Objective To investigate the knowledge,clinical application and training needs of Chinese anesthesiologists for ultrasound-guided intrathecal puncture technique.Methods The survey objects were anesthesiology clinicians in China.The questionnaire was designed by ourselves,and the survey time was from October to November 2023.Questionnaires were sent through wechat platform.The questionnaire was divided into three parts:general demographic information,application of intraspinal puncture,application of intraspinal puncture under ultrasound guidance,and training needs for intraspinal puncture under ultrasound guidance.The influencing factors were analyzed by ordered Logistic regression.Results A total of 1001 questionnaires were collected with a valid ratio was 94.2％(942/1 001).The respondents'knowledge of ultrasound-guided intrathecal puncture was 3.21±1.03,while the clinical application level was 2.43±1.25(P＜0.01).According to ordinal logistic regression analysis,senior doctor(OR=0.312,95％CI0.117-0.829,P=0.019),male(OR=0.658,95％CI 0.511～0.846,P=0.001),central region(OR=0.690,95％CI 0.523-0.911,P=0.009)and percentage of neuraxial anesthesia less than 20％(OR=0.426,95％CI 0.200-0.905,P=0.026)were significantly negatively correlated with the knowledge of ultrasound-guided intrathecal puncture technique.The main obstacle for the clinical application was unfamiliarity of the technique(83.9％)and the equipment(54.6％).The key technical challenges were finding the correct ultrasound views(69.6％),recognizing anatomical structures(69.2％)and poor ultrasound imaging(63.0％).The preferred training methods were simulation training(87.4％)and clinical instruction based on cases(90.0％).Conclusion There is still room for improvement in the understanding and clinical application of ultrasound-guided intrathecal puncture technique for the Chinese anesthesiologists.In the future,more training on ultrasound-guided intrathecal puncture technique could be provided according to our survey.

Objective:To evaluate the effects of 3D printing and mixed reality (MR) in teaching ultrasound-guided spinal puncture for scoliosis and to provide new approaches for enhancing educational outcomes in this field.Methods:Twenty anesthesiologists with no experience of spine ultrasound were selected from the Department of Anesthesiology at Peking Union Medical College Hospital and received training in ultrasound-guided spinal puncture in March 2024. They were assigned to the MR glasses+3D printing group or 3D printing group, with 10 participants in each group. The trainees in the MR glasses+3D printing group observed the spine model with the HoloLens 2 glasses and then conducted ultrasound-guided spinal puncture on the 3D-printed spine model. The trainees in the 3D printing group directly conducted ultrasound-guided spinal puncture on the 3D-printed spine model. The teaching effects were evaluated with objective puncture indicators (success rate and puncture time) and questionnaire survey. Data were analyzed using the independent samples t-test or chi-square test in SPSS 27.0. Results:The puncture time was shorter in the MR glasses+3D printing group compared with the 3D printing group [(165.90±69.91) s vs. (239.30±80.30) s, t=2.18, P=0.043]. The success rate of spinal puncture was 90.00% (9/10) in the MR glasses+3D printing group and 80.00% (8/10) in the 3D printing group, with no statistically significant difference ( P>0.999). The satisfaction [(4.70±0.48) vs. (4.80±0.42), t=0.49, P=0.628] and recommendation [(4.80±0.42) vs. (4.90±0.32), t=0.60, P=0.556] of the training method showed insignificant differences between the MR glasses+3D printing group and the 3D printing group. Conclusions:The combination of 3D printing with MR technology can provide trainees with a safe and repeatable high-fidelity simulation training system for ultrasound-guided spinal puncture. The system can improve the confidence and interest of trainees in ultrasound-guided spinal puncture techniques and enhance training efficiency. This combination demonstrates advantages and potential in training for spinal ultrasound and ultrasound-guided spinal puncture.

Objective:To evaluate the effects of 3D printing and mixed reality (MR) in teaching ultrasound-guided spinal puncture for scoliosis and to provide new approaches for enhancing educational outcomes in this field.Methods:Twenty anesthesiologists with no experience of spine ultrasound were selected from the Department of Anesthesiology at Peking Union Medical College Hospital and received training in ultrasound-guided spinal puncture in March 2024. They were assigned to the MR glasses+3D printing group or 3D printing group, with 10 participants in each group. The trainees in the MR glasses+3D printing group observed the spine model with the HoloLens 2 glasses and then conducted ultrasound-guided spinal puncture on the 3D-printed spine model. The trainees in the 3D printing group directly conducted ultrasound-guided spinal puncture on the 3D-printed spine model. The teaching effects were evaluated with objective puncture indicators (success rate and puncture time) and questionnaire survey. Data were analyzed using the independent samples t-test or chi-square test in SPSS 27.0. Results:The puncture time was shorter in the MR glasses+3D printing group compared with the 3D printing group [(165.90±69.91) s vs. (239.30±80.30) s, t=2.18, P=0.043]. The success rate of spinal puncture was 90.00% (9/10) in the MR glasses+3D printing group and 80.00% (8/10) in the 3D printing group, with no statistically significant difference ( P>0.999). The satisfaction [(4.70±0.48) vs. (4.80±0.42), t=0.49, P=0.628] and recommendation [(4.80±0.42) vs. (4.90±0.32), t=0.60, P=0.556] of the training method showed insignificant differences between the MR glasses+3D printing group and the 3D printing group. Conclusions:The combination of 3D printing with MR technology can provide trainees with a safe and repeatable high-fidelity simulation training system for ultrasound-guided spinal puncture. The system can improve the confidence and interest of trainees in ultrasound-guided spinal puncture techniques and enhance training efficiency. This combination demonstrates advantages and potential in training for spinal ultrasound and ultrasound-guided spinal puncture.

Periodontitis is the most widespread oral disease and is closely related to the oral microbiota. The oral microbiota is adversely affected by some pharmacologic treatments. Systemic antibiotics are widely used for infectious diseases but can lead to gut dysbiosis, causing negative effects on the human body. Whether systemic antibiotic-induced gut dysbiosis can affect the oral microbiota or even periodontitis has not yet been addressed. In this research, mice were exposed to drinking water containing a cocktail of four antibiotics to explore how systemic antibiotics affect microbiota pathogenicity and oral bone loss. The results demonstrated, for the first time, that gut dysbiosis caused by long-term use of antibiotics can disturb the oral microbiota and aggravate periodontitis. Moreover, the expression of cytokines related to Th17 was increased while transcription factors and cytokines related to Treg were decreased in the periodontal tissue. Fecal microbiota transplantation with normal mice feces restored the gut microbiota and barrier, decreased the pathogenicity of the oral microbiota, reversed the Th17/Treg imbalance in periodontal tissue, and alleviated alveolar bone loss. This study highlights the potential adverse effects of long-term systemic antibiotics-induced gut dysbiosis on the oral microbiota and periodontitis. A Th17/Treg imbalance might be related to this relationship. Importantly, these results reveal that the periodontal condition of patients should be assessed regularly when using systemic antibiotics in clinical practice.
Humans ; Mice ; Animals ; Dysbiosis ; Anti-Bacterial Agents/pharmacology* ; Virulence ; Microbiota ; Periodontitis/chemically induced* ; Cytokines

Objective To investigate the anesthesia residents' proficiency in the epidural puncture and training needs using questionnaire survey in China.Methods A questionnaire designed by ourselves was sent to anesthesia residents via the WeChat platform within 1 month.The data were recorded by the system automatically.Results A total of 795 anesthesia residents involved in the investigation,and the number of valid questionnaires was 753 (94.7％).There were 233 (30.9％) junior residents (0-2 yr of training),279 (37.1％) semi-senior residents (3-5 yr of training),and 241 (32.0％) senior residents (＞5yr of training).Compared with junior group,the difficulty score for epidural puncture was significantly decreased,and the confidence scores for performing normal middle lumbar,difficult lumbar,lateral lumbar and thoracic epidural puncture were increased in semi-senior and senior groups (P＜0.05).Compared with semi-senior group,the difficulty score for epidural puncture was significantly decreased,and the confidence scores for performing normal middle lumbar,difficult lumbar,lateral lumbar and thoracic epidural puncture were increased in senior group (P＜0.05).The self-evaluated difficulty of epidural puncture was lower as the number of prior epidural cases was more (r=-0.719,P＜0.01).There were 46.6％ of the residents who had received simulation-based training before performing epidural puncture on the patient,among which most residents considered the simulation-based training is effective in helping to familiarize with procedure (77.2％),familiarize with anatomy (70.4％),simulate the texture of different layers (47.9％),and enhance success rate of epidural puncture (56.7％).There were 75.0％ residents who considered visualization technology is helpful in enhancing the success rate and confidence of epidural puncture.Conclusion Currently,the proficiency of junior anesthesia residents in epidural puncture needs to be strengthened.The simulation-based training has not been widely applied in the epidural training,while residents think high of simulation-based training and are looking forward to visualization technique training.