Do cardiopulmonary resuscitation real-time audiovisual feedback devices improve patient outcomes? A systematic review and metaanalysis

BACKGROUND Cardiac arrest is a leading cause of mortality in America and has increased in the incidence of cases over the last several years.Cardiopulmonary resuscitation(CPR)increases survival outcomes in cases of cardiac arrest;however,healthcare workers often do not perform CPR within recommended guidelines.Real-time audiovisual feedback(RTAVF)devices improve the quality of CPR performed.This systematic review and meta-analysis aims to compare the effect of RTAVF-assisted CPR with conventional CPR and to evaluate whether the use of these devices improved outcomes in both in-hospital cardiac arrest(IHCA)and out-of-hospital cardiac arrest(OHCA)patients.AIM To identify the effect of RTAVF-assisted CPR on patient outcomes and CPR quality with in-and OHCA.METHODS We searched PubMed,SCOPUS,the Cochrane Library,and EMBASE from inception to July 27,2020,for studies comparing patient outcomes and/or CPR quality metrics between RTAVF-assisted CPR and conventional CPR in cases of IHCA or OHCA.The primary outcomes of interest were return of spontaneous circulation(ROSC)and survival to hospital discharge(SHD),with secondary outcomes of chest compression rate and chest compression depth.The methodo-logical quality of the included studies was assessed using the Newcastle-Ottawa scale and Cochrane Collaboration’s“risk of bias”tool.Data was analyzed using R statistical software 4.2.0.results were statistically significant if P<0.05.RESULTS Thirteen studies(n=17600)were included.Patients were on average 69±17.5 years old,with 7022(39.8%)female patients.Overall pooled ROSC in patients in this study was 37%(95%confidence interval=23%-54%).RTAVF-assisted CPR significantly improved ROSC,both overall[risk ratio(RR)1.17(1.001-1.362);P=0.048]and in cases of IHCA[RR 1.36(1.06-1.80);P=0.002].There was no significant improvement in ROSC for OHCA(RR 1.04;0.91-1.19;P=0.47).No significant effect was seen in SHD[RR 1.04(0.91-1.19);P=0.47]or chest compression rate[standardized mean difference(SMD)-2.1;(-4.6-0.5);P=0.09].A significant improvement was seen in chest compression depth[SMD 1.6;(0.02-3.1);P=0.047].CONCLUSION RTAVF-assisted CPR increases ROSC in cases of IHCA and chest compression depth but has no significant effect on ROSC in cases of OHCA,SHD,or chest compression rate.

Real-Time Detection of Unstable Control Loop Behavior in a Feedback Active Noise Cancellation System for In-Ear Headphones

Active noise controls are used in a wide field of applications to cancel out unwanted surrounding noise. Control systems based on the feedback structure however have the disadvantage that they may become unstable during run-time due to changes in the control path—in this context including the listener’s ear. Especially when applied to active noise cancellation (ANC) headphones, the risk of instability is associated with the risk of harmful influence on the listener’s ear, which is exposed to the speaker in striking distance. This paper discusses several methods to enable the analysis of a feedback ANC system during run-time to immediately detect instability. Finally, a solution is proposed, which identifies the open loop behavior parametrically by means of an adaptive filter to subsequently evaluate the coefficients regarding stability.

Correlation analysis of real-time three-dimensional ultrasound in diagnosis of left ventricular function, portal hemodynamics and severity of liver function in patients with liver cirrhosis

Objective:To analyze the correlation between real-time three-dimensional ultrasound in diagnosis of left ventricular function, portal hemodynamics and severity of liver function in patients with liver cirrhosis.Methods: 90 patients with cirrhosis admitted to our hospital from January 2017 to December 2018 were enrolled in the cirrhosis group, and the cirrhosis components were group A, B and C according to the Child-Pauh classification criteria. During the same period, 90 healthy subjects who underwent physical examination were selected as the control group;real-time three-dimensional ultrasonography was performed to examine left ventricular function and portal hemodynamic parameters;Pearson correlation was used to analyze left ventricular function, portal hemodynamics and liver. Functional severity relationship.Results: The left heart E and E/A levels in the cirrhosis group were significantly lower than those in the control group (P<0.05), and the A level was significantly higher than the control group (P<0.05). The Dpv and Q levels in the cirrhosis group were significantly higher than those in the healthy control group. The difference was statistically significant (P<0.05), and the level of Vpv was significantly lower than that of healthy controls (P<0.05). There were significant differences in E, A and E/A levels between different Child-Paugh patients (P<0.05). There were significant differences in portal hemodynamics Dpv, Vpv and Q between the different Child-Paugh grades, and the difference was statistically significant (P<0.05);left heart function E and E/A and liver function severity There was a significant negative correlation (P<0.05). There was a significant positive correlation between left cardiac function A and liver function severity (P<0.05). Portal vein hemodynamics Dpv, Vpv and QE were significantly associated with liver function severity. Positive correlation (P<0.05). Conclusion: Real-time three-dimensional ultrasound can effectively detect left ventricular function and portal hemodynamics changes in patients with cirrhosis, and left heart function, portal hemodynamics and liver function severity are significantly correlated.

Real-time virtual sonography visualization and its clinical application in biliopancreatic disease

AIM:To evaluate the usefulness of real-time virtual sonography(RVS)in biliary and pancreatic diseases.METHODS:This study included 15 patients with biliary and pancreatic diseases.RVS can be used to observe an ultrasound image in real time by merging the ultrasound image with a multiplanar reconstruction computed tomography(CT)image,using pre-scanned CT volume data.The ultrasound used was EUB-8500with a convex probe EUP-C514.The RVS images were evaluated based on 3 levels,namely,excellent,good and poor,by the displacement in position.RESULTS:By combining the objectivity of CT with free scanning using RVS,it was possible to easily interpret the relationship between lesions and the surrounding organs as well as the position of vascular structures.The resulting evaluation levels of the RVS images were12 excellent(pancreatic cancer,bile duct cancer,cholecystolithiasis and cholangiocellular carcinoma)and 3 good(pancreatic cancer and gallbladder cancer).Compared with conventional B-mode ultrasonography and CT,RVS images achieved a rate of 80%superior visualization and 20%better visualization.CONCLUSION:RVS has potential usefulness in objective visualization and diagnosis in the field of biliary and pancreatic diseases.

A Text Categorization System with Soft Real-Time Guarantee

In order to provide predictable runtime performante for text categorization （TC） systems, an innovative system design method is proposed for soft real time TC systems. An analyzable mathematical model is established to approximately describe the nonlinear and time-varying TC systems. According to this mathematical model, the feedback control theory is adopted to prove the system＇s stableness and zero steady state error. The experiments result shows that the error of deadline satisfied ratio in the system is kept within 4 of the desired value. And the number of classifiers can be dynamically adjusted by the system itself to save the computa tion resources. The proposed methodology enables the theo retical analysis and evaluation to the TC systems, leading to a high-quality and low cost implementation approach.

FEL-H Robust Control Real-Time Scheduling

The existing scheduling algorithms cannot adequately support modern embedded real-time applications. An important challenge for future research is how to model and introduce control mechanisms to real-time systems to improve real-time performance, and to allow the system to adapt to changes in the environment, the workload, or to changes in the system architecture due to failures. In this paper, we pursue this goal by formulating and simulating new real-time scheduling models that enable us to easily analyse feedback scheduling with various constraints, overload and disturbance, and by designing a robust, adaptive scheduler that responds gracefully to overload with robust H∞ and feedback error learning control.

Novel approach of ultrasound-guided lateral recess block for a patient with lateral recess stenosis: A case report

BACKGROUND Ultrasound guide technology,which can provide real-time visualization of the needle tip and tissues and avoid many adverse events,is widely used in mini-mally invasive therapy.However,the studies on ultrasound-guided Lateral recess block(LRB)are limited,this is probably because there is no recognized standard method for ultrasound scanning.This study aimed to evaluate the effect of ultrasound-guided LRB in patients with lateral recess stenosis(LRS).CASE SUMMARY A 65-year-old patient complained of low back pain accompanied occasionally by pain and numbness in the left lower limb.Physical examination showed ten-derness on the spinous process and paraspinal muscles from L1 to S1,extensor hallucis longus and tibialis anterior weakness(muscle strength:4-),and a positive straight leg raising test in the left lower limb(60°).Magnetic resonance imaging showed L4–L5 disc degeneration with left LRS and nerve root entrapment.Subsequently,the patient was diagnosed with LRS.This patient was treated with a novel ultrasound-guided LRB approach.The patient’s symptoms significantly improved without any complications at 1 wk postoperatively and at the 3-month follow-up.CONCLUSION This is the first report on the LRS treatment with ultrasound-guided LRB from the contralateral spinous process along the inner side of the articular process by out-plane technique.Further studies are expected to investigate the efficacy and safety of ultrasound-guided LRB for patients with LRS.

Experimental Study on Real-Time Control System Testing

An experimental study on the testing of process control for a real-time control system is presented. Several indexes, such as the capability of system approximation output, the ramp rates, the smoothness and stability of output, and control of temperature overshoot, are selected as performance parameters. With these indexes, the thermal performance of thermal cyelers is validated, analyzed, and monitored. A testing prototype is designed and fabricated as a supplementary instrument for the experimental study. A tracking temperature algorithm with feedforward and feedback controls are also introduced to improve the efficiency of system performance testing.

An Underwater Robot Inspection Anomaly Localization Feedback System Based on Sonar Technology

This article introduces an underwater robot inspection anomaly localization feedback system comprising a real-time water surface tracking,detection,and positioning system located on the water surface,while the underwater robot inspection anomaly feedback system is housed within the underwater robot.The system facilitates the issuance of corresponding mechanical responses based on the water surface’s real-time tracking,detection,and positioning,enabling recognition and feedback of anomaly information.Through sonar technology,the underwater robot inspection anomaly feedback system monitors the underwater robot in real-time,triggering responsive actions upon encountering anomalies.The real-time tracking,detection,and positioning system from the water surface identifies abnormal conditions of underwater robots based on changes in sonar images,subsequently notifying personnel for necessary intervention.

Modified B-ultrasound method for measurement of antral section only to assess gastric function and guide enteral nutrition in critically ill patients

AIM To establish a modified B-ultrasound method of measuring the antral section only to assess gastric motility in healthy people,and evaluate its application in guiding enteral nutrition(EN) in critically ill patients. METHODS First,30 healthy volunteers were selected. The modified B-ultrasound method and the traditional B-ultrasound method were applied to assess gastric function. The correlation of indices of gastric function between the two groups was analyzed statistically. In addition,64 critically ill patients were selected,and the modified B-ultrasound method and the gastric juice withdrawal method were applied to guide the implementation of EN. Daily caloric value,the time required to achieve complete EN,ICU stay,hospitalization time,and serum prealbumin and albumin levels were recorded and compared between the two groups. Kaplan-Meier survival curve was used to compare the complications of EN between the two groups. RESULTS In healthy subjects,there was a good correlation among gastric emptying time,antral contraction frequency andantral motility index between the two groups(r = 0.57,0.61 and 0.54,respectively). The study on critically ill patients also revealed that a better effect of EN was achieved in the modified B-ultrasound method group,in which patients had shorter ICU stay and hospitalization time and higher levels of serum prealbumin and albumin. The Kaplan-Meier survival analysis revealed that the improved B-ultrasound method was associated with significantly fewer EN complications(P = 0.031).CONCLUSION The modified B-ultrasound method can provide a good real-time assessment of gastric function and has a better effect than the traditional method in guiding EN in critically ill patients.

State-of-the-art imaging techniques in endoscopic ultrasound

Endoscopic ultrasound (EUS) has recently evolved through technological improvement of equipment,with a major clinical impact in digestive and mediastinal diseases.State-of-the-art EUS equipment now includes real-time sono-elastography,which might be useful for a better characterization of lesions and increased accuracy of differential diagnosis (for e.g.lymph nodes or focal pancreatic lesions).Contrast-enhanced EUS imaging is also available,and is already being used for the differential diagnosis of focal pancreatic masses.The recent development of low mechanical index contrast harmonic EUS imaging offers hope for improved diagnosis,staging and monitoring of anti-angiogenic treatment.Tridimensional EUS (3D-EUS) techniques can be applied to enhance the spatial understanding of EUS anatomy,especially for improved staging of tumors,obtained through a better assessment of the relationship with major surrounding vessels.Despite the progress gained through all these imaging techniques,they cannot replace cytological or histological diagnosis.However,real-time optical histological diagnosis can be achieved through the use of single-fiber confocal laser endomicroscopy techniques placed under real-time EUS-guidance through a 22G needle.Last,but not least,EUS-assisted natural orifice transluminal endoscopic surgery (NOTES) procedures offer a whole new area of imaging applications,used either for combination of NOTES peritoneoscopy and intraperitoneal EUS,but also for access of retroperitoneal organs through posterior EUS guidance.

Real Time Ultrasound Elastography for the Differentiation of Benign and Malignant Thyroid Nodules

The purpose of this study was to evaluate the predictive value of real-time ultrasound elastography (RUE) in differentiating benign from malignant thyroid nodules, with fine needle aspiration cytology analysis as the reference standard. A total of 78 consecutive patients with thyroid nodules who were selected for fine needle aspiration biopsies were examined in this prospective study. 78 nodules in these patients were examined by conventional ultrasound, and ultrasound elastography. The final diagnosis was obtained from cytological findings. Tissue stiffness on ultrasound elastography was scored from 1 (low stiffness over the entire nodule) to 5 (high stiffness over the entire nodule and surrounding tissue). On real-time ultrasound elastography, 47 of 62 benign nodules (76%) had a score of 1 or 2, whereas 15 of 16 malignant nodules had a score of 3 to 5, with sensitivity of 93.7%, specificity of 90%, a positive predictive value of 71%, and a negative predictive value of 98%. Real-time ultrasound elastography is a promising imaging technique that is useful in the differential diagnosis of thyroid cancer. Utilization of ultrasound elastography could reduce the rate of thyroid biopsies because of its high elasticity being highly associated with benign cytology.

Clinical efficacy of ultrasound-guided pulsed radiofrequency combined with ganglion impar block for treatment of perineal pain

BACKGROUND Ganglion impar block alone or pulsed radiofrequency alone are effective options for treating perineal pain.However,ganglion impar block combined with pulsed radiofrequency(GIB-PRF)for treating perineal pain is rare and the puncture is usually performed with X-ray or computed tomography guidance.AIM To evaluate the safety and clinical efficacy of real-time ultrasound-guided GIBPRF in treating perineal pain.METHODS Thirty patients with perineal pain were included and were treated by GIB-PRF guided by real-time ultrasound imaging between January 2015 and December 2016.Complications were recorded to observe the safety of the ultrasound-guided GIB-PRF procedure,and visual analogue scale(VAS)scores at 24 h before and after treatment and 1,3,and 6 mo later were analyzed to evaluate clinical efficacy.RESULTS Ultrasound-guided GIB-PRF was performed successfully in all patients,and no complications occurred.Compared with pretreatment scores,the VAS scores were significantly lower(P<0.05)at the four time points after treatment.The VAS scores at 1 and 3 mo were slightly lower than those at 24 h(P>0.05)and were significantly lower at 6 mo after treatment(P<0.05).There was a tendency toward lower VAS scores at 6 mo after treatment compared with those at 1 and 3 mo(P>0.05).CONCLUSION Ultrasound-guided GIB-PRF was a safe and effective way to treat perineal pain.The 6-mo short-term clinical efficacy was favorable,but the long-term outcomes need future study.

Current use of intraoperative ultrasound in modern liver surgery

Ultrasound plays an important role not only in preoperative diagnosis but also in intraoperative guidance for liver surgery.Intraoperative ultrasound(IOUS)has become an indispensable tool for modern liver surgeons,especially for minimally invasive surgeries,partially substituting for the surgeon’s hands.In fundamental mode,Doppler mode,contrast enhancement,elastography,and real-time virtual sonography,IOUS can provide additional real-time information regarding the intrahepatic anatomy,tumor site and characteristics,macrovascular invasion,resection margin,transection plane,perfusion and outflow of the remnant liver,and local ablation efficacy for both open and minimally invasive liver resections.Identification and localization of intrahepatic lesions and surrounding structures are crucial for performing liver resection,preserving the adjacent vital vascular and bile ducts,and sparing the functional liver parenchyma.Intraoperative ultrasound can provide critical information for intraoperative decision-making and navigation.Therefore,all liver surgeons must master IOUS techniques,and IOUS should be included in the training of modern liver surgeons.Further investigation of the potential benefits and advances in these techniques will increase the use of IOUS in modern liver surgeries worldwide.This study comprehensively reviews the current use of IOUS in modern liver surgeries.

超声医学专业住院医师规范化培训技能考核满意度调查

目的对参加2022年湖北省超声医学科住院医师规范化培训技能结业考试的考官及考生进行问卷调查并收集反馈意见,为完善住培考试工作提供参考。方法对2022年5月参加考核的64位考官及100名考生进行多维度满意度调查。考官调查内容包括考站设置、考试实用性、考试普适性等项目;考生调查内容包括考试实用性、考试难易度等项目。结果考官调查结果显示考官对于考站设置满意度较高,85.9%的考官认为本次考试的考站设置合理,12.5%的考官认为本次考试的考站数量适中;认同及基本认同本次技能考试能反映学员在住培过程中的所学水平的考官占比54.7%和45.3%;赞成推广考试模式的考官达到100%;考官建议可适当挑选具有阳性体征的标准化病人及深入优化评分标准一致化。考生调查结果显示考点A、入培前工作经验丰富的考生对于考试实用性满意度评分更高,分别为(9.58±0.92)分和(9.57±0.78)分;入培前工作经验丰富、参加过考前模拟考试的考生认为考试难度更小,差异有统计学意义(P<0.05)。结论通过建立标准化病人库及考官培训日常化等措施有助于进一步完善住培技能结业考核制度,在日常规范化培训过程中针对考生的临床基础进行层次化管理和教学、建立考前模拟考试制度等有助于提高考生的应试信心及考试能力。

A virtual 3D interactive painting method for Chinese calligraphy and painting based on real-time force feedback technology

A novel 3D interactive painting method for Chinese calligraphy and painting based on force feedback technology is proposed. The relationship between the force exerted on the brush and the resulting brush deformation is analyzed and a spring-mass model is used to build a model of the 3D Chinese brush. The 2D brush footprint between the brush and the plane of the paper or object is calculated according to the deformation of the 3D brush when force is exerted on the 3D brush. Then the 3D brush footprint is obtained by projecting the 2D brush footprint onto the surface of the 3D object in real time, and a complete 3D brushstroke is obtained by superimposing 3D brush footprints along the painting direction. The proposed method has been suc- cessfully applied in a virtual 3D interactive drawing system based on force feedback technology. In this system, users can paint 3D brushstrokes in real time with a Phantom Desktop haptic device, which can effectively serve as a virtual reality interface to the simulated painting environment for users.

实时超声反馈下腹横肌运动控制的研究

目的:观察实时超声反馈对腹横肌运动控制的影响,探讨下背痛患者腹横肌运动控制训练的方法。方法:对33例试验对象随机分组,比较在有无实时超声反馈下两组试验对象腹横肌的收缩率,腰椎稳定性从1级上升至2级所需的训练次数和训练时间是否存在差异。结果:腹横肌收缩率(P=0.662>0.05)两组间无差异;训练次数(P=0.018<0.05)和训练时间(P=0.011<0.05)两组间存在差异,且训练次数均值试验组(1.5次)小于对照组(3.1次),训练时间均值试验组(13.4min)小于对照组(30.8min)。结论:实时超声反馈不会增加腹横肌收缩的效率;实时超声反馈能使试验对象用较少的次数,在较短时间内掌握腹横肌收缩的方法。

疫情防控下超声医学线上教学的效果评价及双向教学反馈情况初探

目的探讨疫情期间的线上教学中超声诊断科理论教学中的应用。方法以北京大学第三医院超声科参加线上理论教学的同一年资水平的规培生,研究生及进修及高访医生为研究对象,对照往年教学考核成绩作为客观指标,同时采用师生双向调查问卷情况作为主观评价指标。结果实验组与传统教学方法的对照组往期学生的理论考试平均成绩差异没有统计学意义,78.3%的师生问卷结果显示线上教学方法与以往常规线下教学相比效果更好。结论线上教学模式与线下常规教学模式教学质量相似,教师及学生对线上教学的方式接受及满意程度更好。

模拟教学联合视频反馈在超声医学科住院医师规范化培训中的应用

目的探讨模拟教学联合视频反馈在超声医学科住院医师规范化培训(简称住培)中的应用。方法选取超声医学专业住院医师24人为研究对象,随机均分为两组,以超声介入操作为教学内容,观察组进行模拟教学联合视频反馈,对照组进行传统教学,培训结束后对比分析两组住院医师教学成绩及教学效果满意度调查。结果培训后两组住院医师超声介入理论成绩和技能操作水平均较培训前提高,观察组介入操作成绩高于对照组(P<0.05),问卷调查显示观察组住院医师在提高学习能力、临床思维能力、操作能力及自信心等方面效果显著。结论模拟教学联合视频反馈能有效提高介入超声教学效果及住院医师的积极性,值得推广应用。

End-to-End Utilization Control for Aperiodic Tasks in Distributed Real-Time Systems

An increasing number of DRTS （Distributed model. The key challenges of such DRTS are guaranteeing Real-Time Systems） are employing an end-to-end aperiodic task utilization on multiple processors to achieve overload protection, and meeting the end-to-end deadlines of aperiodic tasks. This paper proposes an end-to-end utilization control architecture and an IC-EAT （Integration Control for End-to-End Aperiodic Tasks） algorithm, which features a distributed feedback loop that dynamically enforces the desired utilization bound on multiple processors. IC-EAT integrates admission control with feedback control, which is able to dynamically determine the QoS （Quality of Service） of incoming tasks and guarantee the end-to-end deadlines of admitted tasks. Then an LQOCM （Linear Quadratic Optimal Control Model） is presented. Finally, experiments demonstrate that, for the end-to-end DRTS whose control matrix G falls into the stable region, the IC-EAT is convergent and stable. Moreover,it is capable of providing better QoS guarantees for end-to-end aperiodic tasks and improving the system throughput.