A good knowledge of the theoretical foundations of medicine helps students and physicians to better recognize and treat patients with complex medical conditions, including sepsis and septic shock. The article describes the authors' experience in implementing the analysis of sepsis and septic shock using a high-fidelity simulated clinical scenario in the course of pathological physiology for preclinical medical students. The unique aspect of our approach is the integration of core physiology concepts, such as homeostasis, causality, structure-function relationships, and fundamental pathophysiology concepts (e.g., etiology, pathogenesis, cell and tissue damage, inflammation, symptoms, and syndromes) in the analysis of the patient's condition on the high-fidelity simulator with preclinical medical students. According to the students' feedback, the use of a high-fidelity simulator to analyze the sepsis and septic shock scenario increased their interest in the class, improved their motivation to learn the material, and helped them adapt in a safe environment to making decisions based on a large amount of data about a complex patient condition in a time-sensitive situation.NEW & NOTEWORTHY The authors applied core theoretical concepts of physiology and the fundamental concepts of pathological physiology for teaching sepsis and septic shock clinical scenarios on the high-fidelity simulator in the course of pathological physiology for preclinical medical students. It elevated students' interest and motivation, enhanced the educational experience, and prepared students better for real-world clinical decision-making. We consider that this idea might be an inspiration to colleagues and invite further discussion.
- MeSH
- fyziologie výchova MeSH
- lidé MeSH
- sepse * patofyziologie terapie MeSH
- studenti lékařství * MeSH
- studium lékařství pregraduální metody MeSH
- vyučování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Current sonication experiments in vitro show immense variability in experimental set-ups and equipment used. Many factors such as presence of standing waves or position of sonicated sample in ultrasound field during the experiment affect ultrasound field parameters the sonicated samples actually experience. The main goal of this work was to quantify influence of position of sonicated sample on maximum acoustic intensity and overall amount of ultrasound energy entering sonication vessel when placed at different distances from ultrasound transducer. The measurements were performed in a water sonication tank with use of a circular unfocussed ultrasound transducer (d = 19 mm) and needle hydrophone (d = 0.5 mm). The measurements showed that the differences in amount of ultrasound energy (maximum and minimum energy were compared) entering particular well per time unit at different distances from ultrasound transducer range from 45.5% (48-well culture plate) to 109.9% (96-well culture plate). Moreover, the maximum acoustic intensity of ultrasound field entering particular well can differ by up to 233.2%. Therefore, position of sonicated sample in ultrasound field should not be neglected during sonication experiments in vitro.
PURPOSE: Endoscopic ear surgery has become a popular operative approach to treat middle ear diseases. Surgeons use either 0° or 30° endoscopes worldwide. The main aim of the work was to compare the properties of these two types of endoscopes. MATERIAL AND METHODS: Since this type of evaluation is hard to perform in vivo during the actual surgery, we designed 3D printed temporal bone models with different levels of complexity. The evaluation of endoscopes was based on image analysis or visibility of anatomical structures. RESULTS: The results show that a 30° endoscope offers a view of lateral walls from 4 mm distance, contrary to a 0° endoscope which cannot see lateral walls from this distance at all. On the other hand, visible area of the anterior wall is up to 40 % larger using 0° endoscope, compared to 30° endoscope. Angled endoscope distorts the picture and leads to the deterioration of the image. At commonly used distances above 5 mm from middle ear structures, resolution and image distortion is comparable between both endoscopes. CONCLUSIONS: Our results do not offer a definitive opinion on which endoscope is better for ear surgery. Both types of endoscopes have advantages and disadvantages, and the choice depends on the surgeon's personal preference and on the type of planned procedure.
- MeSH
- 3D tisk * MeSH
- anatomické modely * MeSH
- design vybavení MeSH
- endoskopie * metody MeSH
- endoskopy * MeSH
- lidé MeSH
- otologické chirurgické výkony * metody přístrojové vybavení MeSH
- spánková kost chirurgie MeSH
- střední ucho * chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
OBJECTIVE: Precise control over the ultrasound field parameters experienced by biological samples during sonication experiments in vitro may be quite challenging. The main goal of this work was to outline an approach to construction of sonication test cells that would minimize the interaction between the test cells and ultrasound. METHODS: Optimal dimensions of the test cell were determined through measurements conducted in a water sonication tank using 3D-printed test objects. The offset of local acoustic intensity variability inside the sonication test cell was set to value of ±50% of the reference value (i.e., local acoustic intensity measured at last axial maximum in the free-field condition). The cytotoxicity of several materials used for 3D printing was determined using the MTT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) assay. RESULTS: The sonication test cells were 3D printed from polylactic acid material, which was not toxic to the cells. Silicone membrane HT-6240, which was used to construct the bottom of the test cell, was found to reduce ultrasound energy minimally. Final ultrasound profiles inside the sonication test cells indicated the desired variability of local acoustic intensity. The cell viability in our sonication test cell was comparable to that of commercial culture plates with bottoms constructed with silicone membrane. CONCLUSION: An approach to construction of sonication test cells minimizing the interaction of the test cell and ultrasound has been outlined.
HYPOTHESIS: Higher light intensity settings do not yield improved image quality in endoscopic ear surgery. BACKGROUND: Light intensity is a parameter with major impact on the quality of digital images. For ear surgery, light produces heat associated with a thermal risk to ear structures and the light source setting should be accordingly optimized. METHODS: Several series of still images were acquired during live middle ear surgery, using cadaveric and plastic temporal bone models and with three-dimensional printed models. Images obtained under varying light intensities were compared with the image acquired at maximum intensity of a light emitting diode light source. We analyzed digital image brightness and noise using quantitative methods. RESULTS: Our measurements revealed significantly decreased image brightness with light intensities set below 20% with an increase in noise at light intensities lower than 30%. CONCLUSION: The optimal light source setting corresponded to 30% intensity in our experimental set-up. Special attention should be given to those cases where faster image quality degradation is expected (dark or bloody scenes or larger cavities). The results were strongly dependent on the equipment used. The methods described in this study can serve as a general guide for determining the optimal light source setting in any specific set-up.
- MeSH
- endoskopie MeSH
- lidé MeSH
- otologické chirurgické výkony * MeSH
- spánková kost MeSH
- střední ucho chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECTIVES: The most promising strategy for managing COVID-19 pandemic is achieving sufficient vaccination rate worldwide. The question is how many people will be willing to get vaccinated. STUDY DESIGN: We systematically reviewed peer-reviewed manuscripts monitoring people ́s intention to receive a vaccine against COVID-19. METHODS: Up to December 28, 2020 we identified 62 relevant peer-reviewed articles in PubMed, Web of Science, Scopus and GoogleScholar. RESULTS: Total sample size was 118 855 respondents with overall average COVID-19 vaccine acceptance rate of 72.5% which is “just” the level estimated to be sufficient for reaching herd immunity threshold. Surprisingly, healthcare workers showed smaller interest in receiving the vaccine when compared to general adult population and university students. On the other hand, their attitude to vaccination did not change over time. In case of general adult population, the longer the pandemic lasts, the smaller proportion of population wants to get vaccinated. Vaccination intentions were independent of gross domestic product and human development index. CONCLUSION: Willingness of population to receive COVID-19 is just at the herd immunity threshold and it is decreasing over time (Tab. 2, Fig. 3, Ref. 110).
In many in vitro experiments studying ultrasound bioeffects the sonicated samples are placed to far field with intention of exposing them to as uniform ultrasound field as possible. The main aim of this work is to assess whether the sonicated samples really experience what they are believed to. Also we would like to suggest basic rules for construction of sonication vessels. We used 3.5 MHz and 7 MHz ultrasound transducers for measurements. We measured ultrasound field inside and behind common culture plates and special 3D printed plates placed to last axial maximum in water sonication tank with use of a needle hydrophone. Our results show that even though the sonication vessels with sonicated samples are placed into far field, the sonicated samples are actually exposed to some kind of a near field pattern which develops due to the interaction between ultrasound and well of culture plate. The variability of local acoustic intensity can reach up to several hundreds of percent. Our results are also supported by theoretical calculation and software for simulation of ultrasound fields. Even though the sonicated samples may have actually been exposed to some kind of near field pattern in many past studies, the whole phenomenon of creation of near field pattern can be controlled to some extent for future studies. Thus, we suggest that the sonication vessel should always be designed for particular ultrasound transducer.
- Publikační typ
- časopisecké články MeSH
AIM: Our aim was to examine the contribution of shear wave elastography to ultrasonographic assessment in diffuse thyroid disease, specifically to evaluate the stiffness of the thyroid gland in diffuse thyroid disease and compare it with healthy controls. METHODS: A total of 46 patients with diffuse thyroid disease were examined clinically, by conventional ultrasound, and shear wave elastography. The conventional ultrasound parameters followed were: volume, margin quality, presence of nodules, and vascularisation. We measured the mean, minimum, and maximum stiffnesses by shear wave elastography. Results were correlated with values in 128 healthy subjects. RESULTS: Patients with diffuse thyroid disease had significantly higher mean and maximal stiffnesses of the thyroid gland: 12.5 ± 5 kPa and 35.3 ± 12.8 kPa, respectively, and lower minimal stiffness: 0.5 ± 0.6 kPa than the healthy control group with mean, maximal, and minimal values of 9.5 ± 3.6 kPa, 22.5 ± 7.3 kPa, and 2.2 ± 2.1 kPa (P<0.001). Stiffness values were positively correlated with BMI and volume of the thyroid; they did not correlate with margin quality, presence of nodules nor vascularisation. Compared with healthy volunteers, thyroid glands of patients with diffuse thyroid disease had a blurred margin more frequently and the amount of nodules and vascularisation were higher. Patients with Graves-Basedow disease did not have significantly different mean, maximal, nor minimal stiffnesses than those with thyroiditis. CONCLUSION: Both mean and maximal stiffness of the thyroid gland are significantly higher in diffuse thyroid disease than in the healthy population, while minimal stiffness is lower.
- MeSH
- elastografie * MeSH
- lidé MeSH
- nemoci štítné žlázy * diagnostické zobrazování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Current in vitro sonication experiments show immense variability in experimental set-ups and methods used. As a result, there is uncertainty in the ultrasound field parameters experienced by sonicated samples, poor reproducibility of these experiments and thus reduced scientific value of the results obtained. The scope of this narrative review is to briefly describe mechanisms of action of ultrasound, list the most frequently used experimental set-ups and focus on a description of factors influencing the outcomes and reproducibility of these experiments. The factors assessed include: proper reporting of ultrasound exposure parameters, experimental geometry, coupling medium quality, influence of culture vessels, formation of standing waves, motion/rotation of the sonicated sample and the characteristics of the sample itself. In the discussion we describe pros and cons of particular exposure geometries and factors, and make a few recommendations as to how to increase the reproducibility and validity of the experiments performed.
Skripta
1. vydání 169 stran : ilustrace ; 29 cm
V této knize shrnujeme dlouhodobé zkušenosti s výukou medicíny na pokročilém pacientském simulátoru SimMan 3G.
- Klíčová slova
- simulátor SimMan 3G,
- MeSH
- lékařská informatika MeSH
- náhlé příhody MeSH
- počítačová simulace MeSH
- Konspekt
- Lékařské vědy. Lékařství
- Učební osnovy. Vyučovací předměty. Učebnice
- NLK Obory
- urgentní lékařství
- NLK Publikační typ
- kolektivní monografie
- učebnice vysokých škol
