虚拟现实技术在儿童疼痛管理中的应用进展

近年来虚拟现实技术被引入医疗领域,成为疼痛管理的新形式,但目前在我国儿童疼痛管理中的应用较少。本研究从虚拟现实技术的概述、设备种类与使用方式、干预效果3个部分进行综述,以期为我国虚拟现实技术在儿童疼痛管理中的临床实践提供参考。     

Effectiveness,Patient Satisfaction,and Cost Reduction of Virtual Joint Replacement Clinic Follow-Up of Hip and Knee Arthroplasty

BackgroundTotal hip and knee arthroplasties are increasingly performed operations, and routine follow-up places huge demands on orthopedic services. This study investigates the effectiveness, patients’ satisfaction, and cost reduction of Virtual Joint Replacement Clinic (VJRC) follow-up of total hip arthroplasty and total knee arthroplasty patients in a university hospital. VJRC is especially valuable when in-person appointments are not advised or feasible such as during the COVID-19 pandemic.MethodsA total of 1749 patients who were invited for VJRC follow-up for knee or hip arthroplasty from January 2017 to December 2018 were included in this retrospective study. Patients were referred to VJRC after their 6-week postoperative review. Routine VJRC postoperative review was undertaken at 1 and 7 years and then 3-yearly thereafter. We evaluated the VJRC patient response rate, acceptability, and outcome. Patient satisfaction was measured in a subgroup of patients using a satisfaction survey. VJRC costs were calculated compared to face-to-face follow-up.ResultsThe VJRC had a 92.05% overall response rate. Only 7.22% required further in-person appointments with only 3% being reviewed by an orthopedic consultant. VJRC resulted in an estimated saving of £42,644 per year at our institution. The patients’ satisfaction survey showed that 89.29% of the patients were either satisfied or very satisfied with VJRC follow-up.ConclusionVJRC follow-up for hip and knee arthroplasty patients is an effective alternative to in-person clinic assessment which is accepted by patients, has high patient satisfaction, and can reduce the cost to both health services and patients.     

The effects of different environments on older adults’ ability to successfully cross a closing gap in virtual reality

BackgroundTo navigate through dynamically changing environments and to avoid collisions with stationary and moving obstacles, older adults tend to over rely on their visual system because it is a more reliable source of information. Aging affects both visuomotor integration and visual perception, often resulting in the inability to produce appropriate adaptive locomotor actions in a timely manner.Research questionDoes peripheral visual information in the environment affected older adults’ ability to complete a gap-crossing task with a set of closing doors at different rates (0.6–1.2 m/s)?MethodsFifteen older adults (65–74 years) completed the study inside a virtual environment with three different levels of peripheral visual information: 1) empty; 2) stationary avatars; and 3) moving avatars. Kinematic data was collected using an Optotrak camera system to track the older adults’ body movements during the task.ResultsThe results demonstrated that regardless of the environment or closing door speed, older adults maintained consistent approach speeds. However, older adults collided with the fastest moving doors a significant number of times at the fastest door closing rates for the empty and moving avatar conditions.SignificanceAlthough it appears that older adults are able to attend on a central task (i.e., passing through closing doors) and maintain constant behaviours regardless of the visual information from peripheral environment, richness of the peripheral environment provides accurate feedback about self-motion affects success rates.     

The compromise of virtual screening and its impact on drug discovery

Introduction: Docking and structure-based virtual screening (VS) have been standard approaches in structure-based design for over two decades. However, our understanding of the limitations, potential, and strength of these techniques has enhanced, raising expectations.

Areas covered: Based on a survey of reports in the past five years, we assess whether VS: (1) predicts binding poses in agreement with crystallographic data (when available); (2) is a superior screening tool, as often claimed; (3) is successful in identifying chemical scaffolds that can be starting points for subsequent lead optimization cycles. Data shows that knowledge of the target and its chemotypes in postprocessing lead to viable hits in early drug discovery endeavors.

Expert opinion: VS is capable of accurate placements in the pocket for the most part, but does not consistently score screening collections accurately. What matters is capitalization on available resources to get closer to a viable lead or optimizable series. Integration of approaches, subjective hit selection guided by knowledge of the receptor or endogenous ligand, libraries driven by experimental guides, validation studies to identify the best docking/scoring that reproduces experimental findings, constraints regarding receptor–ligand interactions, thoroughly designed methodologies, and predefined cutoff scoring criteria strengthen VS’s position in pharmaceutical research.     

多模影像技术在解剖性肝切除手术导航中应用价值研究

目的 研究三维可视化（3DV）、吲哚菁绿荧光融合影像（FIGFI）、虚拟现实（VR）技术等多模影像技术在解剖性肝切除手术导航的应用价值。方法 选择2016年1月至2018年6月间南方医科大学珠江医院肝胆外科64例肝脏肿瘤病人临床资料。采用MI-3DVS对薄层CT图像数据进行个体化的肝脏、肝内脉管和肿瘤三维重建，并将三维重建模型导入VR开发引擎中转化为VR模型，指导术前规划和决策；术中使用荧光成像仪对肝脏、肿瘤进行侦测，并联合3DV和VR技术导航肝切除手术。结果 MI-3DVS三维重建的64例病人肝脏、肿瘤及肝内脉管等结构清晰；通过头戴式显示器及安装了捕捉手和手指运动的传感器的操纵手柄融入一个 3D-VR环境，更立体直观地显示前期3DV模型的沉浸感、空间感和立体感；FIGFI可进行肿瘤边界界定、肝切缘的界定、微小肝癌和肝切缘残留病灶的侦测。64例病人中，肝左外叶切除4例，肝左叶切除16例，肝右前叶切除5例，肝右后叶切除5例，肝右叶切除17例，肝中叶切除术5例，肝段切除11例（5段3例、6段6例、7段1例、8段1例），尾状叶切除1例。实际手术过程与术前手术规划一致。术后均未出现腹腔出血、胆漏、肝功能衰竭等严重并发症，围手术期无死亡病例。结论 多模影像技术在术前精确影像评估和术中导航解剖性、功能性、根治性肝切除手术具有重要应用价值。     

Effectiveness of virtual reality in the treatment of hand function in children with cerebral palsy: A systematic review

Study DesignSystematic review.IntroductionChildren with cerebral palsy (CP) may have limited use of their hands for functional activities and for fine motor skills. Virtual reality (VR) is a relatively new and innovative approach to facilitate hand function in children with CP.Purpose of the StudyThe primary purpose of this study was to determine the effectiveness of VR as an intervention to improve hand function in children with CP compared to either conventional physiotherapy or other therapeutic interventions. The secondary purpose was to classify the outcomes evaluated according to the International Classification of Functioning, Disability and Health (ICF) dimensions.MethodsA International prospective register of systematic reviews (PROSPERO)-registered literature search was carried out in August 2015 in MEDLINE, CINAHL, ERIC, HealthSTAR, AMED, BNI, Embase, PsycINFO, PEDro, Cochrane Central Register, DARE, OTSeeker, REHABDATA, HaPI, CIRRIE, and Scopus. PRISMA guidelines were followed. Only randomized controlled trials (RCTs) were included, and their methodological qualities were examined using the Cochrane collaboration's risk of bias (RoB) tool. A narrative synthesis was performed.ResultsThe 6 RCTs published on this topic provide conflicting results. Four studies reported improved hand function (2 low RoB, 1 high RoB, and 1 unclear RoB), whereas 2 studies reported no improvement. All of the RCTs reported the activity element of ICF, but no study explicitly described the effect of VR intervention based on the ICF model.ConclusionThe role of VR ti imrpove hand fucntion in children with CP is unclear due to limited evidence; use as an adjunct has some support.     

虚实结合的翻转课堂在解剖实验教学中的应用

目的评价虚实相结合的翻转课堂在系统解剖学实验教学中的应用。方法选取齐齐哈尔医学院2018级临床专业和医学影像学专业学生共107名,在系统解剖学实验课中,对某些章节采用部分翻转课堂的教学模式,对照章节则采用传统的教学方法。教学结束后进行考核,比较前后章节的课堂测验成绩,另外采用调查问卷,分析学生对两种教学方法的满意度。结果临床医学和医学影像学专业的学生第二次课堂测试的成绩均高于第一次课堂测试的成绩(P <0.01),同时学生对翻转课堂教学模式的满意度高于传统教学法。结论在系统解剖学实验教学中实行翻转课堂教学模式,同时讲解实物标本并应用数字人解剖学系统进行知识内化,不仅能提高学生的学习成绩,也能调动学生学习系统解剖学的热情,增加教学效果满意度,并为其他解剖学专业课的教学模式改革提供参考和借鉴。