Objective To explore the impact of artificial-intelligence perceptual learning when performing the ultrasound-guided popliteal sciatic block. Methods This simulation-based randomized study enrolled residents who underwent ultrasound-guided sciatic nerve block training at the Department of Anesthesiology of Beijing Jishuitan Hospital between January 2022 and February 2022. Residents were randomly divided into a traditional teaching group and an AI teaching group. All residents attended the same nerve block theory courses, while those in the AI teaching group participated in training course using an AI-assisted nerve identification system based on a convolutional neural network instead of traditional training. Results A total of 40 residents were included. The complication rates of paresthesia during puncture in the first month of clinical sciatic nerve block practice after training were significantly lower in the AI teaching group than in the traditional teaching group [11 (4.12%) vs. 36 (14.06%), P = 0.000093]. The rates of paresthesia/pain during injection were significantly lower in the AI teaching group than in the traditional teaching group [6 (2.25%) vs. 17 (6.64%), P = 0.025]. The Assessment Checklist for Ultrasound-Guided Regional Anesthesia (32 ± 3.8 vs. 29.4 ± 3.9, P = 0.001) and nerve block self-rating scores (7.53 ± 1.62 vs. 6.49 ± 1.85, P < 0.001) were significantly higher in the AI teaching group than in the traditional teaching group. There were no significant differences in the remaining indicators. Conclusion The inclusion of an AI-assisted nerve identification system based on convolutional neural network as part of the training program for ultrasound-guided sciatic nerve block via the popliteal approach may reduce the incidence of nerve paresthesia and this might be related to improved perceptual learning. Clinical trial CHiCTR2200055115, registered on 1/ January /2022.
Background. The enhanced recovery after surgery (ERAS) program is aimed to shorten patients’ recovery process and improve clinical outcomes. This study aimed to compare the outcomes between the ERAS program and the traditional pathway among patients with ankle fracture and distal radius fracture. Methods. This is a multicenter prospective clinical controlled study consisting of 323 consecutive adults with ankle fracture from 12 centers and 323 consecutive adults with distal radial fracture from 13 centers scheduled for open reduction and internal fixation between January 2017 and December 2018. According to the perioperative protocol, patients were divided into two groups: the ERAS group and the traditional group. The primary outcome was the patients’ satisfaction of the whole treatment on discharge and at 6 months postoperatively. The secondary outcomes include delapsed time between admission and surgery, length of hospital stay, postoperative complications, functional score, and the MOS item short form health survey-36. Results. Data describing 772 patients with ankle fracture and 658 patients with distal radius fracture were collected, of which 323 patients with ankle fracture and 323 patients with distal radial fracture were included for analysis. The patients in the ERAS group showed higher satisfaction levels on discharge and at 6 months postoperatively than in the traditional group ( P < 0.001 ). In the subgroup analysis, patients with distal radial fracture in the ERAS group were more satisfied with the treatment ( P = 0.001 ). Furthermore, patients with ankle fracture had less time in bed ( P < 0.001 ) and shorter hospital stay ( P < 0.001 ) and patients with distal radial fracture received surgery quickly after being admitted into the ward in the ERAS group than in the traditional group ( P = 0.001 ). Conclusions. Perioperative protocol based on the ERAS program was associated with high satisfaction levels, less time in bed, and short hospital stay without increased complication rate and decreased functional outcomes.
Background Long-term fasting for elective surgery has been proven unnecessary based on established guidelines. Instead, preoperative carbohydrate loading 2 h before surgery and recommencing oral nutrition intake as soon as possible after surgery is recommended. This study was performed to analyze the compliance with and effect of abbreviated perioperative fasting management in patients undergoing surgical repair of fresh fractures based on current guidelines. Methods Patients with fresh fractures were retrospectively analyzed from the prospectively collected database about perioperative managements based on enhanced recovery of surgery (ERAS) from May 2019 to July 2019 at our hospital. A carbohydrate-enriched beverage was recommended up to 2 h before surgery for all surgical patients except those with contraindications. Postoperatively, oral clear liquids were allowed once the patients had regained full consciousness, and solid food was allowed 1 to 2 h later according to the patients’ willingness. The perioperative fasting time was recorded and the patients’ subjective comfort with respect to thirst and hunger was assessed using an interview-assisted questionnaire. Results In total, 306 patients were enrolled in this study. The compliance rate of preoperative carbohydrate loading was 71.6%, and 93.5% of patients began ingestion of oral liquids within 2 h after surgery. The median (interquartile range) preoperative fasting time for liquids and solids was 8 (5.2–12.9) and 19 (15.7–22) hours, respectively. The median postoperative fasting time for liquids and solids was 1 (0.5–1.9) and 2.8 (2.2–3.5) hours, respectively. A total of 70.3% and 74.2% of patients reported no thirst and hunger during the perioperative period, respectively. Logistic regression analysis showed that the preoperative fasting time for liquids was an independent risk factor for perioperative hunger. No risk factor was identified for perioperative thirst. No adverse events such as aspiration pneumonia or gastroesophageal reflux were observed. Conclusions In this study of a real clinical practice setting, abbreviated perioperative fasting management was carried out with high compliance in patients with fresh fractures. The preoperative fasting time should be further shortened to further improve patients’ subjective comfort.
Objective. To investigate the meniscus characteristics of knee osteoarthritis and its guiding significance for minimally invasive surgery. Methods. A total of 100 patients with knee meniscus sports injuries who were treated in our hospital from January 2019 to January 2022 were selected as the research subjects and were grouped according to the interval between injury and surgery, with an interval of 2 months: the early group (53 cases) within 2 months and the delayed group (47 cases) with an interval of more than 2 months. The distribution of intraoperative complications in the two groups was observed and recorded, and the changes in pain degree, joint range of motion, knee joint function, and quality of life scores before and after operation were compared between the two groups. Results. The postoperative VAS score, range of motion, Lysholm score, IKDC knee subjective function score, and quality of life score were significantly improved in both groups ( P < 0.05 ). The incidence of intra-articular cartilage injury in the delayed group was significantly higher than that in the early group ( P < 0.05 ). The patellofemoral cartilage injury was the main part of intra-articular cartilage injury in the two groups, and the incidence of patellofemoral cartilage injury in the delayed group was significantly higher than that in the early group ( P < 0.05 ). The cartilage damage was mainly cartilage damage, and the grades I-II and III-IV cartilage damages were significantly increased in the extension group. Conclusion. Meniscal injury in knee osteoarthritis has certain microscopic characteristics. In this paper, the microscopic classification of meniscus injury in knee osteoarthritis is helpful to guide microscopic surgery and improve the minimally invasive knee osteoarthritis effect of surgical treatment.
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