Sealing-type Three-cavities Ventilation Joint: A New Device in Painless Bronchoscopy

Background: To observe the clinical effect and safety of the sealing-type three-cavities ventilation joint in painless bronchoscopy. To compare the respiratory mechanics between I-gel laryngeal mask and tracheal tube-controlled breath during bronchoscopy. Methods: 200 patients underwent bronchoscopy were recruited and randomly assigned to general anesthesia group (group Ⅰ, n = 100) and local anesthesia group (group Ⅱ, n = 100). General anesthesia group were divided into two groups, the I-gel laryngeal mask combined with sealing-type three-cavities ventilation joint group group(n=50) and the endotracheal tube combined with sealing-type three-cavities ventilation joint group(n=50). Patients in Group I were adopted by I-gel laryngeal mask or endotracheal tube with the sealing-type three-cavities ventilation joint after the induction anesthesia with remifentanil, propofol and succinylcholine. In group II, patients were anaesthetized with lidocaine and followed by 2mg/ kg propofol iv, and spontaneous respirations were retained with nasal cannula. All patients’ vital signs, endoscopic related adverse reactions and arterial blood gas analysis were recorded during the procedure. Results: Group I showed little changes of vital signs (P <0.05), and less adverse reaction such as the intraoperative hypoxia and intraoperative body movement (P <0.05), and no significant decrease of oxygen partial pressure (P <0.05). There is no significant difference in respiratory mechanics including tidal volume and airway pressure between two subgroups in group I(P>0.05). Conclusion: Sealing-type three-cavities ventilation joint prevents the oxygen deficit and makes it possible for us to examine patients through bronchoscope under general anesthesia without gas leakage. Moreover, sealing-type three-cavities ventilation joint provides safe and effective airway control while it does not change respiratory mechanics in endotracheal tube group compared with I-gel laryngeal mask makes endotracheal tube an alternative solution in bronchoscope. Take all these in consideration, sealing-type three-cavities ventilation joint proves to be a feasible method in bronchoscope.

Collaborative Software Visualization in Co-located Environments

<p>Most software visualization systems and tools are designed from a single-user perspective and are bound to the desktop and IDEs. These design decisions do not allow users to analyse software collaboratively or to easily interact and navigate visualizations within a co-located environment at the same time. This thesis presents an exploratory study of collaborative software visualization using multi-touch tables in a co-located environment. The thesis contributes a richer understanding of how pairs of developers make use of shared visualizations on large multi-touch tables to gain insight into the design of software systems. We designed a collaborative software visualization application, called Source-Vis, that contained a suite of 13 visualization techniques adapted for multi-touch interaction. We built two large multi-touch tables (28 and 48 inches) following existing hardware designs, to explore and evaluate SourceVis. We then conducted both qualitative and quantitative user studies, culminating in a study of 44 professional software developers working in pairs. We found that pairs preferred joint group work, used a variety of coupling styles, and made many transitions between coupling and arrangement styles. For collaborative group work we recommend designing for joint group work over parallel individual work, supporting a flexible variety of coupling styles, and supporting fluid transitions between coupling and arrangement styles. We found that the preferred style for joint group work was closely coupled and arranged side by side. We found some global functionally was not easily accessible. We found some of the user interactions and visual interface elements were not designed consistently. For the design of collaborative software visualizations we recommend designing visualizations for closely coupled arrangements with rotation features, providing functionality in the appropriate locality, and providing consistent user interactions and visual interface design. We found sometimes visualization windows overlapped each other and text was hard to read in windows. We found when pairs were performing joint group work the size of the table was appropriate but not for parallel individual. We found that because the table could not differentiate between different simultaneous users that some pair interactions were limited. For the design of multi-touch tables we recommend providing a high resolution workspace, providing appropriate table space, and differentiating between simultaneous user interactions.</p>

Collaborative Software Visualization in Co-located Environments

<p>Most software visualization systems and tools are designed from a single-user perspective and are bound to the desktop and IDEs. These design decisions do not allow users to analyse software collaboratively or to easily interact and navigate visualizations within a co-located environment at the same time. This thesis presents an exploratory study of collaborative software visualization using multi-touch tables in a co-located environment. The thesis contributes a richer understanding of how pairs of developers make use of shared visualizations on large multi-touch tables to gain insight into the design of software systems. We designed a collaborative software visualization application, called Source-Vis, that contained a suite of 13 visualization techniques adapted for multi-touch interaction. We built two large multi-touch tables (28 and 48 inches) following existing hardware designs, to explore and evaluate SourceVis. We then conducted both qualitative and quantitative user studies, culminating in a study of 44 professional software developers working in pairs. We found that pairs preferred joint group work, used a variety of coupling styles, and made many transitions between coupling and arrangement styles. For collaborative group work we recommend designing for joint group work over parallel individual work, supporting a flexible variety of coupling styles, and supporting fluid transitions between coupling and arrangement styles. We found that the preferred style for joint group work was closely coupled and arranged side by side. We found some global functionally was not easily accessible. We found some of the user interactions and visual interface elements were not designed consistently. For the design of collaborative software visualizations we recommend designing visualizations for closely coupled arrangements with rotation features, providing functionality in the appropriate locality, and providing consistent user interactions and visual interface design. We found sometimes visualization windows overlapped each other and text was hard to read in windows. We found when pairs were performing joint group work the size of the table was appropriate but not for parallel individual. We found that because the table could not differentiate between different simultaneous users that some pair interactions were limited. For the design of multi-touch tables we recommend providing a high resolution workspace, providing appropriate table space, and differentiating between simultaneous user interactions.</p>

Effect of Tongluozhitong Prescription-Assisted Intra-Articular Injection of Sodium Hyaluronate on VAS Score and Knee Lysholm Score in Patients with Knee Osteoarthritis

Knee osteoarthritis (KOA) has become one of the leading causes of workforce loss in the middle-aged and elderly population and a global public health problem second only to cardiovascular disease, so we need to find more effective treatments for this disease. In this study, we selected 120 patients with KOA admitted to our hospital from June 2018 to December 2020 and divided them into treatment group 1, treatment group 2, and joint group according to the random number table method, with 40 patients in each group. Treatment group 1 was treated with Tongluozhitong prescription dip-soaking therapy, treatment 2 group was treated with intra-articular injection of sodium hyaluronate, and the joint group was treated with a combination of both modalities for 4 weeks in all three groups. Clinical efficacy, visual analogue scale (VAS), Lysholm knee score (LKS), activity of daily living score (ADL), the levels of bone metabolic markers such as cartilage oligomeric matrix protein (COMP), type II collagen degradation maker (CTX-II), and matrix metalloproteinase-3 (MMP-3), and the levels of inflammatory mediators such as interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and hypersensitive C-reactive protein (hs-CRP) were used as observations to compare and analyze the therapeutic effects of the three treatment regimens in KOA patients. The results showed that the clinical excellence rates of the joint group, treatment group 1, and treatment group 2 were 72.50%, 50.00%, and 90.00%, respectively, with statistically significant differences between any two comparisons. After treatment, VAS scores, serum COMP, CTX-II, MMP-3, IL-1β, TNF-α, and hs-CRP levels decreased in all three groups, and the levels of each index were as follows: joint group < treatment group 1 < treatment group 2, and the difference between any two comparisons was statistically significant. The LKS score and ADL score increased in all three groups, and the levels of each index were as follows: joint group > treatment group 1 > treatment group 2, with statistically significant differences in any two groups compared. None of the patients in the three groups experienced any significant adverse effects during treatment. This suggests that the dip-soaking therapy of Tongluozhitong prescription is more advantageous than intra-articular sodium hyaluronate injection treatment in suppressing the level of serum bone metabolic markers and inflammatory mediators, reducing pathological joint damage, relieving symptoms of pain, alleviating degenerative joint symptoms, and improving knee function in KOA patients. The combination of the two in KOA patients can significantly improve the efficacy and has a good safety profile.

Effects of Combined Epidural Anesthesia and General Anesthesia on Cognitive Function and Stress Responses of Elderly Patients Undergoing Liver Cancer Surgery

This study aimed at exploring the effects of combined epidural anesthesia and general anesthesia on the cognitive function and stress responses of elderly patients undergoing liver cancer surgery. One hundred and fifteen elderly patients were enrolled as research subjects. They were admitted to our hospital and underwent liver cancer surgery from August 2017 to May 2019. Fifty five cases were treated with general anesthesia (GA) (GA group), while the other sixty cases were treated with combined epidural anesthesia and general anesthesia (joint group). Scoring standards of Mini-Mental State Examination (MMSE) were used to evaluate the patients before and after operation. Their operating time, total fluid input (TFI), spontaneous breathing recovery time (SBRT), preoperative and postoperative indices of stress responses (epinephrine (EPI), cortisol (Cor), and norepinephrine (NE)), and postoperative adverse reactions were observed. There were statistically significant differences between the two groups with respect to anesthesia time, TFI, postoperative SBRT, and postoperative directional recovery time (DRT) (c P < 0.05 ). There was no difference in operating time, total fluid loss (TFL), and hospitalization time ( P > 0.05 ). After operation, patients in both groups experienced a cognitive decline of different degrees and the MMSE scores decreased. There was no significant difference in the score between the two groups before operation and 3 days and 7 days after operation ( P > 0.05 ). The score was significantly better in the joint group than that in the GA group at 6 hours and 1 day after operation ( P < 0.05 ). There were no significant differences in levels of EPI, Cor, and NE between the two groups before operation ( P > 0.05 ), but there were significant differences after operation. The total incidence of postoperative adverse reactions was 11.67% in the joint group and 25.45% in the GA group. In conclusion, combined epidural anesthesia and general anesthesia can significantly reduce postoperative cognitive dysfunction and inhibit postoperative stress responses in elderly patients undergoing liver cancer surgery. It has good application value in clinical practice.

Fostering Change Through Occupation-Based Intervention: An International Joint Group Concept Mapping Study

Further consolidation and clarity regarding occupation as a means to foster change in interventions are needed. The study aimed to utilize the knowledge of occupational scholars to systematically determine what is required to use occupation as means to foster change within occupation-based interventions and to generate a conceptual model from those results. Group Concept Mapping involved the following: preparation, generation of ideas, structuring of statements, data analysis, interpretation of maps, and development of conceptual model. Fifty-two international occupational scholars brainstormed 125 ideas. A cluster rating map with nine clusters posed the foundation for a conceptual model with seven themes, namely, artful use of occupation, evidence-based use of occupation, collaboration to promote occupation, coordinating intervention fit, client factors, sociocultural context, and structural influences. The conceptual model, capturing dimensions and dynamics required for using occupation to foster change, may guide future research into occupation-based interventions.

215 LOCATION OF ANASTOMOSIS BEHIND THE STERNOCLAVICULAR JOINT INCREASES THE INCIDENCE OF ANASTOMOTIC STENOSIS IN RETROSTERNAL RECONSTRUCTION AFTER ESOPHAGECTOMY

Anastomotic stenosis after esophagectomy is a major cause of long-term morbidity because it leads to poor dietary intake and malnutrition that markedly reduces quality of life. The aim of this study was to test the hypothesis that the risk of anastomotic stenosis is higher when the anastomosis is located behind the sternoclavicular joint than when it deviates from the sternoclavicular joint. Methods Among 226 patients who underwent esophagectomy between April 2010 and March 2019, we selected 114 patients who underwent retrosternal reconstruction using a gastric conduit for this study. They were classified into two groups according to the location of the anastomosis as determined by postoperative computed tomography scans: anastomosis located behind the sternoclavicular joint (group B; n = 71) and anastomosis deviated from the joint (group D; n = 43). The primary endpoint was the difference in the incidence of anastomotic stenosis between the two groups. Whether the occurrence of anastomotic leak affected the likelihood of anastomotic stenosis was also investigated. Results The incidence of anastomotic stenosis was significantly higher in group B than in group D (71.8% [n = 51] vs 18.6% [n = 8]; p &lt; 0.0001). The incidence of stenosis in patients who developed an anastomotic leak was significantly higher in group B than in group D (88.0% vs 41.7%; p = 0.0057), although the findings were similar in patients who did not develop an anastomotic leak (63.0% and 9.7%, respectively; p &lt; 0.0001). Conclusion There is an increased risk of anastomotic stenosis independent of anastomotic leak when the anastomosis is located behind the sternoclavicular joint in patients who undergo retrosternal reconstruction with a gastric conduit after esophagectomy.

Effect of Propofol and Dexmedetomidine on Pulmonary Injury in Patients with Acute Respiratory Distress Syndrome during Mechanical Ventilation

Objective: This research intended to explore the role of propofol and dexmedetomidine on pulmonary injury in patients with acute respiratory distress syndrome (ARDS) during mechanical ventilation. Methods: A total of 150 ARDS patients undergoing mechanical ventilation in our hospital from January 2017 to May 2019 were randomly grouped into dexmedetomidine group (n=50), propofol group (n=50) and joint group (n=50). The changes of heart rate, systolic blood pressure, diastolic blood pressure in the three groups were compared. Elisa was applied to test the changes of inflammatory factors interleukin-6 (IL-6) and tumor necrosis factor-a (TNF-a) on the first, second and third days after mechanical ventilation. The pulmonary injury score before sedation and after sedation for 2 days (Table 2) was tested. Secondary outcome measures: the incidence of adverse reactions after anesthesia was observed. Results: After sedation, the mean artery pressure and heart rate of the three groups were significantly lower than those before sedation (P < 0.05). After sedation, the expressions of IL-6 and TNF-a in joint group were significantly lower than those in propofol and dexmedetomidine group (P < 0.05). Two-day pulmonary injury scores of the three groups showed that different sedation schemes had positive effects on improving pulmonary injury scores (P < 0.05), and the expressions of IL-6 and TNF-a declined with the decline of pulmonary injury scores. The incidence of adverse reactions in joint group was significantly higher than that in propofol group and dexmedetomidine group (P < 0.05). Conclusion: Propofol and dexmedetomidine can effectively improve the effect of pulmonary injury in ARDS patients during mechanical ventilation, and slow down the occurrence of inflammatory reaction, which is an effective scheme of sedation in clinical mechanical ventilation.

The value of a nano-bamboo charcoal ankle guard combined with ankle-joint rehabilitation treatment on the rehabilitation effect of ankle-joint motor injury

Ankle-joint sports injuries with poor rehabilitation results can seriously affect a patient’s quality of life. Nanobamboo charcoal has a strong adsorbability and disinfection effect. It has been used in ankle guards, but the effect of nanometer-sized bamboo charcoal has not been reported thus far. In this study, 98 patients with an ankle-joint motor injury were divided into a Regular Group and Joint Group (49 cases, each) using the random number table method. The Regular Group received the conventional treatment, and the Joint Group received nano-bamboo charcoal ankle guard combined with ankle-joint rehabilitation treatment. The analysis showed that ankle function, balance function, dorsiflexion range of motion, American Orthopedic Foot Ankle Society score, and total effective rate (91.84% vs. 73.47%) in the Joint Group were all higher than those in the Regular Group, while the Visual Analog Scale and Clinical Symptom Score scores were all lower than those of the conventional group (P < 0.05). This indicates that a nano-bamboo charcoal ankle guard combined with ankle-joint rehabilitation treatment can effectively reduce pain and improve ankle-joint balance, movement, dorsiflexion range of motion, and other functioning parameters of the patients, with a significant curative effect and high clinical application value.