The Impact of High-Fidelity Simulator System on Bronchoscopy Operation Skills of Trainees Who Receive Refresher Training: A Teaching Study.

OBJECTIVE: This study aimed to explore the impact of high-fidelity simulator (HFS) training on the bronchoscopy operation skills, confidence, stress, and learning satisfaction of trainees who further their training at endoscopy center in our hospital. The study also investigated the practical application effects of HFS training and provided a reference for the development of clinical teaching and training programs in hospitals. METHODS: The 18 trainees who furthered their training at the endoscopy center were evaluated for their bronchoscopy operation skills, confidence, and stress levels before and after HFS training. A survey on learning satisfaction was conducted after the completion of HFS training. The scores of all evaluations were collected for comparison of differences before and after HFS training. RESULTS: HFS training improved the clinical operation skill levels and confidence of trainees who further their training at the endoscopy center, reduced their stress, and achieved 100% satisfaction from this training. Education level and department had no significant impact on trainees' operational skills and confidence improvement, and stress reduction (p > 0.05). The results of this study supported the influence of the history of endoscopy operations on the improvement of trainees' improved operational skills after HFS training, but it had no relation to the improvement of confidence and stress reduction. Trainees with a history of endoscopy operations had higher operation skill scores before and after HFS training (n = 5, 94.80 ± 2.95 and 97.60 ± 1.82, respectively) than those without a history of endoscopy operations (n = 13, 80.62 ± 2.53 and 86.38 ± 2.82, respectively), and the difference was significant (p < 0.05). CONCLUSION: HFS training is an effective clinical teaching method that can significantly improve trainees' bronchoscopy operation skills and confidence, reduce stress, and achieve high levels of satisfaction.

Sleep quality and cognitive functioning among Chinese older adults living in the US: A mixed-effects model analysis.

Background: Racial and ethnic disparities in sleep quality and cognitive health are increasingly recognized, yet little is understood about their associations among Chinese older adults living in the United States. This study aims to examine the relationships between sleep parameters and cognitive functioning in this population, utilizing data from the Population Study of Chinese Elderly in Chicago (PINE). Methods: This observational study utilized a two-wave panel design as part of the PINE, including 2,228 participants aged 65 years or older, self-identified as Chinese, who completed interviews at two time points. Cognitive functioning was assessed using a battery of tests on perceptual speed, episodic memory, working memory, and mental status. Sleep quality was assessed using Pittsburgh sleep quality index (PSQI) with four aspects: subjective sleep quality, sleep latency, sleep efficiency, and sleep duration at night. Insomnia was assessed using four items from the Women's Health Initiative Insomnia Rating Scale. Mixed-effects regression models were estimated to assess the predictive effects of sleep parameters on baseline cognitive functioning and the rate of cognitive change over time. Results: Significant negative associations were observed between poor sleep quality and baseline cognitive functioning across various domains, although these initial negative associations diminished over time. More insomnia problems were related to poorer perceptual speed and episodic memory. Long sleep latency, or a long time to sleep onset, was associated with worse functioning across all domains except mental status. Sleep efficiency showed inconsistent associations with various cognitive domains, while sleep duration showed no significant relation to any domains. Conclusions: These findings suggest that poor sleep quality indicators serve as early markers of cognitive impairments. Hence, targeted interventions aimed at improving sleep quality could potentially enhance cognitive health outcomes.

The effect of pulmonary rehabilitation on childhood asthma: a systematic review and meta-analysis.

INTRODUCTION: Pulmonary rehabilitation (PR) is a comprehensive nursing intervention for lung function improvement in patients with respiratory diseases. This systematic review focused on further exploration of the unclear impacts of PR on childhood asthma. EVIDENCE ACQUISITION: Web of Science, Cochrane Library, Embase, PubMed, and other databases were searched until May 2021. Randomized controlled trials (RCTs) comparing the effects of PR (including exercise training and education) and routine care on childhood asthma were included. Study selection, data extraction, and bias risk assessment were performed independently by two investigators. EVIDENCE SYNTHESIS: Fourteen RCTs involving 1401 patients were included. Relative to the control group, the total scores of the asthma quality of life questionnaire were evidently improved in the experimental group, including motor domain scores (MD=0.88, 95% CI: 0.67-1.09), symptom domain scores (MD=1.23, 95% CI: 0.61-1.85), and affective domain scores (MD=1.38, 95% CI: 0.63-2.14). Besides, 6-min walk distance (MD=2.01, 95% CI: 0.86-3.15) and asthma control test (MD=0.31, 95% CI: 0.02-0.60) were prominently improved. However, the maximum oxygen uptake (MD=0.81, 95% CI: -0.2 to 1.82) was not markedly improved. The forced expiratory volume in 1 s (MD=0.42, 95% CI: -0.29 to 1.13), and forced vital capacity (MD=0.07, 95% CI: -0.14 to 0.28) were not remarkably improved. There was an evident improvement in the peak expiratory flow (MD=1.22, 95% CI: 0.15-2.30). CONCLUSIONS: PR improves some lung functions, exercise tolerance and the quality of life of children with asthma, and it might work as a supplementary therapy for the treatment of childhood asthma. Moreover, more RCTs of high quality and in large sample size are needed for further confirmation.

Successful management of tracheal lobular capillary hemangioma with arterial embolization followed by electrosurgical snaring via flexible bronchoscopy in an 11-year-old boy: A case report and literature review.

Lobular capillary hemangioma (LCH), previously known as pyogenic granuloma, is a benign vascular lesion commonly found within the oral and nasal cavities. However, it is rarely encountered within the trachea, especially in pediatric patients, where it manifests as hemoptysis, cough, and wheeze, and is frequently misdiagnosed as bronchitis or asthma. There is limited literature on the presentation, behavior, and management of tracheal LCH. Herein, we describe a rare case of tracheal LCH in an 11-year-old boy with a history of hemoptysis, which was successfully managed with arterial embolization followed by electrocautery loop snaring via flexible bronchoscopy. No complications occurred during and after the procedure. A review of the relevant literature is also provided. Our case is unique, given the therapeutic strategy utilized for pediatric tracheal LCH, and reminds physicians to be aware of tracheal LCH in the differential diagnosis for hemoptysis.

Association between urinary phthalate levels and chronic pain in US adults, 1999-2004: A nationally representative survey.

Introduction: Chronic pain is a public health concern throughout the world. Ascertaining and managing its risk factors helps develop well-directed treatment plans and prevention strategies. Phthalates (PAEs) exposure leads to various health problems. The present study aims to explore the potential correlation between urinary PAEs metabolites and chronic pain in adults. Methods: The study population data were extracted from the National Health and Nutrition Examination Survey (NHANES) conducted from 1999 to 2004 in the United States. Seven urinary PAEs metabolites were used to assess long-term PAEs exposure. The assessment of chronic pain was determined by a self-report questionnaire. Weighted analyses were conducted to consider the complex sampling design. Models were adjusted by demographic data and lifestyle factors. Urinary PAEs metabolites were assessed as both continuous and categorical variables. Tertile 1 was considered as the reference. Stratified analyses were performed by gender and pain site. All data analyses were conducted with STATA, version 15.1. P < 0.05 was considered with statistical significance. Results: A total of 4,196 participants were considered in our final analysis. Chronic pain prevalence reached 52.19% (n = 2,138) among the participants, with women accounting for a large proportion (57.75% vs. 42.25%). After multivariable logistic regression analysis, a higher prevalence of chronic pain was observed among participants in the third tertile of mono-(2-ethyl)-hexyl phthalate (MEHP) (OR = 1.23, 95% CI = 1.02-1.48, P = 0.034) and mono-benzyl phthalate (MBzP) (OR = 1.28, 95% CI = 1.04-1.58, P = 0.022) in our adjusted model. The logtransformed concentration of MBzP also showed a significant association with chronic pain prevalence (OR = 1.09, 95% CI = 1.01-1.18, P = 0.036) in the adjusted model. In further analysis, the positive correlations of urinary phthalate metabolites with chronic pain remained robust when stratified by gender and chronic pain site. Conclusions: Our findings presented a positive correlation between urinary PAEs metabolites and chronic pain among adult participants, and more causal research should be conducted to ascertain the interactions between the two and to expound their underlying mechanisms.

Short-Term Benzalkonium Chloride (C12) Exposure Induced the Occurrence of Wide-Spectrum Antibiotic Resistance in Agricultural Soils.

Antibiotic resistance genes (ARGs) are global pollutants that pose a potential risk to human health. Benzalkonium chloride (C12) (BC) disinfectants are thought to exert selection pressure on antibiotic resistance. However, evidence of BC-induced changes in antibiotic resistance in the soil environment is lacking. Here, we established short-term soil microcosms to investigate ARG profile dynamics in agricultural soils amended with sulfamethazine (SMZ, 10 mg kg-1) and gradient concentrations of BC (0-100 mg kg-1), using high-throughput quantitative PCR and Illumina sequencing. With the increase in BC concentration, the number of ARGs detected in the soil increased, but the normalized ARG abundance decreased. The added SMZ had a limited impact on ARG profiles. Compared to broad-spectrum fungicidal BC, the specificity of SMZ significantly affected the microbial community. Network analysis found that low-medium BC exposure concentrations resulted in the formation of small but strong ARG co-occurrence clusters in the soil, while high BC exposure concentration led to a higher incidence of ARGs. Variation partitioning analysis suggested that BC stress was the major driver shaping the ARG profile. Overall, this study highlighted the emergence and spread of BC-induced ARGs, potentially leading to the antimicrobial resistance problem in agricultural soils.

[Diagnosis and treatment of multiple endocrine neoplasia type 2A: a case report and literature review].

We report a case of multiple endocrine neoplasia (MEN) type 2A and summarize the clinical characteristics, diagnosis and treatment of this condition. The diagnosis of MEN type 2A relies on a comprehensive evaluation of the findings of ultrasound, CT and laboratory examinations, and early diagnosis and treatment is critical to improving the prognosis. Genetic testing of RET is the gold standard for diagnosis of MEN type 2A and 2B. Surgical intervention currently remains the primary choice of treatments of this disease.

Two G-protein-coupled-receptor candidates, Cand2 and Cand7, are involved in Arabidopsis root growth mediated by the bacterial quorum-sensing signals N-acyl-homoserine lactones.

Many Gram-negative bacteria use N-acyl-homoserine lactones (AHLs) as quorum sensing (QS) signaling molecules to coordinate their group behavior. Recently, it was shown that plants can perceive and respond to these bacterial AHLs. However, little is known about the molecular mechanism underlying the response of plants to bacterial QS signals. In this study, we show that the promotion of root elongation in wild type Arabidopsis thaliana induced by the AHLs N-3-oxo-hexanoyl-homoserine lactone (3OC6-HSL) or N-3-oxo-octanoyl-homoserine lactone (3OC8-HSL) was completely abolished in plants with loss-of-function mutations in two candidate G-protein Coupled Receptors (GPCRs), Cand2 and Cand7. Furthermore, real-time PCR analysis revealed that the expression levels of Cand2 and Cand7 were elevated in plants treated with 3OC6-HSL or 3OC8-HSL. These results suggest that Cand2 and Cand7 are involved in the regulation of root growth by bacterial AHLs and that GPCRs play a role in mediating interactions between plants and microbes.

[Childhood and adolescent thyroid carcinoma: a clinical analysis of 86 cases].

OBJECTIVE: To investigate the clinico-pathologic characteristics, treatment and prognosis of thyroid carcinoma in childhood and adolescents. METHODS: From 1984 to 1997, 86 cases with thyroid carcinoma in childhood and adolescent treated were summarized. RESULTS: All cases underwent operation with adjuvant therapy. Pathologically, papillary carcinoma was diagnosed in 73 (84.9%), follicular carcinoma in 6 (7%), papillary-follicular carcinoma in 4 (4.7%) and medullary carcinoma in 3 (3.5%). Cervical lymph node metastasis was found in 59 cases (68.6%), 16 of which with both thyroid carcinoma and bilateral cervical lymph node metastasis (27.1%). Lung metastasis was found in 11 cases. Recurrence occurred in 6 cases after operation. Compared with the thyroid carcinoma in adult patients, cervical lymph node metastasis, bilateral involvement of the thyroid gland with bilateral cervical nodes and lung metastasis rate were more commonly seen in childhood and adolescence. All but 2 patients had been followed up for more than 5 years, 41 patients for more than 10 years. The 5-year and 10-year survival rate was 95.3% (82/86) and 87.8% (36/41), respectively. CONCLUSION: The clinical manifestations of childhood and adolescent thyroid cancer are generally not pathognostic which may lead to misdiagnosis. Surgery is the main method in the comprehensive treatment with a good prognosis. The therapy with (131)I after operation was beneficial for some patients accompanied with lung metastasis.

[Malignant fibrous histiocytoma of head and neck: clinical analysis of 21 cases].

BACKGROUND & OBJECTIVE: Malignant fibrous histiocytoma (MFH) is a type of pleomorphic neoplastic diseases with complex pathological structure. Its histological origin is uncertain. It was often classified as other carcinoma. This study was designed to investigate the clinical and pathological features and improve the diagnosis and treatment. METHODS: To summarize and analyze the clinical experiences of 21 cases of MFH at head and neck proved histologically from June 1984 to June 1999 treated in Department of Head and Neck Surgery, Henan Tumor Hospital. RESULTS: Twenty cases were followed up more than 3 years; one case was lost. The 3-year survival rate was 42.9%(9/21). Nineteen cases were treated with surgery. Two cases in advanced stage were treated by non-surgery who died in 2 and 5 months. Among the patients treated with surgery, 6 cases survived without evidence of recurrence more than 3 years, 13 cases recurred within 2 years and 9 cases with metastasis. Seven cases received second surgery after recurrence. Among them,3 cases survived more than 3 years after second surgery. Of all 21 patients, 12 were proved with cervical lymph node metastasis. CONCLUSION: MFH at head and neck region is a kind of malignant disease with high recurrent rate and the cervical lymph node metastasis rate was 57.1%. Amplified radical surgery is the first choice of treatment. The second surgery has special value to the recurrent patients. Radiotherapy alone or chemotherapy alone is not effective to MFH of head and neck region.