Detection of short stature homeobox 2 and RAS-associated domain family 1 subtype A DNA methylation in interventional pulmonology

One of the most important aspects of interventional pulmonology is to obtain tissue or liquid samples of the chest to diagnose a respiratory disease;however,it is still possible to obtain insufficient tissue or cytologic specimens.Indeed,methylation detection is an effective method by which to establish a diagnosis.This review focuses on the clinical application of short stature homeobox 2 and RAS-associated domain family 1 subtype A DNA methylation detection in interventional pulmonology,including bronchoscopic fluid biopsy,transbronchial needle aspiration,and pleural effusion.

Effect of Induced Anxiety on Respiratory Resistance Using Virtual Reality Simulation

Background: The purpose of this research was to identify significant changes to respiratory resistance resulting from anxiety inducing simulations presented through the medium of virtual reality (VR) goggles. The tested hypothesis was that a virtual reality simulation would produce anxiety in the wearer, and, with it, a statistically significant change in subject respiratory resistance. It was also suggested that there may be a significant difference in the levels of respiratory resistance responses of males and females. The Oculus Rift DK2 VR goggles with video software designed for the Rift were used to induce anxiety in the wearers. Methods: Respiratory resistances in both inhalation and exhalation directions were measured with the Airflow Perturbation Device (APD), a medical instrument used noninvasively. Two groups of subjects were tested: the test group watched a simulation deemed to be anxiety inducing, and the Control group watched a simulation determined to be non-anxiety inducing. Anxiety levels and respiratory resistance were measured before and during the simulation with two anxiety measures, the State Trait Anxiety Inventory (STAI) and the Subjective Units of Distress Scale (SUDS). Results: Statistically significant increases in anxiety level and respiratory resistance were found in the Test group, but no significant differences in anxiety and respiratory resistance levels were found in the control group. Anxiety affected both breathing phases similarly. For the gender hypothesis, we found that one of the tests used to measure anxiety, (the SUDS difference) was statistically significant, while the other test and the difference in respiratory resistance were not statistically significant. Conclusion: Results from this experiment show that anxiety level can be a significant contributor to the physiological measurement of respiratory resistance, and this can have implications for pulmonary function test environments and the psychological conditions of the patients being tested.

Improving pediatric resident laryngoscopy training through the use of a video laryngoscope

Importance:Opportunities for pediatric residents to perform direct laryngoscopy and tracheal intubation(DLTI)are few and the success rate is low.Objective:We hypothesize that incorporation of video laryngoscope(McGrath MAC)into pediatric residents DLTI simulation course will improve the simulated DLTI success rate.Methods:Residents were given 3 attempts at DLTI:(1)baseline using a conventional laryngoscope(CL);(2)using a video laryngoscope(VL);and(3)again using the CL.Residents were given up to 120 seconds to complete each DLTI attempt.Time to successful DLTI was collected.Residents recorded their best view(larynx,epiglottis,vocal cords)with each DLTI attempt.Results:Prior to the intervention,15/17(88.2%)and 16/17(94.1%)of the participants reported prior exposure to DLTI as'less than 10 total attempts'in simulated and live patients respectively.Seventeen pediatric residents performed 51 DLTI attempts(34 with a CL and 17 with the VL).Success rates for DLTI are as follows:Baseline with CL 11/17(64.7%),VL 12/17(70.6%),and last attempt with CL 13/17(76.5%)(P=0.15).Compared to the baseline,the use of VL resulted in a shorter but non-significant decrease in time to successful DLTI(Mean 34.2 sec[SD,22.0]vs.56.5 sec[SD,40.2];P=0.08).Repeat attempts at DLTI with the CL,however,were significantly shorter than baseline(Mean 20.3 sec[SD,12.8]vs.56.5 sec[SD,40.2];P=0.003).Using the VL,more residents could visualize the vocal cords compared to the baseline(14/17[82.3%]vs.9/17[52.9%];P=0.03).Interpretation:Repeated training is certainly a way to improve successful DLTI.Use of VL as a new teaching method led to greater visualization of the vocal cords,shortening operating time and raising self-confidence.