Tale of Two Cities: narrative review of oxygen.

The human brain contributes 2% of the body weight yet receives 15% of cardiac output and demands a constant supply of oxygen (O 2) and nutrients to meet its metabolic needs. Cerebral autoregulation is responsible for maintaining a constant cerebral blood flow that provides the supply of oxygen and maintains the energy storage capacity. We selected oxygen administration-related studies published between 1975-2021 that included meta-analysis, original research, commentaries, editorial, and review articles. In the present narrative review, several important aspects of the oxygen effects on brain tissues and cerebral autoregulation are discussed, as well the role of exogenous O 2 administration in patients with chronic ischemic cerebrovascular disease: We aimed to revisit the utility of O 2 administration in pathophysiological situations whether or not being advantageous. Indeed, a compelling clinical and experimental body of evidence questions the utility of routine oxygen administration in acute and post-recovery brain ischemia, as evident by studies in neurophysiology imaging. While O 2 is still part of common clinical practice, it remains unclear whether its routine use is safe.

Improving Pediatric/Neonatology Residents' Newborn Resuscitation Skills With a Digital Serious Game: DIANA.

Background: Serious games, and especially digital game based learning (DGBL) methodologies, have the potential to strengthen classic learning methodology in all medical procedures characterized by a flowchart (e.g., neonatal resuscitation algorithm). However, few studies have compared short- and long-term knowledge retention in DGBL methodologies with a control group undergoing specialist training led by experienced operators. In particular, resident doctors' learning still has limited representation in simulation-based education literature. Objective: A serious computer game DIANA (DIgital Application in Newborn Assessment) was developed, according to newborn resuscitation algorithm, to train pediatric/neonatology residents in neonatal resuscitation algorithm knowledge and implementation (from procedure knowledge to ventilation/chest compressions rate). We analyzed user learning curves after each session and compared knowledge retention against a classic theoretical teaching session. Methods: Pediatric/neonatology residents of the Azienda Ospedaliera Universitaria Pisana (AOUP) were invited to take part in the study and were split into a game group or a control group; both groups were homogeneous in terms of previous training and baseline scores. The control group attended a classic 80 min teaching session with a neonatal trainer, while game group participants played four 20 min sessions over four different days. Three written tests (pre/immediately post-training and at 28 days) were used to evaluate and compare the two groups' performances. Results: Forty-eight pediatric/neonatology residents participated in the study. While classic training by a neonatal trainer demonstrated an excellent effectiveness in short/long-term knowledge retention, DGBL methodology proved to be equivalent or better. Furthermore, after each game session, DGBL score improved for both procedure knowledge and ventilation/chest compressions rate. Conclusions: In this study, DGBL was as effective as classic specialist training for neonatal resuscitation in terms of both algorithm memorization and knowledge retention. User appreciation for the methodology and ease of administration, including remotely, support the use of DGBL methodologies for pediatric/neonatology residents education.

Enhancing the future of simulation-based education in pediatrics.

Technology-enhanced simulation has emerged as a great educational tool for pediatric education. Indeed, it represents an effective method to instruct on technical and non-technical skills, employed by a large number of pediatric training programs. However, this unique pandemic era posed new challenges also on simulation-based education. Beyond the mere facing of the clinical and societal impacts, it is fundamental to take advantage from the current changes and investigate innovative approaches to improve the education of pediatric healthcare professionals. To this aim, we herein lay down the main pillars that should support the infrastructure of the future technology-enhanced simulation.

Retroesophageal internal jugular-to-internal jugular vein bypass for venous occlusion in a patient with complex hemodialysis access.

This report describes a right-hand dominant, self-dialyzing patient whose left brachiocephalic autogenous access was previously rescued for left brachiocephalic vein thrombosis with a bypass to the right internal jugular vein (IJV). After 1 year, the left IJV thrombosed, resulting in painful edema and venous dilatation. A retroesophageal IJV-IJV bypass was created, preserving the left brachiocephalic autogenous access.

High-output cardiac failure following insertion of right femoral artery to left femoral vein PTFE graft for haemodialysis: a case report.

Arteriovenous grafts used for hemodialysis can produce high-output cardiac failure as a result of shunting of blood through the dialysis access. The following case demonstrates that the problem can occur shortly after graft formation and improved with graft ligation. It caused haemodynamic compromise because of previously undiagnosed, underlying valvular heart disease. It also caused a diagnostic difficulty in the immediate postoperative period as it was mistaken for postsurgical hemorrhage.

Pancreas transplant alone determines early improvement of cardiovascular risk factors and cardiac function in type 1 diabetic patients.

BACKGROUND: The effects of pancreas transplant alone (PTA) on cardiovascular risk factors (CRF) and cardiac function in type 1 diabetes mellitus (T1DM) patients are still unsettled. METHODS: We studied 13 T1DM patients who received PTA with portal drainage and 11 matched control patients. Parameters of glucose and lipid metabolism and several additional classic CRF were assessed before and up to 6 months posttransplant. Cardiac morphology and function were assessed by Doppler echocardiographic examination. RESULTS: Insulin independence was promptly achieved and then maintained after PTA. Total and low-density lipoprotein cholesterol levels were significantly lower after transplantation, whereas high-density lipoprotein cholesterol and triglyceride concentrations did not change. Both systolic and diastolic blood pressure values and fibrinogen levels improved significantly. In addition, PTA determined a significant amelioration of several morphologic and functional cardiac indices. None of the measured parameters changed in the control patients. CONCLUSIONS: PTA with portal drainage induces an early improvement of CRF and ameliorates cardiac function in patients with T1DM.