Name: endotracheal intubation using a flexible intubation endoscope as a standardized model for safe airway management in swine
Uploaded: 2022-08-25T13:30:00
Description: Watch this Scientific Journal Video about Endotracheal Intubation Using a Flexible Intubation Endoscope as a Standardized Model for Safe Airway Management in Swine at JoVE.com

作者要感谢Dagmar Dirvonskis的出色技术支持。

该协议中的实验得到了国家和机构动物护理委员会（Landesuntersuchungsamt Rheinland-Pfalz，科布伦茨，德国;批准号G20-1-135）的批准。实验是按照ARRIVE指南进行的。总体而言，本研究使用了10头平均体重为30公斤±2公斤，日龄为12-16周的麻醉公猪（Sus scrofa homea）。
1. 动物制备
<ol><li>为动物保持正常的环境，以尽量减少压力。在预定的实验前6小时停止进食以降低误?...

在之前的研究中，我们的研究小组已经描述了有关猪模型2，27，32，33的转化益处的具体细节。一般来说，降低动物的压力水平和不必要的疼痛应该是任何研究方案的一个组成部分，对于产生可靠的可重复数据至关重要。因此，对预期气道困难的猪进行清醒内镜引导的插管不是一种选择。
<p class="jov...

An erratum was issued for:&#160;<a href="https://www.jove.com/t/63955">Endotracheal Intubation Using a Flexible Intubation Endoscope As a Standardized Model for Safe Airway Management in Swine</a>. The Protocol, Representative Results, and Discussion sections were updated.
In the Protocol, step 1.5 was updated from:
Disinfect the skin with a disinfectant (alcoholic) before inserting a peripheral vein cannula (22 G) into an ear vein. Spray the area, wipe once, then spray again, and allow the disinfectant to dry.
to:
Disinfect the skin with a disinfectant (alcoholic) before inserting a peripheral vein cannula (22 G) into an ear vein. Spray the area, wipe once, then spray again, and allow the disinfectant to dry. Secure the ear cannula with a band-aid (See Table of Materials).
In the Protocol, step 3.7 was updated from:
While maintaining the position of the endoscope, advance the endotracheal tube until it becomes visible in the camera image. 
NOTE: If the endotracheal tube cannot be advanced through the glottic plane, there is a possibility that it has become caught on the arytenoid cartilage. In this case, the endotracheal tube must be withdrawn 1 cm and rotated by 90&#176; before gently advancing again. If necessary, this maneuver can be repeated. Similar calibers of flexible intubation endoscope and endotracheal tube can minimize the risk of this issue occurring. If the endotracheal tube cannot be advanced despite this maneuver, it is likely that the subglottic narrowness-the narrowest part of the porcine larynx-cannot be passed. In this case, a smaller endotracheal tube size needs to be selected. Regular commercially available endotracheal tubes in sizes 6.5 cm or 7.0 cm ID should be able to pass the glottis as long as no anatomic abnormalities are present.
to:
While maintaining the position of the endoscope, advance the endotracheal tube until it becomes visible in the camera image. 
NOTE: If the endotracheal tube cannot be advanced through the glottic plane, there is a possibility that it has become caught on the arytenoid cartilage. In this case, the endotracheal tube must be withdrawn 1 cm and rotated by 90&#176; before gently advancing again. If necessary, this maneuver can be repeated. Similar calibers of flexible intubation endoscope and endotracheal tube can minimize the risk of this issue occurring. If the endotracheal tube cannot be advanced despite this maneuver, it is likely that the subglottic narrowness-the narrowest part of the porcine larynx-cannot be passed. In this case, a smaller endotracheal tube size needs to be selected. Regular commercially available endotracheal tubes in sizes 6.5 cm or 7.0 cm ID should be able to pass the glottis as long as no anatomic abnormalities are present. Endotracheal tube size requirements vary depending on the piglet size and breed.
In the Representative Results, the sixth paragraph was updated from:
Statistical analyses were performed using commercially available software (see Table of Materials). Normal distribution was examined using the Kolmogorov-Smirnoff test28. If a normal distribution was determined, group differences were analyzed using t-tests of independent samples29 or the Mann-Whitney U test30 for the non-parametric version. Data are presented as mean (&#177; standard deviation). Correlations of ordinal-scale data were examined using Spearman&#39;s correlation coefficient31. A significance level of p &#60; 0.05 was assumed.
to:
Statistical analyses were performed using commercially available software (see Table of Materials). Normal distribution was examined using the Kolmogorov-Smirnoff test28. If a normal distribution was determined, group differences were analyzed using t-tests of independent samples29 or the Mann-Whitney U test30 for the non-parametric version. Data are presented as mean (&#177; standard deviation). Correlations of ordinal-scale data were examined using Spearman&#39;s correlation coefficient31. A significance level of p &#60; 0.05 was assumed. All tests were performed with exploratory intention; therefore p-values are descriptive. Nevertheless, p &#60; 0.05 was accepted as indicative of statistical significance.
In the Representative Results, the legend for figure 1 was updated from:
Figure 1: Number of intubation attempts in group comparison. For the group that was intubated using a flexible intubation endoscope, every intubation attempt was successful; in the group that was conventionally intubated, it took an average of 1.4 attempts before the endotracheal tube could be placed correctly. Error bars show the standard deviation. <a href="https://www.jove.com/files/ftp_upload/63955/63955fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
to:
Figure 1: Number of intubation attempts in group comparison. For the group that was intubated using a flexible intubation endoscope, every intubation attempt was successful; in the group that was conventionally intubated, it took an average of 1.4 attempts before the endotracheal tube could be placed correctly. Error bars show the standard deviation. n = 5 (for each group).&#160;<a href="https://www.jove.com/files/ftp_upload/63955/63955fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
In the Representative Results, figure 2 was updated from:
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/63955/63955fig02.jpg" /> 
Figure 2: Time until CO2 detection in group comparison. For the group that was intubated using a flexible intubation endoscope, it took significantly longer until end-tidal CO2 could be detected, depicted as mean and standard deviation. <a href="https://www.jove.com/files/ftp_upload/63955/63955fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
to:
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/63955/63955fig2v2.jpg" /> 
Figure 2: Time until CO2 detection in group comparison. For the group that was intubated using a flexible intubation endoscope, it took significantly longer until end-tidal CO2 could be detected, depicted as mean and standard deviation. n = 5 (for each group).&#160;<a href="https://www.jove.com/files/ftp_upload/63955/63955fig2v2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
In the Discussion, the fifth paragraph was updated from:
The increased duration had no clinical significance in this cohort. At no time was the termination criterion-a saturation of less than 93%-reached. This is shown in the results because a procedure change was unnecessary at any time. Prior adequate mask ventilation is a critical step to allow sufficient time for fiberoptic endotracheal tube placement to avoid rapid desaturation34. These results are consistent with previous studies comparing conventional intubation and endoscopically assisted intubations with inexperienced providers35.
to:
The increased duration had no clinical significance in this cohort. At no time was the termination criterion-a saturation of less than 93%-reached. This is shown in the results because a procedure change was unnecessary at any time. Prior adequate mask ventilation is a critical step to allow sufficient time for fiberoptic endotracheal tube placement to avoid rapid desaturation34. These results are consistent with previous studies comparing conventional intubation and endoscopically assisted intubations with inexperienced providers35. We attribute the prolonged duration of fiberoptic intubation to the fact that one must first reorient again after insertion, whereas with conventional intubation, one retains a view of the glottis. It is also important to avoid contact with the mucosa with the flexible intubation endoscope during advancement. This requires occasional corrective maneuvers. Last but not least, after successful placement, retraction of the relatively long endoscope is required, which increases the time to CO2 detection slightly.

An erratum was issued for:&#160;<a href="https://www.jove.com/t/63955">Endotracheal Intubation Using a Flexible Intubation Endoscope As a Standardized Model for Safe Airway Management in Swine</a>. The Protocol, Representative Results, and Discussion sections were updated.

Erratum: Endotracheal Intubation Using a Flexible Intubation Endoscope As a Standardized Model for Safe Airway Management in Swine

气管插管通常是猪模型转化研究的基本要求，用于需要安全气道或高通气压（例如心肺复苏期间通气1或急性呼吸窘迫综合征2）或要求脑血流不会因声门上气道装置的内部压迫而受损的各种干预措施3，偶尔在猪4，5的预期困难气道背景下作为替代物传播。
虽然猪的肺生理学显示出与人类相似的特征6，但由于猪口腔解剖结构的特定差异，有时保护气道明显更困难7。猪的鼻子开口窄，舌头很大，喉部活动性极强，会厌相对较大，游离端延伸到软腭。在尾部，喉部与气管形成钝角。枸杞软骨大8.气道最窄的部分位于声门下9层，与儿童10的气道解剖结构相当。由于猪的喉部活动性很强，因此气管插管末端有可能穿过声带，但喉部只会在尾部移位几厘米，这可能会被误认为是正确的插管8，11。此外，在处理猪气道管理时，食管插管是一种常见风险12.
对实验或早期死亡率有相应负面影响的气管插管困难或不可能的发生率尚未系统记录，但已发表几份病例报告13，14。在人类中，有可能在意外困难的传统插管的情况下使用柔性插管内窥镜15。在采取这项措施之前，通常会进行各种假插管。这些反复插管尝试与人类的不良事件有关16，17，尤其是气道并发症18。这些事件在试验动物中是有害的，因为在最简单的情况下，它们代表了实验中的一个混杂变量;在最坏的情况下，它们可能导致不必要的动物损失。
本研究根据人类预期困难气道管理指南开发了一个模型15，19，20，21，22，23，24。以前，在人体研究中已经描述了用于学习光纤插管的类似技术25，26。本报告中提出的方案旨在提供一种标准化且易于适应的插管模型，该模型还允许非气道专家在猪中进行成功和安全的气管插管。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Ambu aScope Regular</td>
			<td>Ambu GmbH, Medizinprodukte, Bad Nauheim, Germany</td>
			<td></td>
			<td>Disposable fiber optic outer diameter 5 mm</td>
		</tr>
		<tr>
			<td>Ambu aView Monitor</td>
			<td>Ambu GmbH, Medizinprodukte, Bad Nauheim, Germany</td>
			<td></td>
			<td>monitor</td>
		</tr>
		<tr>
			<td>Atracurium Hikma 50 mg/5mL</td>
			<td>Hikma Pharma GmbH, Martinsried</td>
			<td></td>
			<td>atracurium</td>
		</tr>
		<tr>
			<td>Azaperone (Stresnil) 40mg/mL</td>
			<td>Lilly Deutschland GmbH, Bad Homburg, Germany</td>
			<td></td>
			<td>azaperone</td>
		</tr>
		<tr>
			<td>BD Discardit II Spritze 2, 5, 10, 20 mL</td>
			<td>Becton Dickinson S.A. Carretera, Mequinenza Fraga, Spain</td>
			<td></td>
			<td>syringe</td>
		</tr>
		<tr>
			<td>BD Luer Connecta</td>
			<td>Becton Dickinson Infusion Therapy, AB Helsingborg, Schweden</td>
			<td></td>
			<td>3-way-stopcock</td>
		</tr>
		<tr>
			<td>BD Microlance 3 20 G</td>
			<td>Becton Dickinson S.A. Carretera, Mequinenza Fraga, Spain</td>
			<td></td>
			<td>cannula</td>
		</tr>
		<tr>
			<td>Curafix i.v. classics</td>
			<td>Lohmann &#38; Rauscher International GmbH &#38; Co. KG, Rengsdorf, Germany</td>
			<td></td>
			<td>Cannula retention dressing</td>
		</tr>
		<tr>
			<td>Engstr&#246;m Carestation</td>
			<td>GE Heathcare, Madison USA</td>
			<td></td>
			<td>ventilator</td>
		</tr>
		<tr>
			<td>Fentanyl-Janssen 0.05 mg/mL</td>
			<td>Janssen-Cilag GmbH, Neuss</td>
			<td></td>
			<td>fentanyl</td>
		</tr>
		<tr>
			<td>F&#252;hrungsstab, Durchmesser 4.3</td>
			<td>R&#252;sch</td>
			<td></td>
			<td>endotracheal tube introducer</td>
		</tr>
		<tr>
			<td>IBM SPSS Statistics for Windows, Version 20</td>
			<td>IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.)</td>
			<td></td>
			<td>Statistical software</td>
		</tr>
		<tr>
			<td>Incetomat-line 150 cm</td>
			<td>Fresenius, Kabi Deutschland, GmbH</td>
			<td></td>
			<td>perfusor line</td>
		</tr>
		<tr>
			<td>Intrafix Primeline</td>
			<td>B. Braun Melsungen AG, Melsungen, Germany</td>
			<td></td>
			<td>Infusion line</td>
		</tr>
		<tr>
			<td>JOZA Einmal Nitril Untersuchungshandschuhe</td>
			<td>JOZA, M&#252;nchen, Germany</td>
			<td></td>
			<td>disposable gloves</td>
		</tr>
		<tr>
			<td>Laryngoscope, 45.48.50, KL 2000</td>
			<td>Medicon</td>
			<td></td>
			<td>Laryngoscope handle</td>
		</tr>
		<tr>
			<td>Littmann Classic III Stethoscope</td>
			<td>3M Deutschland GmbH, Neuss, Germany</td>
			<td></td>
			<td>stethoscope</td>
		</tr>
		<tr>
			<td>Luer Lock</td>
			<td>B.Braun Melsungen AG, Germany</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Maimed Vlieskompresse</td>
			<td>Maimed GmbH, Neuenkirchen, Germany</td>
			<td></td>
			<td>Fleece compress to fix the tongue</td>
		</tr>
		<tr>
			<td>Masimo LNCS Adtx SpO2 sensor</td>
			<td>Masimo Corporation Irvine, Ca 92618 USA</td>
			<td></td>
			<td>saturation clip for the tail</td>
		</tr>
		<tr>
			<td>Masimo LNCS TC-I SpO2 ear clip sensor</td>
			<td>Masimo Corporation Irvine, Ca 92618 USA</td>
			<td></td>
			<td>Saturation clip for the ear</td>
		</tr>
		<tr>
			<td>Masimo Radical 7</td>
			<td>Masimo Corporation Irvine, Ca 92618 USA</td>
			<td></td>
			<td>periphereal oxygen saturation</td>
		</tr>
		<tr>
			<td>Midazolam 15 mg/3 mL</td>
			<td>Hameln Pharma GmbH, Hameln, Germany</td>
			<td></td>
			<td>midazolam</td>
		</tr>
		<tr>
			<td>Midmark Canine Mask Small Plastic with Diaphragm FRSCM-0005</td>
			<td>Midmark Corp., Dayton, Ohio, USA</td>
			<td></td>
			<td>dog ventilation mask</td>
		</tr>
		<tr>
			<td>Octeniderm farblos</td>
			<td>Sch&#252;lke &#38; Mayr GmbH, Nordenstedt, Germany</td>
			<td></td>
			<td>Alcoholic disinfectant</td>
		</tr>
		<tr>
			<td>Original Perfusor syringe 50 mL</td>
			<td>B.Braun Melsungen AG, Germany</td>
			<td></td>
			<td>perfusor syringe</td>
		</tr>
		<tr>
			<td>Perfusor FM Braun</td>
			<td>B.Braun Melsungen AG, Germany</td>
			<td></td>
			<td>syringe pump</td>
		</tr>
		<tr>
			<td>Propofol 2% 20 mg/mL (50 mL flasks)</td>
			<td>Fresenius, Kabi Deutschland, GmbH</td>
			<td></td>
			<td>propofol</td>
		</tr>
		<tr>
			<td>R&#220;SCH F&#252;hrungsstab f&#252;r Endotrachealtubus (ID 5.6 mm)</td>
			<td>Teleflex Medical Sdn. Bhd, Malaysia</td>
			<td></td>
			<td>PVC coated tube guiding wire</td>
		</tr>
		<tr>
			<td>R&#252;schelit Super Safety Clear &#62;ID 6/6.5 /7.0 mm</td>
			<td>Teleflex Medical Sdn. Bhd, Malaysia</td>
			<td></td>
			<td>endotracheal tube</td>
		</tr>
		<tr>
			<td>Stainless Macintosh Gr&#246;&#223;e 4</td>
			<td>Welch Allyn69604</td>
			<td></td>
			<td>blade for laryngoscope</td>
		</tr>
		<tr>
			<td>Sterofundin</td>
			<td>B.Braun Melsungen AG, Melsungen, Germany</td>
			<td></td>
			<td>Balanced electrolyte solution</td>
		</tr>
		<tr>
			<td>Ultrastop Antibeschlagmittel bottle with dropper 25 mL</td>
			<td>Sigmapharm Arzneimittel GmbH, Wien, Austria</td>
			<td></td>
			<td>Antifog agent</td>
		</tr>
		<tr>
			<td>Vasofix Safety 22 G-16 G</td>
			<td>B.Braun Melsungen AG, Germany</td>
			<td></td>
			<td>venous catheter</td>
		</tr>
		<tr>
			<td>VBM Cuff Manometer</td>
			<td>VBM Medizintechnik GmbH, Sulz a.N., Germany</td>
			<td></td>
			<td>cuff pressure gauge</td>
		</tr>
		<tr>
			<td>Zelette</td>
			<td>Lohmann &#38; Rauscher International GmbH &#38; Co. KG, Rengsdorf, Germany</td>
			<td></td>
			<td>Tissue swab</td>
		</tr>
	</tbody>
</table>

endotracheal intubation using a flexible intubation endoscope as a standardized model for safe airway management in swine

气管插管通常是猪模型中需要安全气道或高通气压的各种干预措施的转化研究的基本要求。气管插管是一项具有挑战性的技能，需要最少次数的成功气管插管才能在最佳条件下达到高成功率，这对于非麻醉学研究人员来说通常是无法实现的。由于猪气道解剖结构的特殊，通常可以假设气道困难。无法建立安全的气道可能导致实验动物受伤、不良事件或死亡。使用前瞻性、随机、对照评估方法，已经表明，光纤辅助气管插管需要更长的时间，但比传统插管具有更高的首过成功率，而不会引起临床相关的血氧饱和度下降。该模型为内镜引导的气管插管提供了一种标准化方案，提供了安全的气道，特别是对于在通过直接喉镜 进行 气管插管技术方面缺乏经验的研究人员。预计该程序将最大限度地减少动物痛苦和不必要的动物损失。

在前瞻性、随机、对照研究环境中对10头公猪（12-16周龄，体重30公斤±3公斤）进行了气管插管。将猪随机分为两组：一组常规喉镜插管（CI组），另一组通过方案中描述的柔性插管内窥镜 辅助 插管（FIE组）。小组作业是通过拉密封的信封来完成的。研究者每天随机分配。
该研究由麻醉实习生进行，他们具有3年以上的麻醉经验，对人类气道管理有深刻的了解，并且在猪...

Watch this Scientific Journal Video about Endotracheal Intubation Using a Flexible Intubation Endoscope as a Standardized Model for Safe Airway Management in Swine at JoVE.com

Endotracheal Intubation Using a Flexible Intubation Endoscope as a Standardized Model for Safe Airway Management in Swine

近年来，猪在研究中的使用有所增加。然而，猪的特点是气道解剖困难。通过演示如何进行内窥镜引导的气管插管，本协议旨在进一步提高实验动物的安全性，以避免动物痛苦和不必要的死亡。

使用柔性插管内窥镜作为猪安全气道管理的标准化模型的气管插管

Endotracheal intubation is often a basic requirement for translational research in porcine models for various interventions that require a secured airway ...

该方案为猪内镜引导的气管插管提供了一种标准化方法。这使得保护气道比传统的气管插管更容易、更安全。与标准的常规气管插管相比，这种技术更容易学习，学习曲线更陡峭，并允许经验丰富的检查员直接监督。我们强烈建议诱导麻醉只能由经过专门培训的人员进行或在他们的直接监督下进行。通过使用视频监视器，可以由主管直接进行校正。要开始气管插管，请让一名助手站在麻醉猪头部的左侧。让助手的左手张开嘴巴，向外捏住舌头，然后用压缩离开。指示助手用右手食指向下按压右上唇，以便更好地张开嘴巴。要进行直接喉镜检查，请将喉镜插入口腔右侧并向前推动，同时将舌头向左推。推进喉镜的尖端，直到它停留在声门瓣中。用导管导丝小心地将会厌推到一边，沿着软腭从右侧梨状凹槽向左侧轻轻舀动。将喉镜的手柄传递给助手，将其固定在当前位置。接下来，使用柔性插管内窥镜，气管插管已经安装并连接到视频监视器。将内窥镜口服并推进到舌根，直到声门可见。将声带之间的内窥镜推进到气管中。通过目视识别软骨环和膜部来确认气管的解剖结构。继续推进内窥镜，直到它位于隆起上方。不要触摸敏感的粘膜，以免肿胀和出血。在保持内窥镜位置的同时，推进气管插管，直到它在相机图像中可见。定位后，取下柔性插管内窥镜，同时保持气管插管。接下来，使用 10 毫升注射器用 10 毫升空气给袖带充气。使用袖带管理器控制袖带压力。通过二氧化碳监测定期和定期呼出二氧化碳以及通过听诊双面通气，确认气管插管的正确放置和充分通气。将管子与呼吸机连接后，开始机械通气。此处显示了软插管内窥镜或FIE以及常规插管或CI组中的插管尝试次数和二氧化碳检测所需的时间。在FIE组中，每次插管尝试都是成功的，而在CI组中，平均需要1.4次尝试。在FIE组中，与CI组相比，呼吸机中检测到二氧化碳所需的时间更长。万一内窥镜无法很好地看到声门，重要的是一旦氧气情况出现相关下降，立即恢复面罩通气。

Research

JoVE Journal

Medicine

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation

一个新型插管困难和困难通风救援技术

We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which ...

科研

医学

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

利用视觉和叙事方法，以实现公平的进程中，在临床护理

The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is ...

Guidelines for Elective Pediatric Fiberoptic Intubation

选修儿科光纤插管指南

Fiberoptic intubation in pediatric patients is often required especially in difficult airways of syndromic patients i.e. Pierre Robin Syndrome. Small ...

Endotracheal Intubation in Mice via Direct Laryngoscopy Using an Otoscope

Endotracheal Intubation in Mice via Direct Laryngoscopy Using an Otoscope

气管插管小鼠<em&gt;通过</em&gt;直接喉镜使用耳镜

Mice, both wildtype and transgenic, are the principal mammalian model in biomedical research currently. Intubation and mechanical ventilation are ...

A Simple Method of Mouse Lung Intubation

一个简单的方法小鼠肺插管

A  simple procedure to intubate mice for pulmonary function measurements would  have several advantages in longitudinal studies with limited numbers or  ...

Intubation-mediated Intratracheal (IMIT) Instillation: A Noninvasive, Lung-specific Delivery System

Intubation-mediated Intratracheal IMIT Instillation: A Noninvasive, Lung-specific Delivery System

插管介导气管内（IMIT）灌输：一种无创，龙专用输送系统

Respiratory disease studies typically involve the use of murine models as surrogate systems. However, there are significant physiologic differences ...

An Improved Method for Rapid Intubation of the Trachea in Mice

在小鼠气管插管快速的改进方法

Despite some anatomical and physiological differences, mouse models continue to be an essential tool for studying human lung disease. Bleomycin toxicity ...

Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow

气道局部麻醉清醒用于内镜插管使用喷雾为你去技术在高氧流量

A patient&#39;s willingness to cooperate is an absolute precondition for successful awake intubation of the trachea. Whilst drug-sedation of patients can ...

Tachycardia-Induced Cardiomyopathy As a Chronic Heart Failure Model in Swine

心动过速诱发的心肌病作为猪慢性心力衰竭模型的研究

A stable and reliable model of chronic heart failure is required for many experiments to understand hemodynamics or to test effects of new treatment ...

The Dyspepsia Educational Tool As a Novel Aid in Dyspepsia Management

消化不良教育工具作为消化不良管理中的一种新帮助

Digital educational tools have a well-established role in current healthcare. In particular, disorders that are managed non-pharmacologically benefit from ...