शैडोइंग अभ्यास: A pediatric cerebrovascular approach: techniques and challenges - YouTube के साथ अंग्रेजी बोलना सीखें

⏸ रुका हुआ

Music My

गति:

138 वाक्य

यदि वाक्य बहुत छोटे या लंबे हों, तो समायोजित करने के लिए Edit पर क्लिक करें।

Music My

practice is unique in the fact that I do about 90 percent,

85 percent of what I do is all children.

children with vascular malformations, both of the brain and the neck, maxillofacial areas.

We receive them from newborn actually to 19, 18 years of age.

We do of course also adults with vascular malformations,

but as things are evolving and you can see how fantastic this course is and the tremendous progress that has exist.

So children are not small adults and that has happened throughout medicine.

There was the general doctor first,

then became pediatricians, which was obviously that required different things.

So within the vascular lesions of the human body,

there's a certain amount of diseases that occur in children primarily,

and that affect children sometimes exclusively.

So, based on my practice,

I have dedicated myself to improve the treatment in those children,

decrease the radiation, decrease the time of the procedure,

being very meticulous with the technique, very meticulous with fluids.

For small children that are in severe heart problems with brain problems,

if you use the same techniques in adults,

you actually could have a lot of harm.

So there are dedicated, specific problems that occur in children.

There are specific, dedicated challenges,

technical, medical, physiological, that are specific for children.

And there's even difference between children and newborns.

We have newborns that are born in severe heart failure with a disease called vein of gallant malformation

that even treated is lethal within the first year of life.

So those children require techniques,

for example, we develop techniques to go through the umbilical artery.

So we can actually place a cathode from the umbilical artery to enter the body,

to then navigate into the brain.

In this pediatric population, the diseases are rare,

so it's very hard to do really trials.

We're more involved in developing devices,

actually because coming from children,

they can be translated towards adults.

We also have a lot of patients,

or practices, patients of rare diseases,

such as vascular malformation of the maxillofacial area.

very difficult to treat.

So we have developed techniques like direct percutaneous puncture.

Instead of going from the femoral artery and trying to catheterize them,

it's to actually use 3D angiography or the eye guide

or the different types of technologies that have been developed for adults

and try to use them to place catheters or needles directly into the malformation.

And that has changed the whole ballgame.

We also involve trying to develop things which are called sclerotherapy.

Sclerotherapy is a technique in which you inject something that will damage the endothelium.

And then the healing of that scarring,

that will produce scarring, will actually sclerose or thrombose or close and scar those vascular malformations that they cannot feel.

And that includes venous malformation.

That includes lymphatic malformations.

That includes arteriovenous malformation.

And we're using biological substances such as chemotherapeutic agents, bleomycin for example.

And they've made a tremendous change in the outcome of this patient.

Actually, we're trying to use more and more ultrasound to guide ourselves to do these procedures.

Also, within the medical industry of x-rays,

we're forcing the manufacturers to create things like last image hold.

And then with that last image hold,

will, for example, collimate, try to center memories so that we don't have to radiate these children.

Mothers come to me and ask me that,

will my child have a stroke while you're doing this horrible malformation?

They ask me how much radiation are they gonna get?

Or the anesthesia?

Well, there is a potential role for endovascular radiosurgery.

I worked like 15, 20 years ago to try to treat vascular malformations that way.

But radiation is a difficult thing to control.

It's a difficult thing to prove,

a difficult thing to get approved through a regulatory pathway like the Food and Drug Administration and so on.

And dangerous for everyone, including you as an operator.

Everything is dangerous if it's improperly used.

You know, if you have a genie and you let the genie out of the box and there's no control,

it can be very, very dangerous.

So I would say that radiation has a potential,

but it is not something that is around the corner.

The tools that we have today are pretty much adaptation of adults to children.

So we're still at the beginning.

We're very much interested in developing tools that are designed for newborns and for children,

which today do not exist.

So we take a catheter that is a meter and a half,

because it's the only catheter that we have.

The technology exists, but the market is so small

that industry is not very interested in developing high technology for a very small market.

And this is not simply the question of smaller arteries.

It's a whole question of a different anatomy that you're dealing with.

It's a different anatomy.

It's a different technology necessary for the stiffness, for example.

You know, the blood vessels in children are more fragile in a sense.

But on the other hand, they're more elastic.

So they have their own specific problems,

both technically as well as physiological.

One of the biggest questions that we have is if we take a device,

for example a stent, that is developed for adults which have stopped growing and we put them in small children,

what would happen to those vessels as we increase in size?

And therefore, personally, we have a lot of skepticism of using stents unless we are really forced.

And the other side of the coin is we're going to press

and push industry to develop bioactive or biodegradable devices so that

if I put a stent in a little child and that stent will then be reabsorbed,

it will permit then the normal physiologic growth.

Biodegradable, bioabsorbable, biocompatible.

100

It's one of the great, great, great potential expansion.

101

If we can develop it for children,

102

it can then be transferred to adults.

103

What is interesting is that we've done very small devices based on trying to do it for pediatrics,

104

and those have translated to go to the adult,

105

which permits you to go to more distal circulation.

106

I think that's very valuable for the training of physicians.

107

You know, when I started,

108

it was see one, do one,

109

teach one, that no longer applies.

110

We're not, it's just so much better to train,

111

and I'm very involved in the training of physicians,

112

training physicians in a in vitro model.

113

You know, get all, I mean,

114

you actually today, the reproduction is, Dr. Moret, so fantastic.

115

You know, it's literally like the real thing.

116

But then you get the physician to learn.

117

You get the physician to train,

118

you get the physician to try,

119

you get the physician to make the mistake in a model.

120

By the time you transfer that to the real patient,

121

you have a much better trained physician.

122

And I think industry is now more and more turning to these models.

123

And the regulatory agencies are saying,

124

wait a second, you not only have to go and train in a model first.

125

You know, it used to be sometimes an animal.

126

Then, you know, as you know,

127

there's a lot of movement against training in animals.

128

So these things have replaced a lot of the training.

129

The regulatory agencies will force us to train physicians in this type of models that are now readily available.

130

3D printing can make exactly the same aneurysm immediately, right away.

131

And not only that, I can make 20 of those,

132

or 50, or 100 to train physicians.

133

So that I do believe that following that comes the proctoring.

134

In other words, now you're going to go,

135

this individual who's trained in the model is going to go do humans.

136

So when you go humans,

137

you go with somebody experience,

138

the fracture you, I think that is absolutely the way to go.

शैडोइंग तकनीक क्या है?

शैडोइंग (Shadowing) एक विज्ञान-समर्थित भाषा सीखने की तकनीक है जो मूल रूप से पेशेवर दुभाषिया प्रशिक्षण के लिए विकसित की गई थी। विधि सरल लेकिन शक्तिशाली है: आप मूल अंग्रेज़ी ऑडियो सुनते हैं और तुरंत इसे ज़ोर से दोहराते हैं — जैसे वक्ता की छाया 1-2 सेकंड की देरी से। शोध से पता चलता है कि यह उच्चारण सटीकता, स्वर, लय, जुड़ी हुई ध्वनियाँ, सुनने की समझ और बोलने की प्रवाहशीलता में काफ़ी सुधार करता है।

ShadowingEnglish.com – अंग्रेज़ी शैडोइंग अभ्यास

शैडोइंग अभ्यास: A pediatric cerebrovascular approach: techniques and challenges - YouTube के साथ अंग्रेजी बोलना सीखें

इस पाठ के बारे में

प्रमुख शब्दावली और वाक्यांश

अभ्यास के टिप्स

शैडोइंग तकनीक क्या है?

शैडोइंग अभ्यास: A pediatric cerebrovascular approach: techniques and challenges - YouTube के साथ अंग्रेजी बोलना सीखें

ऐप डाउनलोड करें

इस पाठ के बारे में

प्रमुख शब्दावली और वाक्यांश

अभ्यास के टिप्स

शैडोइंग तकनीक क्या है?