Before caring for patients, video instruction is commonly used for undergraduate medical students, and 360° virtual reality (VR) videos have gained increasing interest in clinical medical education. Therefore, the effect of immersive 360° VR video learning compared with two-dimensional (2D) VR video learning in clinical skills acquisition should be evaluated. This randomized, intervention-controlled clinical trial was aimed to assess whether immersive 360° VR video improves undergraduate medical students' learning effectiveness and reduces the cognitive load in history taking and physical examination (H&P) training. From May 1 2018 to October 30 2018, 64 senior undergraduate medical students in a tertiary academic hospital were randomized to receive a 10-min immersive 360° (360° VR video group; n = 32) or 2D VR instructional video (2D VR video group; n = 32), including essential knowledge and competency of H&P. The demographic characteristics of the two groups were comparable for age, sex, and cognitive style. The total procedure skill score, physical examination score, learner’s satisfaction score, and total cognitive load in the 360° VR video group were significantly higher than those in the 2D VR video group (effect sizes [95% confidence interval]: 0.72 [0.21–1.22], 0.63 [0.12–1.13], 0.56 [0.06–1.06], and 0.53 [0.03–1.03], respectively). This study suggested that a10-minute 360° VR video instruction helped undergraduate medical students perform fundamental H&P skills as effectively as 2D VR video. Furthermore, the 360° VR video might result in significantly better procedural metrics of physical examinations with higher learner satisfaction despite the higher cognitive load.

The incidence of diabetes mellitus is rising worldwide, and prediabetic screening for insulin resistance (IR) has become ever more essential. This study aimed to investigate whether body mass index (BMI), waist circumference (WC), or body fat percentage (BF%) could be a better predictor of IR in a middle-aged and elderly population. In this cross-sectional, community-based study, 394 individuals (97 with IR and 297 without IR) were enrolled in the analysis. IR was measured by homeostasis model assessment (HOMA-IR), and subjects with HOMA-IR value ≧75th percentile were defined as being IR. Associations between IR and BMI, WC and BF% were evaluated by t test, chi square, Pearson correlation, logistic regression, and receiver operating characteristic (ROC) curves. A total of 394 community-dwelling, middle-aged, and elderly persons were enrolled; 138 (35%) were male, and 256 were female (65%). The mean age was 64.41 ± 8.46 years. A significant association was identified between BMI, WC, BF%, and IR, with Pearson correlation coefficients of 0.437 (P < .001), 0.412 (P < .001), and 0.361 (P < .001), respectively. Multivariate logistic regression revealed BMI (OR = 1.31; 95% CI = 1.20–1.42), WC (OR = 1.13; 95% CI = 1.08–1.17), and BF% (OR = 1.17; 95% CI = 1.11–1.23) to be independent predictors of IR. The area under curves of BMI and WC, 0.749 and 0.745 respectively, are greater than that of BF% 0.687. BMI and WC were more strongly associated with IR than was BF%. Excess body weight and body fat distribution were more important than total body fat in predicting IR.

Virtual reality (VR) applications could be beneficial for education, training, and treatment. However, VR may induce symptoms of simulator sickness (SS) such as difficulty focusing, difficulty concentrating, or dizziness that could impair autonomic nervous system function, affect mental workload, and worsen interventional outcomes. In the original randomized controlled trial, which explored the effectiveness of using a 360° VR video versus a two-dimensional VR video to learn history taking and physical examination skills, only the former group participants had SS. Therefore, 28 undergraduate medical students who participated in a 360° VR learning module were included in this post hoc study using a repeated measures design. Data of the Simulator Sickness Questionnaire (SSQ), heart rate variability (HRV) analysis, Task Load Index, and Mini-Clinical Evaluation Exercise were retrospectively reviewed and statistically analyzed. Ten (36%) participants had mild SS (total score > 0 and ≤ 20), and 18 (64%) had no SS symptom. Total SSQ score was positively related to the very low frequency (VLF) band power, physical demand subscale, and frustration subscale, and inversely related to physical examination score. Using multilevel modeling, the VLF power mediated the relationship between total SSQ score and physical examination score. Furthermore, frustration subscale moderated the mediating effects of the VLF power. Our results highlight the importance of documenting SS to evaluate a 360° VR training program. Furthermore, the combination of HRV analysis with mental workload measurement and outcome assessments provided the important clinical value in evaluating the effects of SS in VR applications in medical education.

Both obstructive sleep apnea (OSA) and obesity are major health issues that contribute to increased systemic inflammation in children. To date, adenotonsillectomy (AT) is still the first-line treatment for childhood OSA. However, the relationships among and predictive values of obesity, inflammation, and OSA severity have not been comprehensively investigated. This prospective study investigated body mass index (BMI), serum inflammatory markers, and OSA severity before and after AT in 60 pediatric patients with OSA. At baseline, differences in levels of interleukin-6, interleukin-9, basic fibroblast growth factor, platelet-derived growth factor-BB, as well as regulated on activation, normal T cell expressed and secreted (RANTES) were significant among the various weight status and OSA severity subgroups. After 3 months postoperatively, the differences in these inflammatory markers diminished along with a decrease in OSA severity while obesity persisted. The rate of surgical cure (defined as postoperative obstructive apnea-hypopnea index < 2.0 and obstructive apnea index < 1.0) was 62%. Multivariate analysis revealed that age, BMI z-score, granulocyte-macrophage colony-stimulating factor, monocyte chemotactic protein-1, and RANTES independently predicted surgical cure. Despite the significant reductions in inflammatory markers and OSA severity after AT, an inter-dependent relationship between obesity and OSA persisted. In addition to age and BMI, several inflammatory markers helped to precisely predict surgical cure.

Objectives The association between sleep duration and serum lipid profile in the middle-aged and the elderly is unclear. The aim of this study was to investigate and evaluate the relationships between sleep duration and levels of serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C) and triglycerides in these populations. Design Cross-sectional observational study. Setting Community-based investigation in Guishan Township of northern Taiwan. Participants A total of 400 community-dwelling middle-aged and elderly individuals were enrolled. All participants underwent a baseline assessment in 2014, which included anthropometrics, blood samples and self-administered questionnaires. Participants were classified into three groups based on their sleep duration. Outcome measures Multivariate logistic regression was used to obtain ORs and 95% CIs to assess the relationship between sleep duration and lipid profiles. Results Participant mean age was 64.5 years and 35.3% were men. Subjects with longer (>7 hours) and shorter (<6 hours) nightly sleep duration had a higher prevalence of low HDL-C levels (HDL <40 mg/dL) than those with moderate sleep duration (6–7 hours). Multivariate logistic regression revealed that, compared with individuals with sleep duration of 6–7 hours, the ORs of having low HDL-C were 3.68 (95% CI 1.59 to 8.49) greater for individuals with sleep duration of 7 hours. Conclusions There was a U-shaped relationship between sleep duration and HDL-C levels. Sleep duration >7 hours or <6 hours increased the risk of low serum HDL-C levels.