Perceiving haptic feedback in virtual reality simulators

Background

To improve patient safety, training of psychomotor laparoscopic skills is often done on virtual reality (VR) simulators outside the operating room. Haptic sensations have been found to influence psychomotor performance in laparoscopy. The emulation of haptic feedback is thus an important aspect of VR simulation. Some VR simulators try to simulate these sensations with handles equipped with haptic feedback. We conducted a survey on how laparoscopic surgeons perceive handles with and without haptic feedback.

Methods

Surgeons with different levels of experience in laparoscopy were asked to test two handles: Xitact IHP with haptic feedback and Xitact ITP without haptic feedback (Mentice AB, Gothenburg, Sweden), connected to the LapSim (Surgical Science AB, Sweden) VR simulator. They performed two tasks on the simulator before answering 12 questions regarding the two handles. The surgeons were not informed about the differences in the handles.

Results

A total of 85 % of the 20 surgeons who participated in the survey claimed that it is important that handles with haptic feedback feel realistic. Ninety percent of the surgeons preferred the handles without haptic feedback. The friction in the handles with haptic feedback was perceived to be as in reality (5 %) or too high (95 %). Regarding the handles without haptic feedback, the friction was perceived as in reality (45 %), too low (50 %), or too high (5 %). A total of 85 % of the surgeons thought that the handle with haptic feedback attempts to simulate the resistance offered by tissue to deformation. Ten percent thought that the handle succeeds in doing so.

Conclusions

The surveyed surgeons believe that haptic feedback is an important feature on VR simulators; however, they preferred the handles without haptic feedback because they perceived the handles with haptic feedback to add additional friction, making them unrealistic and not mechanically transparent.     

Smaller stress-sensitive hippocampal subfields in women with borderline personality disorder without posttraumatic stress disorder

Background

Animal and human studies have suggested that hippocampal subfields are differentially vulnerable to stress, but subfield volume has not been investigated in patients with borderline personality disorder (BPD). Based on the putative role of stressful life events as vulnerability factors for BPD, we hypothesized that patients with BPD would exhibit reduced volumes for the stress-sensitive dentate gyrus (DG) and the cornu ammonis (CA) 3 subfields volumes, and that these volumes would be associated with traumatic childhood experiences.

Methods

All participants underwent 3 T magnetic resonance imaging. Hippocampal subfield volumes were estimated using an automated and validated segmentation algorithm implemented in FreeSurfer. Age and total subcortical grey matter volume were covariates. We assessed traumatic childhood experiences using the Childhood Trauma Questionnaire (CTQ).

Results

A total of 18 women with BPD and 21 healthy control women were included in the study. Only 1 patient had comorbid posttraumatic stress disorder (PTSD). The volumes of the left (p = 0.005) and right (p = 0.011) DG-CA4 and left (p = 0.007) and right (p = 0.005) CA2–3 subfields were significantly reduced in patients compared with controls. We also found significant group differences for the left (p = 0.032) and right (p = 0.028) CA1, but not for other hippocampal subfields. No associations were found between CTQ scores and subfield volumes.

Limitations

The self-reported CTQ might be inferior to more comprehensive assessments of traumatic experiences. The sample size was moderate.

Conclusion

The volumes of stress-sensitive hippocampal subfields are reduced in women with BPD without PTSD. However, the degree to which childhood trauma is responsible for these changes is unclear.     

Antibodies to surface IgM and IgD increase the expression of various class II antigens on human B cells

Antibodies to surface IgM and IgD were found to induce increased expression of class II antigens on normal and neoplastic human B cells within 24 h of stimulation. Antigens associated with different class II sub-locus genes (DC, DR and SB) were all found to be increased as determined by monoclonal antibodies (Leu-10 and B 3/4 for DC, D 1/12 for DR and MHM4 for SB-associated antigens). The increased expression of class II antigens was selective as anti-immunoglobulins failed to increase expression of other surface antigens such as B1 and beta 2-microglobulin. The effect of anti-mu and anti-delta could be blocked specifically by corresponding myeloma proteins suggesting that antibodies to surface IgM and IgD, respectively, were responsible for the effect observed. Moreover, antibodies to another surface antigen (B1) failed to induce such changes. Increased class II antigen expression appeared to be dependent on protein synthesis, and early changes in ion fluxes, but could not be elicited by membrane depolarization as reported in murine systems.     

CDw78 — a determinant on a major histocompatibility complex class II subpopulation that can be induced to associate with the cytoskeleton

In the present study we demonstrate that CDw78 monoclonal antibody (mAb) recognizes a distinct subpopulation of major histocompatibility complex (MHC) class II molecules. We show that the CDw78 epitope is present on less than 10 % of the total number of MHC class II molecules expressed on different cells, is not linked to a single isotype, and exhibits a characteristic expression pattern in tonsils. While mAb against MHC class II (DR, DP and DQ) stained the majority of cells both in the mantle zone and in germinal centers, the CDw78 staining was more heterogeneous with the strongest reactivity and the highest number of positive cells in the mantle zone and in the light centrocyte-rich part of the germinal centers. Antibodies to this MHC class II subpopulation (e.g. FN1) induced association with the cytoskeleton and a subsequent capping in more than 90 % of peripheral blood B cells. In contrast, mAb against MHC class II (DR, DP and DQ) did not induce association with the cytoskeleton and only 10–20 % of B cells were induced to cap, suggesting that CDw78 defines a population of MHC class II molecules functionally different from the majority of these antigens. Scatchard plot analysis indicates that FN1 mAb is of relatively low affinity (K_a = 1.5 × 10⁸M^?1) and monovalent Fab fragments fail to bind to the cell surface with measurable affinity. Our data seen in the context of the ability of FN1 to co-stimulate B cells with a suboptimal dose of anti-μ suggest that CDw78 mAb might recognize a functional important subpopulation of MHC class II molecules so far not described. It seems likely that this subpopulation represents dimerized or aggregated MHC class II molecules that can selectively bind this low-affinity mAb.     

CustusX: an open-source research platform for image-guided therapy

Purpose

CustusX is an image-guided therapy (IGT) research platform dedicated to intraoperative navigation and ultrasound imaging. In this paper, we present CustusX as a robust, accurate, and extensible platform with full access to data and algorithms and show examples of application in technological and clinical IGT research.

Methods

CustusX has been developed continuously for more than 15 years based on requirements from clinical and technological researchers within the framework of a well-defined software quality process. The platform was designed as a layered architecture with plugins based on the CTK/OSGi framework, a superbuild that manages dependencies and features supporting the IGT workflow. We describe the use of the system in several different clinical settings and characterize major aspects of the system such as accuracy, frame rate, and latency.

Results

The validation experiments show a navigation system accuracy of \(<\)1.1 mm, a frame rate of 20 fps, and latency of 285 ms for a typical setup. The current platform is extensible, user-friendly and has a streamlined architecture and quality process. CustusX has successfully been used for IGT research in neurosurgery, laparoscopic surgery, vascular surgery, and bronchoscopy.

Conclusions

CustusX is now a mature research platform for intraoperative navigation and ultrasound imaging and is ready for use by the IGT research community. CustusX is open-source and freely available at http://www.custusx.org.

     

Neurocognitive functioning and suicidality in schizophrenia spectrum disorders

Objective

The aim of this study was to investigate whether suicide attempters had higher IQ, better executive functioning, or were more impulsive as measured by neuropsychological tests than non-attempters in a group of patients with schizophrenia spectrum disorders.

Method

One hundred seventy-four patients with schizophrenia spectrum disorders were assessed with a clinical interview for diagnosis, suicidality, symptoms and function, and underwent an extensive neurocognitive test battery.

Results

There were no statistically significant differences in any neurocognitive domains between lifetime suicide attempters and non-attempters, or between patients with different rates of suicide attempts. Currently suicidal patients were significantly more impulsive (had poorer inhibitory control) than currently non-suicidal patients, but this difference was mediated by positive psychotic symptoms.

Conclusion

The findings indicate that among patients with schizophrenia spectrum disorders, there are no significant differences in IQ or neurocognitive functioning between suicide attempters and non-attempters.