Chest compressions quality during sudden cardiac arrest scenario performed in virtual reality: A crossover study in a training environment

Potential attributes of virtual reality (VR) can be a breakthrough in the improvement of sudden cardiac arrest (SCA) training. However, interference with the virtual world is associated with the need of placing additional equipment on the trainee''s body. The primary aim of the study was to evaluate if it does not affect the quality of chest compressions (CCs).91 voluntarily included in the study medical students participated twice in the scenario of SCA – Traditional Scenario (TS) and Virtual Reality Scenario (VRS). In both cases two minutes of resuscitation was performed.If VRS was the first scenario there were significant differences in CCs depth (VRS - Me = 47 mm [IQR 43 – 52] vs TS - Me = 48 mm [IQR 43 – 55]; P = .02) and chest relaxation (VRS - Me = 37% [IQR 5 – 91] vs TS - Me = 97% [IQR 87 – 100]; P < .001). 97.8% of respondents believe that training with the use of VR is more effective than a traditional method (P < .01). Most of the study group (91%, P < .01) denied any negative symptoms during the VR scenario.Virtual reality can be a safe and highly valued by medical students, method of hands-on CPR training. However additional VR equipment placed on the trainee''s body may cause chest compressions harder to provide. If it is not preceded by traditional training, the use of VR may have an adverse impact on depth and full chest relaxation during the training. To make the best use of all the potential that virtual reality offers, future studies should focus on finding the most effective way to combine VR with traditional skill training in CPR courses curriculum.     

Therapeutic effects of brain-computer interface-controlled functional electrical stimulation training on balance and gait performance for stroke: A pilot randomized controlled trial

Background:Brain-computer interface-controlled functional electrical stimulation (BCI-FES) approaches as new feedback training is increasingly being investigated for its usefulness in improving the health of adults or partially impaired upper extremity function in individuals with stroke.Objective:To evaluate the effects of BCI-FES on postural control and gait performance in individuals with chronic hemiparetic stroke.Methods:A total of 25 individuals with chronic hemiparetic stroke (13 individuals received BCI-FES and 12 individuals received functional electrical stimulation [FES]). The BCI-FES group received BCI-FES on the tibialis anterior muscle on the more-affected side for 30 minutes per session, 3 times per week for 5 weeks. The FES group received FES using the same methodology for the same periods. This study used the Mann-Whitney test to compare the two groups before and after training.Results:After training, gait velocity (mean value, 29.0 to 42.0 cm/s) (P = .002) and cadence (mean value, 65.2 to 78.9 steps/min) (P = .020) were significantly improved after BCI-FES training compared to those (mean value, 23.6 to 27.7 cm/s, and mean value, 59.4 to 65.5 steps/min, respectively) after FES approach. In the less-affected side, step length was significantly increased after BCI-FES (mean value, from 28.0 cm to 34.7 cm) more than that on FES approach (mean value, from 23.4 to 25.4 cm) (P = .031).Conclusion:The results of the BCI-FES training shows potential advantages on walking abilities in individuals with chronic hemiparetic stroke.     

Virtual Reality Training Versus Blended Learning of Laparoscopic Cholecystectomy: A Randomized Controlled Trial With Laparoscopic Novices

This study compared virtual reality (VR) training with low cost-blended learning (BL) in a structured training program.Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks.Laparoscopy-naïve medical students were randomized in 2 groups stratified for sex. The BL group (n = 42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n = 42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, OH). Each group trained 3 × 4 hours followed by a knowledge test concerning LC. Blinded raters assessed the operative performance of cadaveric porcine LC using the Objective Structured Assessment of Technical Skills (OSATS). The LC was discontinued when it was not completed within 80 min. Students evaluated their training modality with questionnaires.The VR group completed the LC significantly faster and more often within 80 min than BL (45% v 21%, P = .02). The BL group scored higher than the VR group in the knowledge test (13.3 ± 1.3 vs 11.0 ± 1.7, P < 0.001). Both groups showed equal operative performance of LC in the OSATS score (49.4 ± 10.5 vs 49.7 ± 12.0, P = 0.90). Students generally liked training and felt well prepared for assisting in laparoscopic surgery. The efficiency of the training was judged higher by the VR group than by the BL group.VR and BL can both be applied for training the basics of LC. Multimodality training programs should be developed that combine the advantages of both approaches.     

The effects of core stability training in nurses with nonspecific low back pain

To investigate the effect of core stability training on nonspecific low back pain (NSLBP) in nurses.The data were collected retrospectively by reviewing the patient''s medical records and pain questionnaires in our rehabilitation center. A total of 40 nurses with NSLBP were included and divided into observation group and control group. Each group were given routine health education for NSLBP. Core stability training was performed in observation group for 4 weeks. Surface electromyography (sEMG) evaluation of erector spine and multifidus muscle, pain Numeric Rating Scale (NRS) and Japanese Orthopaedic Association (JOA) scores were evaluated and analyzed before and 4 weeks after intervention.There was no significant difference of NRS score and JOA score between two groups before intervention (P > .05, respectively). The NRS and JOA scores were significantly improved in both two groups after 4 weeks of intervention (P < .05, respectively). Moreover, the improvement of NRS and JOA scores in the observation group were better than those of the control group (P < .05, respectively). No significant difference of average electromyography (AEMG) or median frequency (MF) were noted between the healthy side and the affected side in both groups before or after intervention (P > .05, respectively). After 4 weeks of intervention, the AEMG of the healthy and the affected side of the two groups showed an improved trend without significant difference (P > .05, respectively). The MF of affected side was significantly higher 4 weeks after intervention than those before treatment in the observation and control group (P < .05, respectively).Core stability training can alleviate pain, improve the fatigue resistance of the core muscles and the balance of the functions of bilateral multifidus muscles in nurses with NSLBP.     

Teaching ultrasound-guided peripheral venous catheter placement through immersive virtual reality: An explorative pilot study

Introduction:Immersive virtual reality (IVR)-based training is gaining ground as an educational tool in healthcare. When combined with well-established educational methods, IVR can potentially increase competency and autonomy in ultrasound (US)-guided peripheral venous cannulation.The aim of this study was to examine the impact of adding IVR training to a course in US-guided peripheral venous cannulation.Methods:Medical students (n = 19) from the University of Southern Denmark with no former standardized US education were recruited to voluntarily participate in a pilot study, designed as a randomized controlled trial. The primary outcome was the proportion of successful peripheral venous cannulations on a phantom. Secondary outcomes included the proportion of surface punctures on the phantom and procedure time. Participants received e-learning on the basic US before randomization to either IVR (n = 10) or no further training (n = 9). The additional IVR training comprised 10 virtual scenarios for US-guided peripheral venous catheter (PVC) placement. Students were subsequently evaluated in peripheral venous cannulation by a blinded assessor.Results:The proportion of successful peripheral venous cannulations was significantly higher in the IVR group (P ≤ .001). The proportions of successful cannulations were significantly higher in the IVR group compared to the control group for the 1st and 2nd PVC (P = .011, P = .023), but not for the 3rd PVC (P = .087). Similar results were found for the proportion of surface punctures (1st: P ≤ .001, 2nd: P = .001, and 3rd: P = .114). No significant differences in procedure times were found between the groups.Conclusion:This pilot study showed that adding an IVR-based training simulation to an existing e-learning curriculum significantly increased the learning efficacy of US-guided PVC placement for medical students.     

Dental implant navigation system guide the surgery future

No study has investigated the effect of learning curves on the accuracy of dental implant navigation systems. This study evaluated the accuracy of the dental implant navigation system and established the learning curve according to operation site and operating time. Each dental model was used for drilling 3 missing tooth positions, and a patient tracking module was created. The same dentist performed the drilling test for 5 sets of dental models. CT back scanning was performed on the dental models. Customized implants based on the drilled holes were inserted. The relative error between the preoperative planning and actual implant was calculated. Using the dental navigation system could help dentists position implants more accurately. Increasing the frequency with which a dentist used the navigation system resulted in shorter operations. Longitudinal and angular deviation were significantly (P < 0.0001 and P = 0.0164). We found that the same level of accuracy could be obtained for the maxilla and mandible implants. The Student's t test demonstrated that the longitudinal error, but not the total or angular error, differed significantly (P = 0.0012). The learning curve for the dental implant navigation system exhibited a learning plateau after 5 tests. The current system exhibited similar accuracy for both maxillary and mandibular dental implants in different dental locations. The one-way ANOVA revealed that the total, longitudinal, and angular errors differed significantly (P < 0.0001, P < 0.0001 and P = 0.0153). In addition, it possesses high potential for future use in dental implant surgery and its learning curve can serve as a reference for dentists.     

Causes of Thickening of Carotid Intima-Media Thickness in Patients With Alcoholic Liver Disease: A Prospective Observational Study

Several studies have reported the relationship between alcoholic liver disease (ALD) and carotid intima-media thickness (CIMT). Few studies, however, have investigated the causes of CIMT thickening in patients with ALD. The authors explored the causes of CIMT thickening in patients with ALD.The authors enrolled 152 patients who were stratified into groups: nonthickening CIMT with ALD (group A); thickening CIMT with ALD (group B); nonthickening CIMT without ALD (group C); and thickening CIMT without ALD (group D).The CIMT was significantly different between patients with and without ALD (χ² = 3.875, P = 0.049). The patients in groups A, B, and C were significantly younger than group D (P = 0.001, 0.036, and 0.001, respectively). The body mass indexes (BMI) in groups A and B were significantly higher than in group C (P = 0.000 and 0.007, respectively). The blood glucose levels in groups B and D were significantly higher than in group C (P = 0.016 and 0.018, respectively). The blood uric acid levels in group B were significantly higher than in groups A, C, and D (P = 0.009, 0.000, and 0.003, respectively). The blood uric acid in group A was significantly higher than in group C (P = 0.002). The serum total cholesterol (TC) levels of patients in group B were significantly higher than in groups A and C (P = 0.027 and 0.000, respectively) and the serum TC level in group A was significantly higher than in group C (P = 0.048). The serum triglyceride (TG) levels in groups A and B were significantly higher than in group C (P = 0.027 and 0.000, respectively). The serum of very low-density lipoprotein (VLDL) levels in group B were significantly higher than in group C (P = 0.000). Although a comparison of the low-density lipoprotein (LDL) and high-density lipoprotein (HDL) serum levels among the 4 groups indicated no changes. The serum LDL levels in group B were significantly higher than in group A (P = 0.008). No significant differences were observed among the groups with respect to serum homocysteine, C-reactive protein (CRP), interleukin-6 (IL-6), malondialdehyde (MDA), superoxide dismutase (SOD), soluble OX40 ligand (sOX40L), or heat shock protein (HSP) 60 or 70.Alcoholic liver disease may result in CIMT thickening. Carotid intima-media thickness is associated with age and metabolic factors in patients with ALD. In addition, ALD might promote the premature occurrence of CIMT thickening. The thickening of carotid artery intima thickness, however, is not associated with cytokine profiles, oxidative balance, or immune responses in patients with ALD.     

Comparison of the Fracture Resistance and Fracture Mode of Contemporary Restorative Materials to Overcome the Offset of Mandibular Implant-Supported,Cement-Retained Crowns

Background: The purpose was to compare the fracture resistance and the mode of failure of different contemporary restorative materials to restore implant supported, cement-retained mandibular molars. Methods: Two 5 × 10 mm titanium dental implants were mounted in resin blocks and prefabricated titanium and zirconia abutments were connected to each implant. Each implant received forty crowns resembling mandibular first molars. The specimens were divided into four groups (n = 10/group) for each abutment according to the type of material; Group A: porcelain fused to metal crowns; Group B: monolithic zirconia crowns; Group C: zirconia coping with ceramic veneer; Group D: all ceramic lithium disilicate crowns. Specimens were cemented to the abutments, mounted into a universal testing machine, and vertical static load was applied at a speed of 1 mm/min. The test stopped at signs of visual/audible fracture/chipping. Fracture resistance values were analyzed using ANOVA and Tukey’s tests (α ≤ 0.05). The modes of failure were visually observed. Results: A statistically significant difference (p < 0.001) of the fracture resistance values among tested groups was found. The group that showed the highest fracture resistance was Group A for both the titanium and the zirconia abutments (3.029 + 0.248 and 2.59 ± 0.39, respectively) while Group D for both abutments (1.134 + 0.289 and 1.68 ± 0.13) exhibited the least resistance. Conclusions: Fracture resistance and fracture mode varied depending on type of restorative material. For both titanium and zirconia abutments, porcelain fused to metal showed the highest fracture resistance values followed by monolithic zirconia.     

A program to improve the quality of dental unit water in a medical center

The water quality of dental unit waterlines (DUWLs) is associated with patient safety. No program for DUWL water quality improvement has been formulated since the time they were established 20 years ago. This study provides an improvement program for the quality of dental unit water. The improvement program was implemented step by step: discharge of DUWLs for 5 minutes in the morning before clinical service to flush out the water left in the pipeline overnight; weekly disinfection of the handpiece connector with 75% alcohol and replacement of the old connector when the water quality of the same dental chair unit (DCU) was continuously found to be unqualified; monthly disinfection of the water supply system and pipeline; and establishment of DCU maintenance work standards and staff education and training. From 2016 to 2018, the water quality of 18 DCUs was tested by microorganism culture. The colonies >200 colony forming unit were categorized as unqualified. This program was divided into a pre-test phase, Phase 1, a maintenance phase, and Phase 2. A Chi-square test was used to calculate the difference of unqualified water quality numbers between each phase of the improvement program. In the pre-test phase, the water quality rate (high quality number/high-quality number + low-quality number) was 58.3%. In Phase 1, the quality rate before and after the intervention was 64.8% (35/54) and 92.2% (83/90) (P < .001), respectively. After Phase 1, the quality rate reached 100%. However, the quality rate dropped to 75% during the maintenance phase. Then, we proceeded into Phase 2 of the improvement program by further monthly disinfection to DUWLs. In Phase 2, the quality rate was 62/73 (84.9%) and improved to 142/144 (98.6%) after the intervention (P < .001). The quality rate reached 100% once again and was maintained at 100% thereafter. In conclusion, the 4 steps of the improvement program improved the water quality of the DUWL, which is important for patient safety.     

The impact of exercise training for chronic heart failure patients with cardiac resynchronization therapy: A systematic review and meta-analysis

Background and objective:Systematically review the current published literature on the impact of exercise training (ET) in chronic heart failure (CHF) patients who were conducted cardiac resynchronization therapy (CRT).Methods:PubMed, EMBASE, and the Cochrane Library of Controlled Trails databases were searched for trials comparing the additional effects of ET in CHF patients after CRT implantation with no exercise or usual care control up until 2020.03.07. We independently screened the literature, extracted data, employed the tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) to evaluate study quality and risk of bias, and performed meta-analysis with Revman 5.3 software.Results:Eight trials were identified for qualitative analysis and 7 randomized controlled trails (RCTs) included 235 participants (120 ET; 115 controls) for quantitative analysis. The results showed that the maximal workload (mean difference [MD] 26.32 W, 95% CI 19.41–33.23; P < .00001, I² = 0%) and the exercise duration (MD 68.95 seconds, 95% CI 15.41–122.48; P = .01, I² = 76%) had significant improvement in the ET group versus control. Subgroup analysis showed that compared with control, the change in peak oxygen uptake (VO₂) (MD 3.05 ml/kg/minute, 95% CI 2.53–3.56; P < .00001, I² = 0%), left ventricular ejection fraction (LVEF) (MD 4.97%, 95% CI 1.44–8.49; P = .006, I² = 59%), and health related quality of life (HRQoL) (the change in Minnesota living with heart failure questionnaire [MLHFQ]: MD −19.96, 95% CI −21.57 to −18.34; P < .00001, I² = 0%) were significantly improved in the light to moderate intensity training (non-HIT) group, while there seemed no statistical difference of above endpoints in the high intensity training (HIT) group.Conclusion:During the short term (up to 6 months), non-HIT could improve exercise capacity, cardiac function, and HRQoL in CHF patients with CRT. However, due to the small number of participants, a high-quality large-sample multicenter trial is demanded.     

Effects of robot (SUBAR)-assisted gait training in patients with chronic stroke: Randomized controlled trial

Background:SUBAR is a new ground walking exoskeletal robot. The objective of this study is to investigate SUBAR-assisted gait training''s effects in patients with chronic stroke.Methods:This preliminary study is a prospective randomized controlled trial. Thirty adults were enrolled 6 months after the onset of stroke with functional ambulation category scores ≥ 3. Patients were randomly assigned to receive robot-assisted gait training (SUBAR group, n = 15) or conventional physiotherapy (control group, n = 15). All patients received a total of 10 treatment sessions of 30 minutes each for 3 weeks. Before and after the 10-treatment sessions, patients were evaluated. The primary outcome is the 10 meter walk test and the secondary outcomes were the functional ambulation category scale, the Motricity Index-Lower, Modified Ashworth Scale (MAS), timed up and go, Rivermead Mobility Index, Berg Balance Scale (BBS), and gait analysis.Results:In the SUBAR group, MAS and step length were significantly improved between pre- and posttreatment measurements (Δmean ± SD: −1.1 ± 1.6 and 5.5 ± 7.6, P = .019 and .016, respectively). The SUBAR group improved the stride length and step length of the affected limb but not significantly. The control group had significant improvements in the BBS, MAS, and stride length between pre- and posttreatment measurements (Δmean ± SD: 3.5 ± 4.6, −0.8 ± 1.5, and 6.5 ± 9.5; P = .004, .031, and .035, respectively). The BBS improved more in the control group than in the SUBAR group. There were no other differences between the SUBAR group and the control group.Conclusion:Our results suggest that SUBAR-assisted gait training improved gait parameters in patients with chronic stroke. However, there was no significant difference in most outcome measures compared to conventional physiotherapy. Further research is warranted to measure the effects of SUBAR-assisted gait training.     

Influence of Whole-Body Vibration Training Without Visual Feedback on Balance and Lower-Extremity Muscle Strength of the Elderly: A Randomized Controlled Trial

The purpose of this study was to investigate the influence of whole-body vibration (WBV) training without visual feedback on balance and lower-extremity muscle strength in the elderly.Elderly subjects who did not exercise regularly participated in this study. Subjects were randomly divided into a WBV with eyes open group, a visual feedback-deprived plus WBV (VFDWBV) group, and a control group (0 Hz, eyes open). WBV training was provided over a 3-month period, 3 times per week for 5 min each session. Balance performance was measured with the limits of stability test, and muscle strength was measured with an isokinetic dynamometer.A total of 45 elderly subjects with an average age of 69.22 ± 3.97 years, divided into a WBV group (n = 14), a VFDWBV group (n = 17), and a control group (n = 14), completed the trial. Statistically significant differences were found in the balance performance of the 3 groups at different time points (time × group interaction: F = 13.213, P < 0.001), and the VFDWBV group had more improvement in balance than the WBV and control groups. The strength of the knee extensor and flexor muscles had time × group interactions: F = 29.604, P < 0.001 and F = 4.684, P = 0.015, respectively; the VFDWBV group had more improvement on lower-extremity muscle strength than the WBV and control groups. The 6-month follow-up showed that the rates of hospital visits for medical services due to falls were 0% in the WBV group (0/14), 0% in the VFDWBV group (0/17), and 28.57% in the control group (4/14).Results showed that WBV training at 20 Hz without visual feedback can significantly improve the balance performance and lower-extremity muscle strength of the elderly.     

Impact of 2 different posterior screw fixation techniques on primary stability in a cervical translational injury model: A biomechanical evaluation

Background:In case of injuries to the subaxial cervical spine, especially in osteoporotic bone, the question of the most stable operative technique arises. There are several techniques of screw fixation available regarding dorsal stabilization. This study investigates 2 techniques (lateral mass screws (LMS) vs cervical pedicle screws (CPS)) in the subaxial cervical spine regarding primary stability in a biomechanical testing using a translational injury model.Methods:A total of 10 human formalin fixed and 10 human fresh-frozen specimens (C 4 - T 1) were investigated. Specimens were randomized in 2 groups. Fracture generation of a luxation injury between C 5 and C 6 was created by a transection of all ligamentous structures as well as the intervertebral disc and a resection of the facet joints.Dorsal stabilization of C 4/C 5 to C 6/C 7 was performed in group A by lateral mass screws, in group B by pedicle screws. In the biomechanical testing, the specimens were loaded at 2 N/s in translation direction until implant failure.Results:Formalin fixed specimen: Mean load failure was 513.8 (±86.74) Newton (N) for group A (LMS) and 570.4 (±156.5) N for group B (CPS). There was no significant difference (P = .6905).Fresh frozen specimen: Mean load failure was 402.3 (±96.4) N for group A (LMS) and 500.7 (±190.3) N for group B (CPS). There was no significant difference (P = .4206).Conclusion:In our loading model respecting the translational injury pattern and a flexion movement we could not verify statistically significant differences between lateral mass screws and cervical pedicle screws. Mean loading failure was slightly higher in the CPS group though.     

A Retrospective Study on the Transferring Accuracy of a Fully Guided Digital Template in the Anterior Zone

The accuracy of implant placement with a fully guided digital template can be influenced by many factors, such as arch difference, alveolar bone density, timing of implant placement and open flap. The purpose of this article was to evaluate the factors presumptively affecting the accuracy of implant placement assisted by the fully guided template in the anterior zone. In 40 patients with missing anterior teeth, a total of 52 implants were placed with tooth-borne, fully guided templates after CBCT evaluation, in West China Hospital of Stomatology, Sichuan University. After overlapping the pre-and post-operative DICOM data, measurements were taken in the dental implant planning software (Nobel Clinician^®) to calculate linear and angular deviations between virtual placement plan and actual implant placement. Grouping was categorized according to three factors that possibly have an influence on accuracy: arch type (maxilla/mandible), timing of implant placement (immediate/delayed), surgical technique (open flap/flapless). The data was analyzed with independent sample t-test (p < 0.05). The results showed that the apical, coronal, depth and angular mean deviations of implant positions in anterior zone were 1.13 ± 0.39 mm, 0.86 ± 0.33 mm, 0.41 ± 0.66 mm, 3.32 ± 1.65° with the fully guided templates. The accuracy at apex level, coronal level and the angulation were similar between the maxilla and mandible, and the magnitude of all four deviations between immediate and delayed implantation, open flap and flapless technique were small. No statistically significant difference was observed (p > 0.05). Whereas there was significant difference in depth deviation between maxilla and mandible (p < 0.05). Conclusively, the implant site, alveolar bone density, timing of implant placement and surgical techniques merely compromise the implant placement accuracy under the assistance of a fully guided template.     

Effects of functional movement screen training in high-school baseball players: A randomized controlled clinical trial

Background:In recent years, the functional movement screen (FMS) and FMS training have attracted attention as a means of preventing injury, but no studies have examined the effect of such training in high-school baseball players. The aim of this study was to clarify the effect of FMS training on FMS score, physical function and baseball performance in high-school baseball players.Methods:Subjects in this randomized controlled clinical trial were high-school male baseball players assigned to either an FMS training group (intervention group) or a control group. The intervention group performed FMS training 4 times per week for 12 weeks. FMS ability, physical function, and baseball performance were measured prior to the intervention, 8, 12, and 24 weeks after the intervention in the subjects’ school environment.Results:A total of 71 baseball players aged 15 to 17 years were recruited and assigned to either an intervention group (n = 37) or control group (n = 34). There was no significant difference in the characteristics of participants between the 2 groups. Most FMS scores improved to 12 weeks after continued training. In the intervention group compared with the control group, deep squat, hurdle step, inline lunge, active straight leg raise, trunk stability push-up and rotary stability FMS score, total FMS score and eyes closed single leg stance time significantly increased after 8 weeks of training. While hurdle step, inline lunge, active straight leg raise, trunk stability push-up, total FMS score, and eyes closed single leg stance time significantly increased, pitching ball speed significantly decreased at the end of the 12 week training period. Eyes closed single leg stance time and feeling of fatigue significantly improved 12 weeks after training. The number of subjects who scored less than 14 for the total FMS score in the intervention group compared with control group were significantly less after 8 and 12 weeks of FMS training.Conclusion:FMS training for 8 weeks contributes to improving FMS scores for high-school baseball players, but FMS scores go down if FMS training is not continued.Trial registration:University Hospital Medical Information Network Center, Tokyo, Japan: UMIN000027553. Registered on May 30, 2017.     

High Stroke Volume Variation Method by Mannitol Administration Can Decrease Blood Loss During Donor Hepatectomy

Optimal fluid management to reduce blood loss during donor hepatectomy is important for maximizing donor safety. Mannitol can induce osmotic diuresis, helping prevent increased intravascular volume status. We therefore evaluated the effect of high stroke volume variation (SVV) method by mannitol administration and fluid restriction on blood loss during donor hepatectomy.In this prospective study, 64 donors scheduled for donor right hepatectomy were included and allocated into 2 groups. In group A, the SVV value of each patient was maintained at 10% to 20% during hepatic resection with 0.5 g/kg mannitol administration and fluid restriction at a rate of 2 to 4 mL/kg/h. In group B, the SVV value was maintained at <10% by fluid administration at a rate of 6 to 10 mL/kg/h without diuretic administration during surgery. Intraoperative blood loss was estimated by the loss of red cell mass. Surgeon satisfaction scores and postoperative outcomes, including acute kidney injury, abnormal chest radiographic findings, and hospital stay duration, were also assessed.SVV during hepatectomy was significantly higher in group A than in group B (11.0 ± 1.7 vs 6.5 ± 1.1, P < 0.001). The red cell mass loss was significantly lower in group A than in group B (145.4 ± 107.6 vs 307.9 ± 110.7 mL, P < 0.001). Surgeon satisfaction scores were higher in group A than in group B (2.8 ± 0.5 vs 2.0 ± 0.6, P < 0.001). The incidence of acute kidney injury, abnormal chest radiographic findings, and duration of hospital stay did not significantly differ between the 2 groups.Maintenance of high SVV by mannitol administration is effective and safe for reducing blood loss during donor hepatectomy.     

Inspiratory muscle training for recovered COVID-19 patients after weaning from mechanical ventilation: A pilot control clinical study

Background.To the best of our knowledge, no studies have evaluated the effects of inspiratory muscle training (IMT) on recovered COVID-19 patients after weaning from mechanical ventilation. Therefore, this study assessed the efficacy of IMT on recovered COVID-19 patients following mechanical ventilation.Methods.Forty-two recovered COVID-19 patients (33 men and 9 women) weaned from mechanical ventilation with a mean age of 48.05 ± 8.85 years were enrolled in this pilot control clinical study. Twenty-one patients were equipped to 2-week IMT (IMT group) and 21 matched peers were recruited as a control (control group). Forced vital capacity (FVC%), forced expiratory volume in 1 second (FEV1%), dyspnea severity index (DSI), quality of life (QOL), and six-minute walk test (6-MWT) were assessed initially before starting the study intervention and immediately after intervention.Results.Significant interaction effects were observed in the IMT when compared to control group, FVC% (F = 5.31, P = .041, ηP² = 0.13), FEV1% (F = 4.91, P = .043, ηP² = 0.12), DSI (F = 4.56, P = .032, ηP² = 0.15), QOL (F = 6.14, P = .021, ηP² = 0.17), and 6-MWT (F = 9.34, P = .028, ηP² = 0.16). Within-group analysis showed a significant improvement in the IMT group (FVC%, P = .047, FEV1%, P = .039, DSI, P = .001, QOL, P < .001, and 6-MWT, P < .001), whereas the control group displayed nonsignificant changes (P > .05).Conclusions.A 2-week IMT improves pulmonary functions, dyspnea, functional performance, and QOL in recovered intensive care unit (ICU) COVID-19 patients after consecutive weaning from mechanical ventilation. IMT program should be encouraged in the COVID-19 management protocol, specifically with ICU patients.     

Non-resuscitative first aid training and assessment for junior secondary school students: A pre-post study

School-based first aid interventions can contribute to the number of adults trained in first aid in the community over time but few studies have examined the effectiveness of teaching non-resuscitative first aid on knowledge, attitudes and skills. Currently, there is no consensus on the optimal content and duration of first aid training for junior secondary students. The aim of this study was to evaluated the effectiveness of a 2.5 hour introductory non-resuscitative first aid course for junior secondary students.This prospective, single-centre, pre-post study included 140 students (11–13 years old). Students completed a questionnaire on first aid knowledge, attitude towards first aid and self-confidence to perform first aid before and after a training session. Six emergency medicine physicians taught practical first aid skills training. A game-based formative assessment was undertaken where the instructors assessed small teams of students’ role-playing injured classmates and first aid responders (and vice-versa) treating abrasions, ankle sprain, choking and a scald injury.Few students had prior first aid training (14%). After adjusting for student''s age, sex, prior first aid training and format delivery, the course was associated with increased mean knowledge score (pre-training 53%, post-training 88%; mean difference [MD] 35%, 95% CI: 32% to 38%), positive attitudes and more confidence in performing first aid after training (all P < .001). All teams showed a good level of competency in treating simulated injuries with first aid kits.This brief non-resuscitative first aid course was associated with noticeable and valuable changes in knowledge score and self-confidence level in performing first aid. The game-based formative assessment facilitated a positive learning environment for skill competency evaluation.     

Symptom control after different duration of triptorelin treatment following conservative surgery for deep infiltrating endometriosis: Post-hoc analysis of a multicentre,prospective, real-world study

Triptorelin has been used after surgery in deep infiltrating endometriosis. This post-hoc analysis aimed to evaluate symptom control between patients receiving 1-3 triptorelin injections and those receiving 4–6 injections within 24 months of conservative surgery for deep infiltrating endometriosis, in the real-world.Included patients were divided into two groups (received up to 3 months injections in group A, 4–6 injections in group B) based on the numbers of triptorelin (Diphereline, 3.75 mg intramuscular injection once every 28 days for up to 24 weeks) administration. Evolution in score of pain intensity at 3, 6, 9, 12, 18, and 24 months after primary triptorelin administration and symptom improvement/recurrence rates between two groups were compared. Symptoms of pain intensity were assessed using a visual analogue scale (VAS) with a range from 0 to 10 cm. An improvement in symptoms was defined as a reduction of at least 3 cm or 3 units from pre-surgery levels.156 patients in group A and 228 in group B. Pain symptom score (mean ± standard deviation) diminished to a nadir at 3-months for group A and 6-months for group B; at 6-months nadir scores were significantly lower in group B (0.9 ± 1.7 vs 0.4 ± 1.2 respectively, P = .002). No significant difference for pain symptom scores between both groups at 24-months (P = .269). The 6-month and 24-month cumulative improvement rates of pain (80.6% vs 89.8%, P = .014 and 82.6% vs 90.7%, P = .025) and gastro-intestinal symptoms (61.0% vs 80.8%, P = .022 and 61.0% vs 83.3%, P = .008) were significantly higher in group B, whereas there was no significant difference in rates of menstrual disorders and urinary symptoms. There is no significant difference for 12-months and 24-months cumulative recurrence rates of total symptoms between both groups (11.3% vs 13.8%, P = .568 and 16.1% vs 26.0%, P = .094).In women with deep infiltrating endometriosis, longer treatment with triptorelin following conservative surgery was associated with a decrease in symptom intensity and greater improvement of pain symptoms in the short-term and greater improvement of gastro-intestinal symptoms in the long-term.Trial registration number: ClinicalTrials.gov, {"type":"clinical-trial","attrs":{"text":"NCT01942369","term_id":"NCT01942369"}}NCT01942369.     

Effect of ketorolac tromethamine combined with dezocine prior administration on hemodynamics and postoperative analgesia in patients undergoing laparoscopic hernia repair

Objective:To observe the effect of Ketorolac tromethamine combined with dezocine prior administration on hemodynamics and postoperative sedation in patients undergoing laparoscopic hernia repair.Methods:100 male patients aged 60 to 80 years old, a line to elective laparoscopic inguinal hernia repair, were randomly divided into four groups: control group (Group A) and dezocine group (Group B), ketorolac tromethamine group (Group C), ketorolac tromethamine combined with dezocine group (Group D). Patients were administrated with 0.1 mg/kg dezocine in Group B, 0.5 mg/kg ketorolac in Group C, 0.1 mg/kg dezocine, and 0.5 mg/kg ketorolac in Group D, and with an equal dose of normal saline in group A. The heart rate (HR) and mean arterial pressure (MAP) of patients in 4 groups were recorded at each time point as follows, T0 (enter the operating room), T1 (before skin resection), 10 min after pneumoperitoneum (T2), mesh placement (T3), and laryngeal mask extraction (T4). Operation time, awakening time (time from drug withdrawal to consciousness recovery), the dosage of propofol, sufentanil, remifentanil, and intraoperative vasoactive drug dosage were recorded to compare. Visual analog scale score and sedation Ramsay score were evaluated 1, 6, 12, and 24 hours after extubation.Results:There was no significant difference in operation time, anesthesia recovery time, sufentanil dosage, and vasoactive drugs among all groups. The amount of propofol in Group B and D was less than that in Group A and C (P < .05), and there was no difference between Group B and D, A and C (P > .05). The amount of remifentanil in Group B, C, and D was less than that in Group A (P < .05), and Group D was less than B and C (P < .05). After extubation, HR and MAP were significantly higher than before (P < .05). Compared with T0, HR and MAP increased in each group at T4, but MAP and HR in Group D increased the least (P < .05). There were significant differences between Group B, C, D, and A, MAP and HR fluctuated little during extubation (P < .05), but there was a significant difference between Group D and B, C (P < .05). Visual analog scale scores of Group B, C, and D were lower than those of A at 1, 6, and 12 hours after surgery (P < .05), and there was a significant difference between Group D, and B, C (P < .05). Ramsay scores in Group B and D were higher than those in A and C at 1 and 6 hours after the operation (P < .05). There was no difference in the incidence of adverse reactions among groups.Conclusion:The prophylactic use of ketorolac tromethamine and dezocine before laparoscopic inguinal hernia repair can reduce hemodynamic disorder during anesthesia recovery, increase postoperative sedative and analgesic effects.