The use of augmented reality (AR) and virtual reality (VR) for life support training is increasing. These technologies provide an immersive experience that supports learning in a safe and controlled environment. This review focuses on the use of AR and VR for emergency care training for health care providers, medical students, and nonprofessionals. In particular, we analyzed (1) serious games, nonimmersive games, both single-player and multiplayer; (2) VR tools ranging from semi-immersive to immersive virtual and mixed reality; and (3) AR applications. All the toolkits have been investigated in terms of application goals (training, assessment, or both), simulated procedures, and skills. The main goal of this work is to summarize and organize the findings of studies coming from multiple research areas in order to make them accessible to all the professionals involved in medical simulation. The analysis of the state-of-the-art technologies reveals that tools and studies related to the multiplayer experience, haptic feedback, and evaluation of user’s manual skills in the foregoing health care-related environments are still limited and require further investigation. Also, there is an additional need to conduct studies aimed at assessing whether AR/VR-based systems are superior or, at the minimum, comparable to traditional training methods.

Context The etiology of central precocious puberty (CPP) include a spectrum of conditions. Girls with CPP younger than 6 should undergo cranial magnetic resonance imaging (MRI), but it remains controversial whether all girls who develop CPP between the ages of 6 and 8 require neuroimaging examination. Objective To investigate the frequency of brain MRI abnormalities in girls diagnosed with CPP and the relationship between maternal factors, their age at presentation, clinical signs and symptoms, hormonal profiles and neuroimaging findings. Methods Data from 112 girls who showed clinical pubertal progression before 8 years of age who underwent brain MRI were collected between January 2005 and September 2019. Results MRI was normal in 47 (42%) idiopathics (I), 54 (48%) had hypothalamic-pituitary anomalies (HPA) and/or extra-HP anomalies (EHPA), and 11 (10%) had brain tumors or tumor-like conditions (BT/TL), including three with neurological signs. Associated pre-existing disorders were documented in 16. Girls with BT/TL had a higher LH peak after GnRH test (P=0.01) than I, and those over 6 years had a higher cranio-caudal diameter of the pituitary gland (P=0.01); their baseline FSH and LH (P=0.004), and peak FSH (P=0.01) and LH (P=0.05) values were higher than I. Logistic regression showed maternal age at menarche (P=0.02) and peak FSH (P=0.02) as BT/TL risk factors. Conclusions MRI provides valuable information in girls with CPP by demonstrating that less than half have a normal brain MRI and that few can have significant intracranial lesions after the age of 6, despite the absence of suggestive neurological signs.

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