was 20.3 ± 1.4 years; and 61.9% were residing in hostels. It was observed that 44 (21.8%) and 22 (10.9%) students had ever consumed alcohol and smoked, respectively, while only 42 (20.8%) were engaged in physical activity (≥30 min) during most (≥5) of the days of the week. Based on self-assessment, 33 (16.3%) were globally dissatisfied and 88 (43.6%) reported themselves to be introverts. The majority of students were using internet for educational purpose (98%), entertainment (95.0%), accessing social sites (92.5%), checking E-mails (76.2%), and pornographic websites (45%). With regard to IA, 171 (84.7%) were at low risk (score ≤49) and 31 (15.4%) were at high risk (score ≥50). Male students (P = 0.001), ever consumed alcohol (P = 0.003), ever smoker (P = 0.02), and regular physical activity (P = 0.04) were found to be significantly associated with a high risk of IA based on Chi-square test, but none were found significant at higher levels of analyses (adjusted OR). No significant association of IA was found with mental status, global satisfaction, inter-personal relationship, or personality type. Conclusion: A large majority (84.7%) of students in our study are found to be at low risk of internet addiction.

Objective: The aim was to evaluate diagnostic accuracy of 640 slice computed tomography angiography (640-CTCA) in diagnosis of coronary artery stenosis. Materials and Methods: Selective coronary angiography (SCA) and 640 slice CTCA were performed in 120 patients with suspected coronary artery disease (CAD) (78 male, 42 female, aged from 36 to 79 years old, with an average of 58.23 years). Various post-processing reconstructions of coronary arteries and branches, such as volumetric imaging, multi-planar reconstruction, curved planar reconstruction, maximum intensity projection were used. The coronary segments, with statistical evaluations combined with its diameter ≥1.5 mm were collected to analyze the diagnosis accuracy of 640-CTCA on coronary artery stenosis, with SCA as the reference standard. Results: About 96.91% (1535/1584) of coronary artery segments were evaluable arteries, and the sensitivity, specificity, positive and negative predictive value of 640-CTCA for detecting coronary artery stenosis were 93.44%, 99.59%, 95.00% and 99.45% respectively. 3.09% (49/1584) of coronary artery segments could not be evaluated due to motion artifact in 21 segments, calcification in 18 segments and poor display of lumen in 10 segments. There were no significant differences in the diagnostic accuracy of coronary artery stenosis between 640-CTCA and SCA. Conclusion: 640-CTCA has a higher accuracy and specificity, which is a reliable tool in the screening of CAD, coronary surgery, preoperative evaluation and the postoperative follow-up.

Digital imaging and communication in medicine (DICOM) is a standard that specifies a nonproprietary data exchange protocol, which was developed by the American College of Radiology and the National Electrical Manufacturers Association. It has now become the uncontested standard for the exchange and management of biomedical images. Here, we hope to highlight the significance of DICOM in digital imaging and to illustrate its indispensable role in digital imaging in the future.

The simulation of clinical situations with the acquisition of fine motor skills is an essential component of the dental students' learning experience. The traditional approach to dental skills training has drawbacks in terms of cost, availability, lack of real-world cases, with the restraints of time, clinical supervision, and the funding of raw materials such as real and plastic teeth. The introduction of dental haptics opens the door to a more realistic clinical experience which can be free from the previous constraints. The performance of the students should be reviewed invaluably by pinpointing exactly where mistakes may have been made and directed learning should be allowed. Also, haptics offers the possibility of unlimited training hours by which students can gain skills without demands on manpower and resources. This paper provides a comprehensive review of literature on haptics for training of periodontal procedures.

Interest in the devices for rehabilitation applications has been increasing. And the devices before have proved that they might assist in and quantify the rehabilitation for upper limb disability caused by stroke. This paper is to introduce rehabilitation application of a haptic device based on virtual reality technology, which is compact, portable, and modular. The focus here is a device with force feedback designed to provide five degrees of freedom, which are rotation, opposition, translation, pitch, and yaw. With five degrees of freedom above, the device can help individuals with arm weakness do their exercise and make patients achieve favorable rehabilitation efficacy during their upper limb rehabilitation.