ParaVR: A Virtual Reality Training Simulator for Paramedic Skills maintenance

This document is the Accepted Manuscript version of a Published Work that appeared in final form in Journal of Paramedic Practice, copyright © MA Healthcare, after peer review and technical editing by the publisher. To access the final edited and published work see https://www.paramedicpractice.com/features/article/paravr-a-virtual-reality-training-simulator-for-paramedic-skills-maintenance.Background, Virtual Reality (VR) technology is emerging as a powerful educational tool which is used in medical training and has potential benefits for paramedic practice education. Aim The aim of this paper is to report development of ParaVR, which utilises VR to address skills maintenance for paramedics. Methods Computer scientists at the University of Chester and the Welsh Ambulance Services NHS Trust (WAST) developed ParaVR in four stages: 1. Identifying requirements and specifications 2. Alpha version development, 3. Beta version development 4. Management: Development of software, further funding and commercialisation. Results Needle Cricothyrotomy and Needle Thoracostomy emerged as candidates for the prototype ParaVR. The Oculus Rift head mounted display (HMD) combined with Novint Falcon haptic device was used, and a virtual environment crafted using 3D modelling software, ported (a computing term meaning transfer (software) from one system or machine to another) onto Oculus Go and Google cardboard VR platform. Conclusion VR is an emerging educational tool with the potential to enhance paramedic skills development and maintenance. The ParaVR program is the first step in our development, testing, and scaling up of this technology

Accumulation of fibronectin in the heart after myocardial infarction: a putative stimulator of adhesion and proliferation of adipose-derived stem cells

Stem cell therapy is a promising treatment after myocardial infarction (MI). A major problem in stem cell therapy, however, is that only a small proportion of stem cells applied to the heart can survive and differentiate into cardiomyocytes. We hypothesized that fibronectin in the heart after MI might positively affect stem cell adhesion and proliferation at the site of injury. Therefore, we investigated the kinetics of attachment and proliferation of adipose-tissue-derived stem cells (ASC) on fibronectin and analysed the time frame and localization of fibronectin accumulation in the human heart after MI. ASCs were seeded onto fibronectin-coated and uncoated culture wells. The numbers of adhering ASC were quantified after various incubation periods (5-30 min) by using DNA quantification assays. The proliferation of ASC was quantified after culturing ASC for various periods (0-9 days) by using DNA assays. Fibronectin accumulation after MI was quantified by immunohistochemical staining of heart sections from 35 patients, after different infarction periods (0-14 days old). We found that ASC attachment and proliferation on fibronectin-coated culture wells was significantly higher than on uncoated wells. Fibronectin deposition was significantly increased from 12 h to 14 days post-infarction, both in the infarction area and in the border-zone, compared with the uninfarcted heart. Our results suggest that a positive effect of fibronectin on stem cells in the heart can only be achieved when stem cell therapy is applied at least 12 h after MI, when the accumulation of fibronectin occurs in the infarcted heart. © 2008 The Author(s)

Stem Cell Therapy: Pieces of the Puzzle

Acute ischemic injury and chronic cardiomyopathies can cause irreversible loss of cardiac tissue leading to heart failure. Cellular therapy offers a new paradigm for treatment of heart disease. Stem cell therapies in animal models show that transplantation of various cell preparations improves ventricular function after injury. The first clinical trials in patients produced some encouraging results, despite limited evidence for the long-term survival of transplanted cells. Ongoing research at the bench and the bedside aims to compare sources of donor cells, test methods of cell delivery, improve myocardial homing, bolster cell survival, and promote cardiomyocyte differentiation. This article reviews progress toward these goals

Activated phosphoinositide 3-kinase δ syndrome: Update from the ESID Registry and comparison with other autoimmune-lymphoproliferative inborn errors of immunity

Background: Activated phosphoinositide-3-kinase d syndrome (APDS) is an inborn error of immunity (IEI) with infection susceptibility and immune dysregulation, clinically overlapping with other conditions. Management depends on disease evolution, but predictors of severe disease are lacking. Objectives: This study sought to report the extended spectrum of disease manifestations in APDS1 versus APDS2; compare these to CTLA4 deficiency, NFKB1 deficiency, and STAT3 gain of-function (GOF) disease; and identify predictors of severity in APDS. Methods: Data was collected from the ESID (European Society for Immunodeficiencies)-APDS registry and was compared with published cohorts of the other IEIs. Results: The analysis of 170 patients with APDS outlines high penetrance and early onset of APDS compared to the other IEIs. The large clinical heterogeneity even in individuals with the same PIK3CD variant E1021K illustrates how poorly the genotype predicts the disease phenotype and course. The high clinical overlap between APDS and the other investigated IEIs suggests relevant pathophysiological convergence of the affected pathways. Preferentially affected organ systems indicate specific pathophysiology: bronchiectasis is typical of APDS1; interstitial lung disease and enteropathy are more common in STAT3 GOF and CTLA4 deficiency. Endocrinopathies are most frequent in STAT3 GOF, but growth impairment is also common, particularly in APDS2. Early clinical presentation is a risk factor for severe disease in APDS. Conclusions: APDS illustrates how a single genetic variant can result in a diverse autoimmune-lymphoproliferative phenotype. Overlap with other IEIs is substantial. Some specific features distinguish APDS1 from APDS2. Early onset is a risk factor for severe disease course calling for specific treatment studies in younger patients. (J Allergy Clin Immunol 2023;152:984-96.

Toward better treatment of clogged arteries

Real-time detailed monitoring of angioplasty balloon deformation may lead to improved medical devices to treat hardened artery walls.Peer reviewed: YesNRC publication: Ye

PW12B-BO103-22 real-time control of angioplasty balloon inflation based on feedback from intravascular optical coherence tomography

Peer reviewed: YesNRC publication: Ye

Real-time control of angioplasty balloon inflation based on feedback from intravascular optical coherence tomography: Experimental validation on an excised heart and a beating heart model

We report on real-time control of balloon inflation inside porcine arteries. In the first step, experiments were done in a coronary artery of an excised heart. In the second step, experiments were done in a beating heart setup providing conditions very close to in vivo conditions without the complications. A programmable syringe pump was used to inflate a compliant balloon in arteries, while intravascular optical coherence tomography (IVOCT) monitoring was performed. In a feedback loop, IVOCT images were processed to provide the balloon diameter values in real time to control the pump action in order to achieve a target diameter. In different experiments, various flow rates and target diameters were used. In the excised heart experiment, there was good convergence to target diameters resulting in a satisfactory balloon inflation control. In the beating heart experiment, there were oscillations in the diameter values due to cyclic arterial contractions. In these experiments, the control system maintained diameter averages satisfactorily close to predetermined target values. Real-time control of balloon inflation could not only provide a safer outcome for angioplasty procedures, but could also provide additional information for diagnostics since it implicitly provides information about the artery response to the inflation process. \ua9 1964-2012 IEEE.Peer reviewed: YesNRC publication: Ye

Optical Coherence Tomography Layer Thickness Characterization of a Mock Artery during Angioplasty Balloon Deployment

Optical coherence tomography (OCT) is used to study the deformation of a mock artery in an angioplasty simulation setup. An OCT probe integrated in a balloon catheter provides intraluminal real-time images during balloon inflation. Swept-source OCT is used for imaging. A 4 mm semi-compliant polyurethane balloon is used for experiments. The balloon is inflated inside a custom-built multi-layer artery phantom. The phantom has three layers to mock artery layers, namely, intima, media and adventitia. Semi-automatic segmentation of phantom layers is performed to provide a detailed assessment of the phantom deformation at various inflation pressures. Characterization of luminal diameter and thickness of different layers of the mock artery is provided for various inflation pressures.Peer reviewed: NoNRC publication: Ye