ABSTRACT
Virtual reality (VR)-based training has shown some benefits in medical education, supporting skill acquisition, and helping reduce anxiety in real-world settings. However, the use of VR simulators in veterinary education remains limited. This study aimed to introduce a VR simulator to support veterinarian training in canine anaesthesia induction and endotracheal intubation. This study involved a group that learned solely with instructional videos (video group), and one that learned concurrently with the video and VR simulator (VR group). Third- and fourth-year veterinary students were included and underwent a descriptive test on canine endotracheal intubation. Canine endotracheal intubation success rates were compared between the video (n = 364) and VR (n = 60) groups of fifth-year students. A survey on the VR usability was conducted (n=91). The median descriptive test scores improved in the VR (63.3/100) vs the video group (51.5/100). The canine intubation success rates were comparable in the VR and video groups at 84.3â¯% and 77.4â¯%, respectively. A total of 90.1â¯% of the surveyed students rated the ease of use of the simulator highly. Overall, VR simulators were well-received, suggesting benefits in new skill retention. Further studies are required to evaluate the extent of skill improvement through VR-based training, compared to conventional methods, and to assess its impact on student motivation. Evaluating the long-term effects of VR-based training on skill development and retention will also provide a deeper understanding of its educational benefits.
ABSTRACT
A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX. INTRODUCTION: The aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the relationship of this risk with age, sex, time since baseline and bone mineral density (BMD). METHODS: We studied 665,971 men and 1,438,535 women from 64 cohorts in 32 countries followed for a total of 19.5 million person-years. The effect of a prior history of fracture on the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture, and hip fracture alone was examined using an extended Poisson model in each cohort. Covariates examined were age, sex, BMD, and duration of follow-up. The results of the different studies were merged by using the weighted ß-coefficients. RESULTS: A previous fracture history, compared with individuals without a prior fracture, was associated with a significantly increased risk of any clinical fracture (hazard ratio, HR = 1.88; 95% CI = 1.72-2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95% CI = 1.69-2.07), major osteoporotic fracture (HR = 1.83; 95% CI = 1.63-2.06), or for hip fracture (HR = 1.82; 95% CI = 1.62-2.06). There was no significant difference in risk ratio between men and women. Subsequent fracture risk was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any clinical fracture (14%), osteoporotic fracture (17%), and for hip fracture (33%). The risk ratio for all fracture outcomes related to prior fracture decreased significantly with adjustment for age and time since baseline examination. CONCLUSION: A previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by BMD. The effect is similar in men and women. Its quantitation on an international basis permits the more accurate use of this risk factor in case finding strategies.
Subject(s)
Hip Fractures , Osteoporosis , Osteoporotic Fractures , Male , Humans , Female , Osteoporotic Fractures/etiology , Osteoporotic Fractures/complications , Osteoporosis/complications , Hip Fractures/etiology , Hip Fractures/complications , Bone Density , Risk Factors , Risk AssessmentABSTRACT
The purpose of this study was to evaluate the clinical outcomes of patients with stage 3 mandibular medication-related osteonecrosis of the jaw (MRONJ) treated using a submental island flap in combination with mylohyoid muscle reconstruction after rim mandibulectomy. The medical records of 12 patients treated between January 2019 and April 2022 were analysed retrospectively. Primary wound healing was assessed as the maintenance of full mucosal coverage without signs of infection at 6 months postoperatively. The follow-up period ranged from 7 to 38 months, with an average of 21.8 months. All 12 patients (100%) experienced primary wound healing, with normal mouth opening and occlusion, and without pathological mandibular fracture or facial aesthetic problems during the follow-up period. Postoperative panoramic images revealed new bone formation in the treated areas of the mandible in four patients. During the follow-up period, one patient continuing bevacizumab and zoledronate administration for the primary cancer developed MRONJ in the same area at 13 months postoperatively and finally died. Hence the total success rate was 91.7%. In summary, for patients with stage 3 mandibular MRONJ treated with rim mandibulectomy, the submental island flap combined with mylohyoid muscle is an effective reconstructive option for wound-healing and possible bone regeneration of denuded bone.
Subject(s)
Bisphosphonate-Associated Osteonecrosis of the Jaw , Mandibular Osteotomy , Humans , Retrospective Studies , Bisphosphonate-Associated Osteonecrosis of the Jaw/diagnostic imaging , Bisphosphonate-Associated Osteonecrosis of the Jaw/surgery , Esthetics, Dental , Surgical Flaps , Mandible/surgery , MusclesABSTRACT
INTRODUCTION: This report presents the case of a novel subtype of acute encephalopathy syndrome in childhood found in a patient with influenza type A infection; the patient exhibited evident magnetic resonance imaging (MRI) findings. CASE REPORT: A 4-year-old boy was transferred to our hospital for prolonged (lasting 60 min) status epilepticus with influenza encephalopathy. Mild brain hypothermia therapy was applied for 72 h, followed by targeted temperature management for 96 h with mechanical ventilation in the intensive care unit. Moreover, methylprednisolone pulse therapy and immunoglobulin therapy were administered. One month after the treatment, his physical status recovered such that he was able to run, take food orally, communicate verbally, and successfully return to kindergarten. Interestingly, serial MRI studies revealed findings that were compatible with 1) acute necrotizing encephalopathy (ANE), 2) mild encephalitis/encephalopathy with a reversible splenial lesion (MERS type II), 3) acute cerebellitis, and 4) acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) on days 2, 4, 7, and 16, respectively. CONCLUSIONS: To the best of our knowledge, these significant MRI findings associated with acute encephalopathy have never been reported. Thus, herein, we propose the new term radiological "multiple encephalopathy syndrome (MES)" based on our case of acute encephalopathy in childhood.
Subject(s)
Brain Diseases , Encephalitis , Influenza, Human , Brain Diseases/diagnostic imaging , Brain Diseases/therapy , Child, Preschool , Humans , Magnetic Resonance Imaging , Male , Seizures/pathology , SyndromeABSTRACT
We describe the collection of cohorts together with the analysis plan for an update of the fracture risk prediction tool FRAX with respect to current and novel risk factors. The resource comprises 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. INTRODUCTION: The availability of the fracture risk assessment tool FRAX® has substantially enhanced the targeting of treatment to those at high risk of fracture with FRAX now incorporated into more than 100 clinical osteoporosis guidelines worldwide. The aim of this study is to determine whether the current algorithms can be further optimised with respect to current and novel risk factors. METHODS: A computerised literature search was performed in PubMed from inception until May 17, 2019, to identify eligible cohorts for updating the FRAX coefficients. Additionally, we searched the abstracts of conference proceedings of the American Society for Bone and Mineral Research, European Calcified Tissue Society and World Congress of Osteoporosis. Prospective cohort studies with data on baseline clinical risk factors and incident fractures were eligible. RESULTS: Of the 836 records retrieved, 53 were selected for full-text assessment after screening on title and abstract. Twelve cohorts were deemed eligible and of these, 4 novel cohorts were identified. These cohorts, together with 60 previously identified cohorts, will provide the resource for constructing an updated version of FRAX comprising 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. For each known and candidate risk factor, multivariate hazard functions for hip fracture, major osteoporotic fracture and death will be tested using extended Poisson regression. Sex- and/or ethnicity-specific differences in the weights of the risk factors will be investigated. After meta-analyses of the cohort-specific beta coefficients for each risk factor, models comprising 10-year probability of hip and major osteoporotic fracture, with or without femoral neck bone mineral density, will be computed. CONCLUSIONS: These assembled cohorts and described models will provide the framework for an updated FRAX tool enabling enhanced assessment of fracture risk (PROSPERO (CRD42021227266)).
Subject(s)
Hip Fractures , Osteoporosis , Osteoporotic Fractures , Bone Density , Hip Fractures/complications , Hip Fractures/etiology , Humans , Osteoporosis/complications , Osteoporosis/epidemiology , Osteoporotic Fractures/epidemiology , Osteoporotic Fractures/etiology , Prospective Studies , Risk Assessment/methods , Risk FactorsABSTRACT
OBJECTIVES: Addictions to video gaming, smartphones, and Personal Computer (PCs)/tablets have become serious public health problems worldwide. METHODS: We distributed a lifestyle survey to sixth-grade students (aged 11-12 years) during the 10-year period 2008-2017 and compared their responses in the first 5-year period (2008-2012) with those during the second 5-year period (2013-2017). The survey asked whether the student was (1) in a good mood upon waking, (2) the time that the student woke up, (3) the time that he/she went to bed, (4) the hours of TV watched per day, (5) the hours of video games played per day, (6) the hours of smartphone use per day, (7) the hours of PC or tablet PC use per day, (8) whether the student had a positive sense of self, (9) the number of times the student ate breakfast each week, and (10) how often the student turned off the TV during meals. RESULTS: Compared with the first 5-year period, during the second period significantly more students reported waking up before 6:30 a.m. (P < 0.01), going to bed before 10:00 p.m. (P < 0.05), and watching TV for <1 h (P < 0.001), and significantly fewer students reported playing video games for <1 h (P < 0.05), using a smartphone for <1 h (P < 0.001), and using a PC or tablet PC for <1 h (P < 0.001). CONCLUSIONS: Educational campaigns should specifically address the use of addictive technologies among adolescents.
Subject(s)
Smartphone , Video Games , Adolescent , Cross-Sectional Studies , Female , Humans , Life Style , Students , Surveys and QuestionnairesSubject(s)
COVID-19 , Skin Diseases , COVID-19/epidemiology , Humans , Japan/epidemiology , Prevalence , SARS-CoV-2 , Skin Diseases/epidemiologyABSTRACT
The hydrolytic processes occurring at the surface of silicon nitride (Si3N4) bioceramic have been indicated as a powerful pathway to instantaneous inactivation of SARS-CoV-2 virus. However, the virus inactivation mechanisms promoted by Si3N4 remain yet to be elucidated. In this study, we provide evidence of the instantaneous damage incurred on the SARS-CoV-2 virus upon contact with Si3N4. We also emphasize the safety characteristics of Si3N4 for mammalian cells. Contact between the virions and micrometric Si3N4 particles immediately targeted a variety of viral molecules by inducing post-translational oxidative modifications of S-containing amino acids, nitration of the tyrosine residue in the spike receptor binding domain, and oxidation of RNA purines to form formamidopyrimidine. This structural damage in turn led to a reshuffling of the protein secondary structure. These clear fingerprints of viral structure modifications were linked to inhibition of viral functionality and infectivity. This study validates the notion that Si3N4 bioceramic is a safe and effective antiviral compound; and a primary antiviral candidate to replace the toxic and allergenic compounds presently used in contact with the human body and in long-term environmental sanitation.
ABSTRACT
Globally, vaccination has reduced the prevalence of meningitis caused by Streptococcus pneumoniae Neisseria meningitidis, and Haemophilus influenzae. However, neonatal Group B Streptococcus (GBS) meningitis continues to remain a problematic infection of the central nervous system. Here, we report a case of bacterial meningitis in a 34-day old male baby who presented with fever. A cerebrospinal fluid (CSF) test on the day of admission showed an increase in cell count with decreased glucose level. A rapid latex test of the CSF using a commercial kit diagnosed the causative pathogen as GBS. We administered the antibiotics ampicillin, cefotaxime, gentamicin and panipenem/betamipron to the patient for over 14 days. Partial seizures were frequently observed during the course and were well-controlled with midazolam and phenobarbital. Brain magnetic resonance imaging on day 17 showed subdural hygroma in the frontal region, and 99mTc ethyl-cysteinate dimer-single photon emission computed tomography confirmed a decreased cerebral blood flow predominantly in the left frontal region. After three years of follow-up, the condition of the patient improved without any neurological sequelae. Our report highlights that rapid identification of the causative organism is essential in infantile late-onset meningitis. In addition, we consider that the latex kit-based rapid testing of CSF is beneficial for identifying the causative agent of bacterial meningitis.
Subject(s)
Meningitis, Bacterial , Anti-Bacterial Agents/therapeutic use , Bacteriological Techniques , Haemophilus influenzae , Humans , Infant , Latex Fixation Tests , Male , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/drug therapy , Streptococcus pneumoniaeSubject(s)
COVID-19 , Loneliness , Government , Humans , Japan/epidemiology , SARS-CoV-2 , Social IsolationABSTRACT
OBJECTIVE: Hemorrhagic shock and encephalopathy syndrome (HSES) is the most severe form of acute encephalopathy that progresses rapidly, often resulting in death or severe neurological sequelae. We report the case of a 4-year-old girl with HSES with shock and impaired consciousness. PATIENT AND METHODS: Blood test results showed hypercytokinemia, and the 4-year-old patient was immediately admitted to the intensive care unit. Within 4 h of symptom onset, she received mild brain hypothermia therapy with a target body temperature of 35°C. Methylprednisolone pulse, high dose immunoglobulin, and large doses of circulatory drugs were administered. RESULTS: After 72 h of brain hypothermia therapy, targeted temperature management with a target body temperature between 36°C and 37°C was continued for 96 h. The patient was diagnosed with HSES based on acute encephalopathy with shock, hypercytokinemia, low platelet count, coagulation disorder, renal damage, and intestinal bleeding. Magnetic resonance imaging results revealed no signs of any specific acute encephalopathy. She was discharged without neurological sequelae 28 days after symptom onset. CONCLUSIONS: Mild brain hypothermia therapy initiated in the early stages followed by targeted temperature management may be an effective way to improve neurological outcomes in children suffering from HSES.
Subject(s)
Blood Coagulation Disorders/drug therapy , Brain Diseases/drug therapy , Hypothermia, Induced , Hypothermia/drug therapy , Immunoglobulins/therapeutic use , Methylprednisolone/therapeutic use , Proton Pump Inhibitors/therapeutic use , Shock, Hemorrhagic/drug therapy , Blood Coagulation Disorders/blood , Blood Coagulation Disorders/diagnosis , Brain Diseases/blood , Brain Diseases/diagnosis , Child, Preschool , Female , Humans , Hypothermia/blood , Hypothermia/diagnosis , Immunoglobulins/administration & dosage , Intensive Care Units , Magnetic Resonance Imaging , Methylprednisolone/administration & dosage , Proton Pump Inhibitors/administration & dosage , Shock, Hemorrhagic/blood , Shock, Hemorrhagic/diagnosis , Tomography, X-Ray ComputedSubject(s)
Adenocarcinoma/mortality , Adenocarcinoma/pathology , Colorectal Neoplasms/mortality , Colorectal Neoplasms/pathology , Lymphatic Metastasis , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasm Metastasis , Neoplasm Recurrence, Local , Prognosis , Young AdultABSTRACT
There have been several clinical reports of transient postoperative hyperglycemia in patients with insulinoma, but the effect of insulinoma on normal ß-cells has not been investigated. We examined the glucose transporter 2 (GLUT2) and glucagon-like peptide 1 receptor (GLP1R) expression in normal pancreatic ß-cells of five patients with insulinoma and five patients with normal glucose tolerance (NGT) as controls. The positive rate of GLUT2-or GLP1R-positive islets in the nontumor area was calculated by the ratio with the analyzed islets. For functional in vitro analyses, q-PCR and Western blotting were performed after insulin loading on MIN6 cells. The expression rates of both GLUT2 and GLP1R were significantly lower in nontumor area islets of insulinoma patients than in patients with NGT (GLUT2: 31.6 ± 15.3% vs 95.9 ± 6.7%, p < 0.01, GLP1R: 66.8 ± 15.0% vs 96.7 ± 5.0%, p < 0.01). Exposure of MIN6 cells to high concentrations of insulin resulted in a significant decrease in GLUT2 protein for 12 h and GLP1R protein for 24 h (GLUT2; 1.00 ± 0.079 vs 0.81 ± 0.04. p = 0.02, GLP1R; 1.00 ± 0.10 vs 0.50 ± 0.24, p = 0.03) but not in those mRNAs. Our findings show that insulinoma is associated with the downregulation of GLUT2 and GLP1R expression in nontumor area islets. These phenomena may be caused by high levels of insulin.
Subject(s)
Glucagon-Like Peptide-1 Receptor/metabolism , Glucose Transporter Type 2/metabolism , Hyperinsulinism/etiology , Insulinoma/surgery , Pancreatic Neoplasms/surgery , Aged , Animals , Cell Line , Female , Glucagon-Like Peptide-1 Receptor/genetics , Glucose Transporter Type 2/genetics , Humans , Insulin/pharmacology , Insulin Secretion , Insulin-Secreting Cells/drug effects , Insulin-Secreting Cells/metabolism , Insulinoma/metabolism , Male , Mice , Middle Aged , Pancreatic Neoplasms/metabolism , Postoperative PeriodABSTRACT
Delayed orthostatic hypotension (OH) is a minor subset of orthostatic dysregulation (OD). Cerebral blood oxygenation in juvenile patients with delayed OH has not been studied. We investigated the bilateral changes in cerebral oxygenation in the prefrontal cortex during an active standing test in 23 juvenile patients with delayed OH using near-infrared spectroscopy (NIRS). We measured the oxy-Hb, deoxy-Hb, and total-Hb during the active standing test. Four observations were made during the test: t1 in a resting supine position, t2 when maintaining blood pressure, and the remaining two (t3, t4) during hypotension. The concentration of oxy-Hb significantly decreased prior to satisfying the diagnostic criteria of delayed OH after standing and did not change thereafter. The concentration of deoxy-Hb increased gradually during the measurement periods. In addition, total-Hb increased from t2 to t3. There was no significant difference in the change in each Hb parameter between the left and right cerebral hemispheres. Our results indicate that NIRS parameters are more sensitive than blood pressure for the interpretation of cerebral autoregulation in juvenile patients with delayed OH.
Subject(s)
Cardiovascular System , Cerebrovascular Circulation , Hypotension, Orthostatic , Oxygen , Standing Position , Adolescent , Blood Pressure , Cerebrovascular Circulation/physiology , Humans , Hypotension, Orthostatic/blood , Hypotension, Orthostatic/diagnosis , Oxygen/blood , Spectroscopy, Near-InfraredABSTRACT
Fast ignition (FI) is a promising approach for high-energy-gain inertial confinement fusion in the laboratory. To achieve ignition, the energy of a short-pulse laser is required to be delivered efficiently to the pre-compressed fuel core via a high-energy electron beam. Therefore, understanding the transport and energy deposition of this electron beam inside the pre-compressed core is the key for FI. Here we report on the direct observation of the electron beam transport and deposition in a compressed core through the stimulated Cu Kα emission in the super-penetration scheme. Simulations reproducing the experimental measurements indicate that, at the time of peak compression, about 1% of the short-pulse energy is coupled to a relatively low-density core with a radius of 70 µm. Analysis with the support of 2D particle-in-cell simulations uncovers the key factors improving this coupling efficiency. Our findings are of critical importance for optimizing FI experiments in a super-penetration scheme.