Puncture training with simulation models has emerged as a critical method for transmitting puncture skills, improving success rates, and minimizing injuries. Yet, obstacles such as proper material for ultrasound guidance, restricted options of 3D printing resources, and available substances to simulate human skin and muscle still hinder the production of simulation models that closely replicate clinical practice. This study aimed to develop a selective laser melting (SLM), 3D-printed simulation model that replicated the spine and skin contours of patients with spinal scoliosis. The 3D models of the scoliotic spines were developed from 3D reconstructions of high-resolution, computed tomography images from patients with spinal scoliosis, while the models of the skin to the bone structure were constructed based on the 3D reconstructions of the skin contours. SLM technology was used to print 3D models of the patients’ spines. Gelatin casting was implemented to simulate the patients’ skin and muscle tissues and to meet ultrasound anatomical requirements. Practical puncture training, which closely resembles clinical puncture practice, was then carried out to validate the effectiveness of the model. Improvements in proficiency and confidence in performing ultrasound-guided punctures after the simulation-model training were evaluated using the paired sample t test. This research utilized 3D digital modeling, SLM 3D printing technology, and gelatin casting to establish simulation models of patients’ spines and skin contours impacted by spinal scoliosis. The use of medical grade stainless steel material for modeling the spine and gelatin for skin and muscle tissues ensured the model had superior ultrasound anatomical properties. After the simulation training session, participants’ proficiency and confidence in both ultrasound-assisted positioning and real-time guided puncture showed significant improvement, demonstrating the effectiveness of the simulation training model. The simulation model closely mimicked real clinical situations and was an effective training tool for medical professionals. Furthermore, these findings demonstrated the potential of 3D printing technology in developing simulation models that closely replicate real-world clinical scenarios and may have significant implications for medical education and training.

A 35-year-old female presented with a 2-year history of persistent periumbilical pain and reduced flatulence. Initial investigations, including blood biochemistry and abdominal CT, were unremarkable. Pelvic CT revealed a small amount of fluid in the pelvic cavity. Later, an X-ray suggested intermittent incomplete intestinal obstruction (Figure 1A). Symptomatic treatment provided only temporary relief. The patient's condition was further complicated by recurrent abdominal pain, requiring regular use of tramadol (approximately 2-3 times per week). Six months into her illness, amidst stress at work, her symptoms worsened. Blood tests showed positive B2GP1-IgM, leading to a provisional diagnosis of antiphospholipid syndrome (APS). However, apart from the positive blood test, there were no other bases for diagnosing APS. Persistent pain led the patient to a pain clinic, where she was found to have tenderness in the left iliolumbar muscle. Lumbar MRI is generally normal. Based on the above examination findings, we suspect the patient may have iliolumbar muscle fascial pain syndrome, which is potentially caused by the lumbar sympathetic nerve.

BackgroundThe anesthetic management of patients with glucagonoma is complicated by a number of factors including glucose fluctuation, characterized necrolytic migratory erythema in oral and pharyngeal, which may lead to an unexpected difficult airway.Case presentationHerein we describe the anesthetic considerations and management of a 47-year-old adult with glucagonoma, who presented for a laparoscopic splenectomy and distal pancreatectomy procedure.ConclusionThis report details fiberoptic intubation in an adult with glucagonoma and necrolytic migratory erythema. We recommend that this approach be considered in patients with glucagonoma and severe necrolytic migratory erythema undergoing general anesthesia.

The facet joint injection is the most common procedure used to release lower back pain. In this paper, we proposed a deep learning method for detecting and segmenting facet joints in ultrasound images based on convolutional neural networks (CNNs) and enhanced data annotation. In the enhanced data annotation, a facet joint was considered as the first target and the ventral complex as the second target to improve the capability of CNNs in recognizing the facet joint. A total of 300 cases of patients undergoing pain treatment were included. The ultrasound images were captured and labeled by two professional anesthesiologists, and then augmented to train a deep learning model based on the Mask Region-based CNN (Mask R-CNN). The performance of the deep learning model was evaluated using the average precision (AP) on the testing sets. The data augmentation and data annotation methods were found to improve the AP. The AP50 for facet joint detection and segmentation was 90.4% and 85.0%, respectively, demonstrating the satisfying performance of the deep learning model. We presented a deep learning method for facet joint detection and segmentation in ultrasound images based on enhanced data annotation and the Mask R-CNN. The feasibility and potential of deep learning techniques in facet joint ultrasound image analysis have been demonstrated.

OBJECTIVES:To determine the impact of scenario-based lecture and personalized video feedback on anesthesia residents' communication skills during preoperative visits. METHODS:A total of 24 anesthesia residents were randomly divided into a video group and a control group. Residents in both groups took part in a simulated interview and received a scenario-based lecture on how to communicate with patients during preoperative visits. Afterwards, residents in the video group received personalized video feedback recorded during the simulated interview. One week later all the residents undertook another simulated interview. The communication skills of all the residents were assessed using the Consultation and Relational Empathy measure (CARE) scale by two examiners and one standardized patient (SP), both of whom were blinded to the group allocation. RESULTS:CARE scores were comparable between the two groups before training, and significantly improved after training in both groups (all P < 0.05). The video group showed significantly greater increase in CARE score after the training than the control group, especially assessed by the SP (t = 6.980, P <0.001). There were significant correlations between the examiner-assessed scores and SP-assessed scores (both P = 0.001). CONCLUSIONS:Scenario-based lectures with simulated interviews provide a good method for training communication skills of anesthesia residents, and personalized video feedback can enhance their performance on showing empathy during preoperative interview.

Abstract Background Accurate self-assessment is crucial for the professional development of physicians. There has been sparse data on the accuracy of self-assessments on Anesthesiology Milestones. The aim of this study was to investigate the differences between resident self-assessments and faculty-assessments on Anesthesiology Milestones and the associated factors. Methods This was a cross-sectional study conducted in a general tertiary university-affiliated hospital. We included anesthesia residents who were enrolled in the standardized residency training program in postgraduate year two and three at the time of the Milestone evaluation. We requested evaluations of competencies from both the Clinical Competency Committee faculty and the anesthesia residents themselves, utilizing the Chinese version of Anesthesiology Milestones in January 2023 and January 2024. The primary outcome was the differences between self- and faculty-assessments, calculated by subtracting the faculty-rated score from the self-rated score on each subcompetency. Results A total of 46 and 42 residents were evaluated in year 2023 and 2024, respectively. The self-rated sum score was significantly higher than that rated by faculty [mean (standardized deviation): 120.39 (32.41) vs. 114.44 (23.71), P = 0.008 in paired t test] with an intraclass correlation coefficient of 0.55 [95% confidence interval (CI): 0.31 to 0.70]. The Bland–Altman plots revealed significant overestimation in patient care (bias 0.32, 95% CI: 0.05 to 0.60), practice-based learning and improvement (bias 0.45, 95% CI: 0.07 to 0.84), and professionalism (bias 0.37, 95% CI: 0.02 to 0.72). Ratings from residents with master’s degrees (mean difference: -1.06, 95% CI: -1.80 to -0.32, P = 0.005) and doctorate degrees (mean difference: -1.14, 95% CI: -1.91 to -0.38, P = 0.003) were closer to the faculty-assessments than residents with bachelor's degrees. Compared with patient care, the differences between self- and faculty- rated scores were smaller in medical knowledge (mean difference: -0.18, 95% CI: -0.35 to -0.02, P = 0.031) and interpersonal and communication skills (mean difference: -0.41, 95% CI: -0.64 to -0.19, P < 0.001) in the generalized estimating equation logistic regression model. Conclusions This study revealed that residents tended to overestimate themselves, emphasizing the need to improve the accuracy of Milestones self-assessment. The differences between self- and faculty-assessments were associated with residents’ degrees and domains of competency.

BACKGROUND Downgrading target treatment and laparoscopic partial nephrectomy have become increasingly popular in patients with renal cell carcinomas. Rare as it is, pneumothorax is one of the most severe intraoperative complications which needs immediate recognition. On the other hand, as a rheumatological disease, lupus nephritis requires a long period of hormone therapy. Cases of pneumothorax in hormone-consuming renal cancer patients are even fewer. CASE SUMMARY A 39-year-old woman was admitted to our department to take a laparoscopic partial nephrectomy. The patient had a medical history of lupus nephritis and renal clear cell carcinoma with hormone and target treatment. Her blood oxygen saturation dropped to 92% during the operation, and pneumothorax was detected by ultrasound. O2 inhalation and lung dilation were performed. Her vital signs were monitored closely throughout the operation. The operation was accomplished, and she regained consciousness smoothly. A postoperative bedside chest X-ray was conducted after she was transferred to the urosurgery ward, while no evidence of further pneumothorax or lib injury was observed. CONCLUSION Pneumothorax is a severe complication in laparoscopic or robotic-assisted laparoscopic operations, especially in retroperitoneal ones. It is easily neglected unless the injury of the diaphragm is found. Low insufflation pressure and shorter operation time are necessary for patients with a history of long-term hormone consumption or chronic immune system disease.

背景:临床决策和应急处理能力是麻醉住院医师培养过程中的难点,也是保证临床安全的基础.目的:本研究在骨科临床手术麻醉教学中引入模拟病例运行教学方式,以提高住院医师临床决策和应急处理能力,并提高教学效果.方法:以麻醉科第二年规范化培训住院医师为培训对象,开展骨科手术麻醉应急处理的模拟培训课程.通过2个罕见、后果严重的骨科手术病例——恶性高热和术中肺栓塞进行模拟教学演练,并在演练结束后进行引导性反馈.在培训前后通过主观及客观问卷评估教学效果.结果:培训课程后,学员的客观评估评分显著提高(P<0.05),同时学员对培训课程满意度较传统模式教学高.结论:模拟病例教学方式弥补了传统教学的缺点,具有较好的教学效果,可以应用于骨科手术麻醉的临床教学中.

Background Total knee arthroplasty (TKA) is usually associated with moderate to severe postoperative pain. Peripheral nerve block (PNB) and local infiltration analgesia (LIA) are two major methods for postoperative analgesia. Femoral nerve block (FNB) leads to residual posterior knee pain; thus, currently sciatic nerve block (SNB) and LIA are two major options for supplementing FNB. However, the efficacy and safety of LIA compared with combined femoral and sciatic nerve block still remain controversial. Here, we conducted a study to analyze the postoperative analgesic efficacy of these two methods. Method Two hundred six patients undergoing TKA were enrolled in a retrospective cohort study. The patients received either PNB or LIA. All patients in PNB group were conducted combined femoral and sciatic nerve block. All patients were encouraged to use patient-controlled analgesia (PCA) after surgery. The postoperative visual analog scale (VAS) at rest or with movement during the first 24 h and 48 h was recorded. We analyzed the VAS of 24 h, VAS of 48 h, opioid consumption, and adverse effects between PNB group and LIA group. Chi-square test and nonparametric test were used in this study. Results There were 82 patients in the PNB group and 124 patients in the LIA group. The patients' characteristics such as age, height, weight, and ASA showed no significant difference (P > 0.05). No significant differences were found (P > 0.05) between the two groups regarding VAS score at rest or with movement. The LIA group had less opioid consumption than the PNB group but without significant difference (P > 0.05). In both groups, the most common side effect was nausea, and the side effects showed no significant differences between groups (P > 0.05). Conclusion Local infiltration analgesia provided a similar analgesic effect and complications compared with combined femoral and sciatic nerve block in the short term. Considering less opioid consumption with local infiltration analgesia though without significant difference and its convenience, local infiltration analgesia provided better postoperative analgesia.

Background Major lumber spine surgeries in the prone position have high mortality and morbidity, especially in elderly patients. Intraoperative goal-directed fluid therapy (GDT) has improved outcomes in abdominal and thoracic surgical procedures. However the utility of intraoperative GDT in spine surgery has not been present. In this study, we investigated whether GDT would reduce the postoperative complications in elderly patients undergoing lumbar stenosis decompression in the prone position. Methods In this single-center, randomized controlled clinical trial, we randomly assigned 84 patients aged > 60 undergoing lumbar decompression surgery to either a GDT group or a control group, who received conventional anesthesiologist-directed fluid therapy. Perioperative lactic acid concentrations with 7 different time point, intraoperative fluid balance and postoperative complications from admittance to 30 days after surgery were recorded. Results Lactic acid concentrations were higher in the control group than in the GTD group from the start of operation to 24 h after the operation, reaching maximum concentrations at exit from the post-anesthesia care unit (2.50 ± 1.22 mmol/l compared with 1.32 ± 0.42 mmol/l in controls; p<0.001). More total fluid volume was infused in GDT patients than in control patients (2416 ± 539 ml vs. 2036 ± 424ml, p<0.001). GDT patients had fewer infectious complications that did control patients (4.7% vs. 19.5%, P<0.001) after the surgery. Conclusion GDT during lumbar decompressive surgery under general anesthesia in elderly patients results in significantly better postoperative outcomes, which may be due to optimal fluid management and better perfusion of tissues and organs. Trial registration NCT02470221. Initial registration date was 06/09/2015.

BACKGROUND: The Chinese health care system must meet the needs of 19% of the world’s population. Despite recent economic growth, health care resources are unevenly distributed. This creates the potential for job stress and burnout. We therefore conducted a survey among anesthesiologists in the Beijing–Tianjin–Hebei region focusing on job satisfaction and burnout to determine the incidence and associated factors. METHODS: A large cross-sectional study was performed in the Beijing–Tianjin–Hebei region of China. The anonymous questionnaire was designed to collect and analyze the following information: (1) demographic characteristics and employer information; (2) job satisfaction assessed by Minnesota Satisfaction Questionnaire; (3) burnout assessed by Maslach Burnout Inventory-Human Service Survey; and (4) sleep pattern and physician–patient communication. RESULTS: Surveys were completed and returned from 211 hospitals (response rate 74%) and 2873 anesthesiologists (response rate 70%) during the period of June to August 2015. The overall job satisfaction score of Minnesota Satisfaction Questionnaire was 65.3 ± 11.5. Among the participants, 69% (95% confidence interval [CI], 67%–71%) met the criteria for burnout. The prevalence of high emotional exhaustion, high depersonalization, and low personal accomplishment was 57% (95% CI, 55%–59%), 49% (95% CI, 47%–51%), and 57% (95% CI, 55%–58%), respectively. Using multivariable logistic regression analysis, we found that age, hospital category, working hours per week, caseload per day, frequency of perceived challenging cases, income, and sleep quality were independent variables associated with burnout. Anesthesiologists with a high level of depersonalization tended to engage in shorter preoperative conversations with patients, provide less information about pain or the procedure, and to have less empathy with them. CONCLUSIONS: The anesthesiologists in the Beijing–Tianjin–Hebei region of China expressed a below-average level of job satisfaction, and suffered a significant degree of burnout. Improvement in job satisfaction and burnout might create a positive work climate that could benefit both the quality of patient care and the profession of anesthesiology in China.