BACKGROUND & AIMS: PURPOSE:In order to engage medical students and residents from public health centers to utilize the telemedicine features of surgery on their own smartphones and tablets as an educational tool, an innovative streaming system was developed with the purpose of streaming live footage from open surgeries to smartphones and tablets, allowing the visualization of the surgical field from the surgeon's perspective. The current study aims to describe the results of an evaluation on level 1 of Kirkpatrick's Model for Evaluation of the streaming system usage during gynecological surgeries, based on the perception of medical students and gynecology residents. METHODS:Consisted of a live video streaming (from the surgeon's point of view) of gynecological surgeries for smartphones and tablets, one for each volunteer. The volunteers were able to connect to the local wireless network, created by the streaming system, through an access password and watch the video transmission on a web browser on their smartphones. Then, they answered a Likert-type questionnaire containing 14 items about the educational applicability of the streaming system, as well as comparing it to watching an in loco procedure. This study is formally approved by the local ethics commission (Certificate No. 53175915.7.0000.5171/2016). RESULTS:Twenty-one volunteers participated, totalizing 294 items answered, in which 94.2% were in agreement with the items affirmative, 4.1% were neutral, and only 1.7% answers corresponded to negative impressions. Cronbach's α was .82, which represents a good reliability level. Spearman's coefficients were highly significant in 4 comparisons and moderately significant in the other 20 comparisons. CONCLUSIONS:This study presents a local streaming video system of live surgeries to smartphones and tablets and shows its educational utility, low cost, and simple usage, which offers convenience and satisfactory image resolution, thus being potentially applicable in surgical teaching.

背景与目标： 目的：为了吸引来自公共卫生中心的医学生和居民在他们自己的智能手机和平板电脑上利用外科手术的远程医疗功能作为教育工具，开发了一种创新的流媒体系统，其目的是将现场录像从开放式手术流向智能手机。和平板电脑，可以从外科医生的角度看到手术区域。本研究旨在根据医学生和妇科住院医师的看法，描述对柯克帕特里克妇科手术流系统使用率评估模型第1级的评估结果。
方法：由智能手机和平板电脑的妇科手术的实时视频流（从外科医生的角度来看）组成，每位志愿者一个。志愿者们能够通过访问密码连接到流系统创建的本地无线网络，并在智能手机的网络浏览器上观看视频传输。然后，他们回答了一个Likert型问卷，其中包含14个有关流系统的教育适用性的项目，并将其与观看本地程序进行了比较。这项研究已获得当地伦理委员会的正式批准（证书编号53175915.7.0000.5171 / 2016）。
结果：21名志愿者参加，总共回答294项，其中94.2％与肯定的回答相符，中立的占4.1％，只有1.7％的回答与负面印象相对应。 Cronbach的α为0.82，表示良好的可靠性水平。 Spearman系数在4个比较中高度显着，在其他20个比较中适度。
结论：本研究为智能手机和平板电脑提供了实时手术的本地流式视频系统，并显示了其教育实用性，低成本和简单易用的特点，提供了便利和令人满意的图像分辨率，因此有可能应用于外科教学。

BACKGROUND & AIMS: BACKGROUND:The validity of using the Remote Food Photography Method (RFPM) for measuring food intake of minority preschool children's intake is not well documented. OBJECTIVE:Our aim was to determine the validity of intake estimations made by human raters using the RFPM compared with those obtained by weighing all foods and beverages consumed by 3- to 5-year-old children (weighed method). DESIGN:We conducted a cross-sectional observational study. PARTICIPANTS/SETTINGS:A convenience sample of 54 3- to 5-year-old Hispanic and African-American children were observed during a 12-hour period at Baylor Metabolic Research Unit between June 2013 and January 2014. MAIN OUTCOME MEASURES:All foods/beverages consumed by the children were provided by Baylor research coordinators who took and wirelessly transmitted before-and-after pictures of the trays to trained human raters at the Pennington Biomedical Research Center who estimated grams consumed. Energy and macronutrients were calculated using the Food and Nutrient Database for Dietary Studies or food facts data provided by manufacturers. STATISTICAL ANALYSES:Paired t test, mean differences, and Bland-Altman limits of agreement were performed. RESULTS:Compared to the weighed method, the rater method significantly overestimated total intake by 34±71 g (P<0.0001), with a mean percent error of 2.9% (root mean square error=7.1%), and total energy intake by 75±102 kcal (P<0.0001), with a mean percent error of 7.5% (root mean square error=12.3%). The standard error for the macronutrient intakes ranged from 11.0% to 20.2%. The Bland-Altman approach demonstrated a positive slope for the rater method relative to the weighed method for total intake in grams (P=0.006), carbohydrate (P=0.01), and protein (P=0.01) (ie, magnitude of the bias increased with increasing intakes). CONCLUSIONS:The rater method overestimated total intake in grams and energy in kilocalories in minority preschool children in a well-controlled condition and needs to be further tested in a free-living environment.

背景与目标： 背景：使用远程食物摄影法（RFPM）来测量少数学龄前儿童的食物摄入量的有效性尚未得到充分证明。
目的：我们的目的是确定与使用3至5岁儿童对所有食品和饮料进行称重（称重法）得出的结果相比，使用RFPM进行的人类评估者对摄入量所作估计的有效性。
设计：我们进行了横断面观察研究。
参与者/地点：2013年6月至2014年1月期间，在12个小时的时间里，在贝勒代谢研究室观察了54名3至5岁的西班牙裔和非裔美国人儿童的便利样本。
主要观察指标：儿童食用的所有食物/饮料均由贝勒研究协调员提供，他们将托盘的照片前后无线传输至Pennington生物医学研究中心的受过训练的人类评估者，他们估计食用的克数。使用饮食研究的食物和营养数据库或制造商提供的食物事实数据计算能量和大量营养素。
统计分析：进行配对t检验，均数差和Bland-Altman一致性极限。
结果：与称量方法相比，评估者方法显着高估了总摄入量34±71 g（P <0.0001），平均百分比误差为2.9％（均方根误差= 7.1％），总能量摄入为75 ±102 kcal（P <0.0001），平均误差为7.5％（均方根误差为12.3％）。大量营养素摄入的标准误为11.0％至20.2％。 Bland-Altman方法显示评估者方法相对于总摄入量（克）（P = 0.006），碳水化合物（P = 0.01）和蛋白质（P = 0.01）（即偏差的大小）的加权方法具有正斜率随着摄入量的增加而增加）。
结论：评估者方法高估了少数学龄前儿童在良好控制条件下的总摄入量（以克为单位）和以卡路里为单位的能量（以卡路里为单位），需要在自由生活的环境中进行进一步的测试。

BACKGROUND & AIMS: :The endoscope is a popular imaging modality used in many preevaluations and surgical treatments, and is also one of the essential tools in minimally invasive surgery. However, regular endoscopes provide only 2-D images. Even though stereoendoscopy systems can display 3-D images, the real anatomical structure of the observed lesion is unavailable and can only be judged by the surgeon's imagination. In this paper, we present a constraint-based factorization method for reconstructing 3-D structures registered to the patient, from 2-D endoscopic images. The proposed method incorporates the geometric constraints from the tracked surgical instrument into the traditional factorization method based on frame-to-frame feature motion on the endoscopically viewed scene. Experiments with real and synthetic data demonstrate good real-scale 3-D extraction, with greater accuracy than is available from traditional methods. The reconstruction process can also be accomplished in a few seconds, making it suitable for on-line surgical applications to provide surgeons with additional 3-D shape information, critical distance monitoring and warnings.

背景与目标： ：内窥镜是在许多预评估和手术治疗中使用的流行成像方式，也是微创手术中必不可少的工具之一。但是，常规内窥镜仅提供2D图像。即使立体内窥镜系统可以显示3D图像，所观察到的病变的真实解剖结构也不可用，只能由外科医生的想象力来判断。在本文中，我们提出了一种基于约束的因式分解方法，用于从2-D内窥镜图像重建注册给患者的3-D结构。所提出的方法将来自被跟踪的手术器械的几何约束纳入基于内窥镜观察场景中帧到帧特征运动的传统分解方法中。使用真实数据和合成数据进行的实验表明，可以进行良好的真实3D提取，其准确性要高于传统方法。重建过程也可以在几秒钟内完成，使其适用于在线手术应用，从而为外科医生提供额外的3-D形状信息，关键距离监控和警告。

BACKGROUND & AIMS: PURPOSE:The main objective of this study was to determine the reliability and concurrent validity of using Modified Sphygmomanometer (sphyg) and body weighing scale to determine the magnitude of pressure and body weight change during digital spinal examination. SUBJECTS:One hundred and twenty apparently healthy subjects were recruited. METHODS:Weighing scale was used to measure the body weight of the investigator while Mercury sphygmomanometer was used to measure the pressure exerted. There was test re-test interval of 2 weeks. Data were analysed by descriptive statistic and Pearson product moment correlation. RESULTS:The result showed that there was significant correlation between the weight change (WC) values obtained on the weighing scale on day 1 and 2 (r=0.91). Also, there was significant correlation between Pressure obtained in the sphygmomanometer on day 1 and 2 (r=0.94). Similarly, there was significant correlation between the WC and Pressure Change (PC), (r=-0.49). The participant's age, height, weight and BMI contributed significantly as predictors for both BWC and PC change respectively. CONCLUSION:This study concluded that weighing scale and Mercury sphygmomanometer are reliable and valid to determine the magnitude of pressure applied during DPAP.

背景与目标： 目的：本研究的主要目的是确定使用改良血压计和体重计确定数字化脊柱检查过程中压力和体重变化幅度的可靠性和同时有效性。
受试者：招募了一百二十名看起来健康的受试者。
方法：用体重计测量研究者的体重，用水银血压计测量施加的压力。重新测试间隔为2周。通过描述性统计和皮尔逊乘积矩相关性分析数据。
结果：结果表明，第1天和第2天在体重秤上获得的体重变化（WC）值之间存在显着相关性（r = 0.91）。同样，第1天和第2天在血压计中获得的压力之间也存在显着相关性（r = 0.94）。同样，WC和压力变化（PC）之间也存在显着相关性（r = -0.49）。参与者的年龄，身高，体重和BMI分别是BWC和PC改变的预测指标。
结论：本研究得出结论，称重秤和水银血压计对于确定DPAP期间施加的压力大小是可靠且有效的。

BACKGROUND & AIMS: :Aggressive digital papillary adenocarcinoma is a rare neoplasm of eccrine sweat gland origin. An acral location and a high recurrence rate are characteristic features. Its histopathologic features are distinctive, and the tumor expresses carcinoembryonic and S-100 protein antigens. We demonstrated immunoreactivity of the tumor to ferritin antibody, a new immunohistologic marker for sweat gland malignancies.

背景与目标： ：侵袭性数字乳头状腺癌是内分泌汗腺起源的罕见肿瘤。骨部位和高复发率是特征性特征。其组织病理学特征是独特的，并且肿瘤表达癌胚和S-100蛋白抗原。我们证明了肿瘤对铁蛋白抗体的免疫反应性，铁蛋白抗体是汗腺恶性肿瘤的一种新的免疫组织学标记。

BACKGROUND & AIMS: :Image-processing is an advantage of heads-up surgery and expected to facilitate ophthalmic surgeries. To evaluate image-processing quantitatively, we analyzed the surgical images of twenty eyes that underwent vitrectomy with internal limiting membrane (ILM) peeling assisted by Brilliant Blue G (BBG). Still images of the peeling procedure were obtained from the surgical video, and the color difference was calculated between two adjacent spots inside and outside the ILM-peeling contour, i.e., without and with BBG staining, respectively. The color differences were compared between the two settings with and without image-processing, delivered by an algorithm to enhance the color and contrast. Color differences were calculated using two methods: the Euclidean distance based on RGB values (RGB distance) and the Delta-E00 formula provided by the International Commission on Illumination. In five cases, minimum light intensities required to recognize the contour of ILM-peeling were compared during surgeries between the two settings with and without enhancement. Image-processing increased the mean color difference significantly (P < 0.001) from 15.47 and 4.49 to 34.03 and 8.00, respectively, for the RGB distance and Delta-E00. The minimum light intensity was reduced from 15 to 5 on average by image-enhancement. These results showed image-processing enhances color differences and reduces light intensities during vitrectomy.

背景与目标： ：图像处理是平视手术的一个优势，有望促进眼科手术。为了定量评估图像处理，我们分析了二十只眼睛的手术图像，这些眼睛接受了玻璃内切除术，并用Brilliant Blue G（BBG）辅助进行了内部限制膜（ILM）剥离。从外科手术视频中获得了脱皮过程的静止图像，并计算了ILM脱皮轮廓的内部和外部两个相邻点之间的色差，即分别不使用BBG染色和使用BBG染色。通过算法来增强色彩和对比度，比较了在有图像处理和没有图像处理的两种设置之间的色差。使用两种方法计算色差：基于RGB值的欧几里德距离（RGB距离）和国际照明委员会提供的Delta-E00公式。在五种情况下，在手术过程中，在有和没有增强的情况下，在两种设置之间比较了识别ILM剥离轮廓所需的最小光强度。对于RGB距离和Delta-E00，图像处理将平均色差分别从15.47和4.49显着增加（P <0.001）到34.03和8.00。通过图像增强，最小光强度平均从15降低到5。这些结果表明，在玻璃体切割术中，图像处理可增强色差并降低光强度。

BACKGROUND & AIMS: :Metastatic melanoma is one of the most immunogenic malignancies due to its high rate of mutations and neoantigen formation. Response to BRAF inhibitors (BRAFi) may be determined by intratumoral immune activation within melanoma metastases. To evaluate whether CD8+ T cell infiltration and distribution within melanoma metastases can predict clinical response to BRAFi, we developed a methodology to integrate immunohistochemistry with automated image analysis of CD8+ T cell position. CD8+ distribution patterns were correlated with gene expression data to identify and quantify "hot" areas within a tumor. Furthermore, the relative activation of CD8+cells, based on transcriptomic analysis, and their relationship to other CD8+ T cells and non-CD8+ cells within the tumor suggested a less crowded distribution of cells around activated CD8+ T cells. Furthermore, the relative activation of these CD8+ T cells was associated with improved clinical outcomes and decreased tumor cell proliferation. This study demonstrates the potential of digital pathomics to incorporate immune cell spatial distribution within metastases and RNAseq analysis to predict clinical response to BRAF inhibition in metastatic melanoma.

背景与目标： ：转移性黑素瘤由于其高突变率和新抗原形成而成为最具免疫原性的恶性肿瘤之一。对BRAF抑制剂（BRAFi）的反应可以通过黑色素瘤转移瘤内的肿瘤内免疫激活来确定。为了评估黑色素瘤转移中CD8 T细胞的浸润和分布是否可以预测对BRAFi的临床反应，我们开发了一种方法，将免疫组织化学与CD8 T细胞位置的自动图像分析相结合。 CD8分布模式与基因表达数据相关联，以鉴定和量化肿瘤内的“热”区域。此外，基于转录组学分析，CD8细胞的相对活化及其与肿瘤内其他CD8 T细胞和非CD8细胞的关系表明，活化的CD8 T细胞周围的细胞分布较少。此外，这些CD8 T细胞的相对活化与改善的临床结果和减少的肿瘤细胞增殖有关。这项研究证明了数字病理学在转移中结合免疫细胞空间分布和RNAseq分析来预测转移性黑色素瘤对BRAF抑制的临床反应的潜力。

BACKGROUND & AIMS: :Blended online and digital learning includes a variety of activities that combine engaging classroom-based education with online learning. The aim of this study is to evaluate undergraduate students' perceptions of a blended online and digital curriculum for anatomy and physiology in the nursing degree program. A quantitative methodology was used with a sample of 100 undergraduate nursing students from a single Australian University. Descriptive statistics are and presented in this article. Of the 100 participants, 90% were enrolled in the standard mode compared to 10% in a flexible mode of delivery. Results indicated that 29% of participants preferred laboratory classes as having the most impact. Participants (46%) also agreed that recorded lectures were useful, with 36% indicating that the online platform was easy to navigate going as far as wanting more online quizzes (49%). More than half of the participants (54%) acknowledged that anatomy and physiology was important for their future careers. The blended online and digital learner preferences in delivering anatomy and physiology-related courses should be adjusted in order for learning to be effective for undergraduate students in the future.

背景与目标： ：混合的在线和数字学习包括将课堂教学与在线学习相结合的各种活动。这项研究的目的是评估本科生对护理学位课程中有关解剖学和生理学的在线和数字混合课程的看法。定量方法用于来自单个澳大利亚大学的100名本科护理学生的样本。本文将介绍描述性统计信息。在100名参与者中，有90％以标准模式注册，而在灵活交付模式中则为10％。结果表明，有29％的参与者更喜欢实验室课程，因为其影响最大。参与者（46％）也同意录制的讲座非常有用，有36％的参与者表示，在线平台易于浏览，甚至需要更多在线测验（49％）。一半以上的参与者（54％）承认，解剖学和生理学对他们的未来职业很重要。应调整在线和数字学习者在提供解剖学和生理学相关课程方面的偏好，以使学习在将来对本科生有效。

BACKGROUND & AIMS: : The gene expression profile of a tissue averages the expression profiles of all cells in this tissue. Digital tissue deconvolution addresses the following inverse problem: given the expression profile y of a tissue, what is the cellular composition c of that tissue? If X is a matrix whose columns are reference profiles of individual cell types, the composition c can be computed by minimizing ℒ ( y - X c ) for a given loss function ℒ . Current methods use predefined all-purpose loss functions. They successfully quantify the dominating cells of a tissue, while often falling short in detecting small cell populations. In this study we use training data to learn the loss function ℒ along with the composition c . This allows us to adapt to application-specific requirements such as focusing on small cell populations or distinguishing phenotypically similar cell populations. Our method quantifies large cell fractions as accurately as existing methods and significantly improves the detection of small cell populations and the distinction of similar cell types.

背景与目标： ：
组织的基因表达谱将组织中所有细胞的表达谱平均化。数字组织反卷积解决了以下反问题：给定表达谱
ÿ
组织的细胞组成是什么
C
那张纸巾？如果
X
是一个矩阵，其列是各个细胞类型，组成的参考资料
C
可以通过最小化来计算

ℒ

（

ÿ
--
X
C

）


对于给定的损失函数

ℒ

。当前的方法使用预定义的通用损失函数。他们成功地量化了组织中占主导地位的细胞，而在检测小细胞群体时常常不尽人意。在这项研究中，我们使用训练数据来学习损失函数

ℒ

连同组成
C
。这使我们能够适应特定于应用程序的要求，例如专注于小细胞群体或区分表型相似的细胞群体。我们的方法与现有方法一样准确地定量了大细胞部分，并显着改善了小细胞群体的检测和相似细胞类型的区分。

BACKGROUND & AIMS: BACKGROUND:Constraint-Induced Movement therapy (CI therapy) is shown to reduce disability, increase use of the more affected arm/hand, and promote brain plasticity for individuals with upper extremity hemiparesis post-stroke. Randomized controlled trials consistently demonstrate that CI therapy is superior to other rehabilitation paradigms, yet it is available to only a small minority of the estimated 1.2 million chronic stroke survivors with upper extremity disability. The current study aims to establish the comparative effectiveness of a novel, patient-centered approach to rehabilitation utilizing newly developed, inexpensive, and commercially available gaming technology to disseminate CI therapy to underserved individuals. Video game delivery of CI therapy will be compared against traditional clinic-based CI therapy and standard upper extremity rehabilitation. Additionally, individual factors that differentially influence response to one treatment versus another will be examined. METHODS:This protocol outlines a multi-site, randomized controlled trial with parallel group design. Two hundred twenty four adults with chronic hemiparesis post-stroke will be recruited at four sites. Participants are randomized to one of four study groups: (1) traditional clinic-based CI therapy, (2) therapist-as-consultant video game CI therapy, (3) therapist-as-consultant video game CI therapy with additional therapist contact via telerehabilitation/video consultation, and (4) standard upper extremity rehabilitation. After 6-month follow-up, individuals assigned to the standard upper extremity rehabilitation condition crossover to stand-alone video game CI therapy preceded by a therapist consultation. All interventions are delivered over a period of three weeks. Primary outcome measures include motor improvement as measured by the Wolf Motor Function Test (WMFT), quality of arm use for daily activities as measured by Motor Activity Log (MAL), and quality of life as measured by the Quality of Life in Neurological Disorders (NeuroQOL). DISCUSSION:This multi-site RCT is designed to determine comparative effectiveness of in-home technology-based delivery of CI therapy versus standard upper extremity rehabilitation and in-clinic CI therapy. The study design also enables evaluation of the effect of therapist contact time on treatment outcomes within a therapist-as-consultant model of gaming and technology-based rehabilitation. TRIAL REGISTRATION:Clinicaltrials.gov, NCT02631850 .

背景与目标： 背景：约束诱导运动疗法（CI疗法）被证明可以减少残疾，增加受影响的手臂/手的使用，并促进卒中后上肢偏瘫的患者的大脑可塑性。随机对照试验始终证明，CI疗法优于其他康复范例，但只有大约120万患有上肢残疾的慢性卒中幸存者中的一小部分可以使用CI疗法。当前的研究旨在建立一种以患者为中心的新型康复方法的相对有效性，该方法利用新开发的，廉价的和可商购的游戏技术将CI疗法传播给服务欠缺的个人。 CI疗法的视频游戏交付将与传统的基于临床的CI疗法和标准的上肢康复进行比较。另外，将检查对一种治疗方法与另一种治疗方法有不同影响的个体因素。
方法：本方案概述了采用平行分组设计的多站点随机对照试验。将在四个地点招募24名患有中风后慢性偏瘫的成年人。参与者被随机分为四个研究组之一：（1）传统的基于临床的CI治疗；（2）作为治疗师的顾问视频游戏CI疗法；（3）作为治疗师的顾问视频游戏CI疗法，并通过其他治疗师联系远程康复/视频咨询，以及（4）标准的上肢康复。经过6个月的随访，分配给标准上肢康复条件的患者转入独立的视频游戏CI治疗，然后进行治疗师咨询。所有干预措施均在三个星期内完成。主要结局指标包括通过沃尔夫运动功能测试（WMFT）进行的运动改善，通过运动活动日志（MAL）进行的日常活动的手臂使用质量以及通过神经系统疾病的生活质量进行的生活质量评估（ NeuroQOL）。
讨论：该多站点RCT旨在确定基于家庭技术的CI疗法与标准上肢康复和诊所CI疗法的比较效果。该研究设计还可以在以博弈和技术为基础的康复治疗师-顾问模型中评估治疗师接触时间对治疗结果的影响。
试用注册：Clinicaltrials.gov，NCT02631850。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: OBJECTIVE:Social media and other digital technology use facilitate connection among adolescents, but also may reinforce norms and substance-related content from peers and advertisers. We use nationally representative data to examine the association between digital technology and past 30-day use of alcohol, cannabis, and vaping. METHODS:Data were drawn from the 2018 Monitoring the Future survey of US adolescents (N = 44,482). Poisson regressions estimated the association between hours/day of technology use and past 30-day use of alcohol, cannabis, and vaping adjusting for grade, sociodemographics, and other past-year drug use. RESULTS:Across grades, mean hours of social media/day was 3.06 (standard deviation = 2.90), past 30-day alcohol, cannabis, flavor vaping, cannabis vaping, and nicotine vaping were 15.7 %, 12.6 %, 10.6 %, 4.9 %, and 11.2 %, respectively. Digital technology use that required interaction with others was associated with increased risk of past 30-day drinking, cannabis use, and vaping. For example, social media 3+ hours/day was associated with past 30-day drinking (adjusted relative risk [aRR]: 1.99, 95 % CI: 1.65, 2.41). The magnitude of association was consistent across texting, phone calls, and video chatting, which were all more strongly associated with substance use than with activities that do not require interaction such as gaming and watching videos. CONCLUSION:Digital technology that facilitates interaction among adolescents, such as texting and social media, is associated with past substance use. Magnitudes of association are consistent across substances, supporting the hypothesis that networks of adolescents are social drivers of substance use, rather than the technology itself.

背景与目标： 目的：社交媒体和其他数字技术的使用促进了青少年之间的联系，但也可能加强了来自同龄人和广告商的规范和与物质有关的内容。我们使用具有国家代表性的数据来​​检查数字技术与过去30天的酒精，大麻和电子烟的使用之间的关联。
方法：数据来自2018年美国青少年监控未来调查（N = 44,482）。 Poisson回归估计了技术使用的小时数/天与过去30天的酒精，大麻使用和根据等级，社会人口统计学和其他过去一年的药物使用情况进行调整的雾化之间的关联。
结果：在所有年级中，每天社交媒体的平均小时数为3.06（标准偏差= 2.90），过去30天的酒精，大麻，味雾，大麻雾和尼古丁雾化分别为15.7％，12.6％，10.6％，4.9％ ，和11.2％。需要与他人互动的数字技术使用与过去30天喝酒，使用大麻和吸毒的风险增加有关。例如，每天3小时的社交媒体与过去30天的饮酒相关（调整后的相对风险[aRR]：1.99，95％CI：1.65，2.41）。在短信，电话和视频聊天之间，关联的程度是一致的，与不需要使用游戏和观看视频等不需要互动的活动相比，与吸食毒品的关联更紧密。
结论：促进青少年之间互动的数字技术，例如短信和社交媒体，与过去的毒品使用有关。各种物质之间的关联程度是一致的，支持以下假设：青少年网络是物质使用的社会驱动力，而不是技术本身。

BACKGROUND & AIMS: :Objective: Despite being a cardinal clinical sign of systemic sclerosis (SSc), digital pitting has been little studied. Our objective was to test, in a pilot study, the hypothesis that pitting is painful and associated with digital vascular disease severity.Method: Fifty patients with SSc were recruited: 25 with and 25 without digital pitting. Fingertip pain was assessed on a 0-10 scale. Thermography of both hands assessed surface temperature, allowing calculation of the distal-dorsal difference (temperature gradient) for each finger. Nailfold capillaroscopy was performed in each finger using a dermatoscope, and graded on a 0-3 scale (0 = normal; 3 = grossly abnormal).Results: In the 25 patients with digital pitting, 65 fingers in total were affected (mainly the index and middle fingers). Pain scores were higher in 'pitting' patients [median 4 (interquartile range 3-8) vs 0 (0-2), p < 0.001], and pitting patients reported that pitting impacted on activities of everyday living. Temperature gradients along the fingers did not differ significantly between patients with and without pitting (p = 0.248). Pitting patients were more likely to have 'grossly abnormal' capillaries than those without pitting, and less likely to have 'no/mild' nailfold capillary changes.Conclusions: Digital pitting is painful and impacts on hand function. Capillaroscopy findings provide further support for an association between pitting and severity of digital vascular change. Larger, more comprehensive studies are required to examine the pathophysiology of pitting and to pave the way to therapeutic intervention, ideally including preventive strategies.

背景与目标： ：目的：尽管是全身性硬化症（SSc）的主要临床体征，但对数字麻点的研究很少。我们的目的是在一项初步研究中测试以下观点：麻点疼痛且与数字血管疾病的严重程度有关。方法：招募了50名SSc患者：25名有数字麻点的患者和25名无数字麻点的患者。指尖疼痛的评估范围为0-10。两只手的热像仪可以评估表面温度，从而可以计算出每个手指的远端-背侧差异（温度梯度）。使用皮镜在每根手指上进行针状毛细血管镜检查，并以0-3评分（0 =正常; 3 =严重异常）进行分级。结果：在25例数字化点蚀患者中，总共有65根手指受到影响（主要是指和中指）。 '麻点'患者的疼痛评分较高[中位数4（四分位间距3-8）vs 0（0-2），p <0.001]，并且麻点患者报告麻点影响日常生活活动。带有和不带有点蚀的患者之间沿手指的温度梯度差异不显着（p = 0.248）。点蚀患者比没有点蚀的患者更有可能出现“严重异常”的毛细血管，并且没有“无/轻微”的指甲皱纹毛细血管改变的结论。结论：数字化点蚀是痛苦的，并且会影响手部功能。毛细血管镜检查结果为点蚀与数字血管变化严重程度之间的关联提供了进一步的支持。需要更大，更全面的研究来检查点蚀的病理生理，并为治疗干预铺平道路，理想情况下应包括预防策略。

BACKGROUND & AIMS: :The rapid development and proliferation of digital health technologies have not only changed the medical professions, but offer great potential for public health, particularly in health promotion and disease prevention.At the same time, this emerging field is also characterized by conceptual and terminological fuzziness, a marked lack of high-quality evidence, and an absence of an honest discussion of unintended consequences and side effects. Further challenges for digital public health lie in the fact that the development of new health technologies is mainly driven by technological progress and less by evidence-based needs and research in public health.In this overview paper, we aim at conceptually denoting the field of digital public health, using principal public health functions as guiding principles. We discuss some current applications of digital health technologies in fulfilling public health functions and propose a needs-based development of digital health technologies.We will further address specific challenges to digital public health, in particular socio-economic differences in the usage of and profiting from digital health technologies, data protection and privacy issues, as well as ethical issues.

背景与目标： ：数字健康技术的迅速发展和扩散不仅改变了医学专业，而且为公共卫生提供了巨大的潜力，特别是在健康促进和疾病预防方面。与此同时，这一新兴领域还具有概念和术语模糊性的特点。 ，明显缺乏高质量的证据，也没有对意想不到的后果和副作用进行诚实的讨论。数字公共卫生的进一步挑战在于，新卫生技术的发展主要是由技术进步驱动的，而不是由基于证据的需求和公共卫生研究驱动的。公共卫生，以主要公共卫生职能为指导原则。我们讨论了数字卫生技术在履行公共卫生职能方面的当前应用，并提出了基于需求的数字卫生技术开发。我们将进一步解决数字公共卫生方面的具体挑战，尤其是使用和从中获利的社会经济差异数字医疗技术，数据保护和隐私问题以及道德问题。

BACKGROUND & AIMS: AIMS:Precise evaluation of proliferative activity is essential for the stratified treatment of luminal-type breast cancer (BC). Immunohistochemical staining of Ki-67 has been widely used to determine proliferative activity and is recognised to be a useful prognostic marker. However, there remains discussion concerning the methodology. We aimed to develop an automated and reliable Ki-67 assessment approach for invasive BC. MATERIALS AND RESULTS:A retrospective study was designed to include two cohorts consisting of 152 and 261 consecutive patients with luminal-type BC. Representative tissue blocks following surgery were collected, and three serial sections were stained automatically with Ki-67, pan-cytokeratin and p63. The whole slides were scanned digitally and aligned using VirtualTripleStaining - an extension to the VirtualDoubleStaining™ technique provided by Visiopharm software. The aligned files underwent automated invasive cancer detection, hot-spot identification and Ki-67 counting. The automated scores showed a significant positive correlation with the pathologists' scores (r = 0.82, P < 0.0001). Among selected patients with curative surgery and standard adjuvant therapies (n = 130), the digitally assessed low Ki-67 group (<20%) demonstrated a significantly better prognosis (breast cancer-specific survival, P = 0.030; hazard ratio = 0.038) than the high Ki-67 group. CONCLUSIONS:Digital image analysis yielded similar results to the scores determined by experienced pathologists. The prognostic utility was verified in our cohort, and an automated process is expected to have high reproducibility. Although some pitfalls were confirmed and thus need to be monitored by laboratory staff, the application could be utilised for the assessment of BC.

背景与目标： 目的：精确评估增殖活性对于管腔型乳腺癌（BC）的分层治疗至关重要。 Ki-67的免疫组织化学染色已被广泛用于确定增殖活性，并被认为是有用的预后标志物。但是，仍然存在有关该方法的讨论。我们旨在为侵入性BC开发一种自动化且可靠的Ki-67评估方法。
材料与结果：一项回顾性研究旨在包括两个队列，分别由152例和261例腔内型BC患者组成。收集手术后的代表性组织块，并用Ki-67，泛细胞角蛋白和p63自动对三个连续切片进行染色。整个幻灯片都进​​行了数字扫描，并使用VirtualTripleStaining（Visiopharm软件提供的VirtualDoubleStaining™技术的扩展）进行了对齐。对齐后的文件进行了自动浸润癌检测，热点识别和Ki-67计数。自动评分显示与病理学家评分显着正相关（r = 0.82，P <0.0001）。在选定的具有根治性手术和标准辅助疗法的患者中（n = 130），经数字评估的低Ki-67组（<20％）表现出更好的预后（乳腺癌特异性生存率，P = 0.030;危险比= 0.038）比高Ki-67组高。
结论：数字图像分析得出的结果与经验丰富的病理学家确定的分数相似。预后的效用已在我们的队列中得到验证，并且自动化过程有望具有很高的可重复性。尽管确定了一些陷阱，因此需要由实验室工作人员进行监控，但该应用程序可用于评估BC。