Visuomotor learning in immersive 3D virtual reality in Parkinson’s disease and in aging

Successful adaptation to novel sensorimotor contexts critically depends on efficient sensory processing and integration mechanisms, particularly those required to combine visual and proprioceptive inputs. If the basal ganglia are a critical part of specialized circuits that adapt motor behavior to new sensorimotor contexts, then patients who are suffering from basal ganglia dysfunction, as in Parkinson's disease should show sensorimotor learning impairments. However, this issue has been under-explored. We tested the ability of 8 patients with Parkinson's disease (PD), off medication, ten healthy elderly subjects and ten healthy young adults to reach to a remembered 3D location presented in an immersive virtual environment. A multi-phase learning paradigm was used having four conditions: baseline, initial learning, reversal learning and aftereffect. In initial learning, the computer altered the position of a simulated arm endpoint used for movement feedback by shifting its apparent location diagonally, requiring thereby both horizontal and vertical compensations. This visual distortion forced subjects to learn new coordinations between what they saw in the virtual environment and the actual position of their limbs, which they had to derive from proprioceptive information (or efference copy). In reversal learning, the sign of the distortion was reversed. Both elderly subjects and PD patients showed learning phase-dependent difficulties. First, elderly controls were slower than young subjects when learning both dimensions of the initial biaxial discordance. However, their performance improved during reversal learning and as a result elderly and young controls showed similar adaptation rates during reversal learning. Second, in striking contrast to healthy elderly subjects, PD patients were more profoundly impaired during the reversal phase of learning. PD patients were able to learn the initial biaxial discordance but were on average slower than age-matched controls in adapting to the horizontal component of the biaxial discordance. More importantly, when the biaxial discordance was reversed, PD patients were unable to make appropriate movement corrections. Therefore, they showed significantly degraded learning indices relative to age-matched controls for both dimensions of the biaxial discordance. Together, these results suggest that the ability to adapt to a sudden biaxial visuomotor discordance applied in three-dimensional space declines in normal aging and Parkinson disease. Furthermore, the presence of learning rate differences in the PD patients relative to age-matched controls supports an important contribution of basal ganglia-related circuits in learning novel visuomotor coordinations, particularly those in which subjects must learn to adapt to sensorimotor contingencies that were reversed from those just learned.     

A real-time dynamic 3D model of the human inguinal region for surgical education

A suitable dynamic 3D model that allows the simulation of the inguinal region with real-time performance on a personal computer was developed. A geometric model adjusted to real data was created by means of semiautomatic contour segmentation of anatomic units from the visible human project and data generated from classical anatomic information. A dynamic model included converting muscular units from their continuous geometric representation into a set of voxels and then real-time interaction and performance. The current implementation enables deformation of the realistic model associated with pushing and stretching interaction, allowing immersion in the anatomy of the inguinal structures. The model does not allow simulation of surgical interventions.     

1例重度急性胰腺炎患者抗感染治疗的药学监护

摘 要临床药师参与1例重度急性胰腺炎患者的药物治疗,结合患者病史、临床症状及实验室指标等,根据病原学检测结果,借助万古霉素血药浓度监测进行抗感染方案调整,并协助医生对患者制定个体化用药方案。经治疗后,患者病情得到基本控制,且未出现相关药品不良反应。提示临床药师在参与患者治疗过程中,可结合患者特殊的生理病理状态、药物浓度监测及临床反应等,协助临床医师优化药物治疗方案,提高患者用药的有效性和安全性。     

认知行为疗法联合虚拟现实技术治疗青少年失眠症患者的效果研究

背景近年来青少年失眠症患者逐年增多,认知行为疗法是治疗该病的传统方法,但存在一定缺陷。虚拟现实技术是一种新的治疗方式,但将其用于青年失眠症的研究目前较为缺乏。目的探究认知行为疗法联合虚拟现实技术（联合疗法）治疗青少年失眠症患者的效果。方法选取2020年4月至2021年6月在杭州市第七人民医院接受治疗的青少年失眠症患者为研究对象,采用随机数字表法分为对照组（单用认知行为疗法）和试验组（采用联合疗法）,在两组治疗前与治疗4周后分别采用匹兹堡睡眠质量指数（PSQI）进行评价,以分析不同疗法的临床疗效。结果初步纳入青少年失眠症患者77例,删除脱落15例（对照组12例,试验组3例）,最终纳入62例,其中对照组32例,试验组30例。治疗4周后两组患者的睡眠障碍得分、催眠药物得分、日间功能障碍得分比较,差异无统计学意义（P>0.05）;试验组患者的睡眠质量得分、入睡时间得分、睡眠时间得分、睡眠效率得分、PSQI总分低于对照组（P<0.05）。试验组的有效率高于对照组（P<0.05）;试验组的治疗满意度高于对照组（P<0.05）;试验组的脱落率低于对照组（P<0.05）。结论联合疗法对青少年失眠症患者的治疗效果较好,患者满意度较高,可有效改善患者睡眠质量,具有较好的临床应用价值。     

虚拟现实技术联合情志干预对卒中后抑郁患者恢复效果的影响

目的:观察虚拟现实技术联合中医情志干预对卒中后抑郁患者恢复效果的影响。方法:将卒中后抑郁患者90例,按照随机奇偶数字法分为2组。对照组45例给予常规护理干预,观察组45例在对照组的基础上联合虚拟现实技术+情志护理干预。比较2组汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分、神经功能缺损(NIHSS)评分及遵医行为评分。结果:护理干预后,2组HAMA、HAMD、NIHSS评分均较治疗前明显降低(P<0.05),观察组各项评分均低于对照组(P<0.05)。护理干预后,观察组按时用药、合理饮食、配合锻炼、定期复诊评分及总分值均明显高于对照组,差异有统计学意义(P<0.05)。结论:虚拟现实技术联合情志干预可有效改善卒中后抑郁患者抑郁症状,改善遵医行为,促进受损神经功能恢复。     

Leap Motion Controller–based training for upper extremity rehabilitation in children and adolescents with physical disabilities: A randomized controlled trial

Study DesignRandomized controlled trial.IntroductionJuvenile idiopathic arthritis (JIA), cerebral palsy (CP), and brachial plexus birth injury (BPBI) are the most common disorders that cause upper extremity impairments in children and adolescents. Leap Motion Controller–based training (LMCBT) is a novel therapeutic method for upper extremity rehabilitation.Purpose of the StudyThe aim of the present study was to investigate the potential efficacy of an 8-week LMCBT program set as an upper extremity rehabilitation program by comparing conventional rehabilitation program in children and adolescents with physical disabilities such as JIA, CP, and BPBI.MethodsA randomized control trial which included children and adolescents of different disabilities (JIA, CP, BPBI) were grouped according to their diagnosis. All patients were randomized into 2 groups namely LMCBT (group I) and conventional treatment (group II) for the treatment (3 days/8 weeks). Duruoz Hand Index and Jebson Taylor Hand Function Test were used as primary outcomes. Secondary outcomes included the nine-hole peg test, Childhood Health Assessment Questionnaire, and assessments of grip and pinch strength using a dynamometer.ResultsOne hundred three patients were included in the study, and 92 of them completed the treatment. After treatment, significant differences were found in Childhood Health Assessment Questionnaire, Duruoz Hand Index, Jebson Taylor Hand Function Test, nine-hole peg test, and grip and pinch strength scores in almost all groups (effect size [ES] = 0.10 to −0.77 for group I and 0.09 to −0.70 for group II in CP; ES = 0.31 to 2.65 for the group I and 0.12 to 1.66 for group II in JIA; and ES = 0 to −0.44 for group I and 0.08 to −0.62 for group II in BPBI) (P < .05). Comparisons between LMCBT and conventional treatment groups showed similar results in all parameters in all disease groups (P > .05).ConclusionsThis study has quantitatively shown that LMCBT should be used as an effective alternative treatment option in children and adolescents with physical disabilities.     

增强现实导航技术联合吲哚菁绿分子荧光影像在肝门部胆管癌根治术中应用研究

目的 探讨增强现实导航技术联合吲哚菁绿（ICG）分子荧光影像在肝门部胆管根治性手术的可行性、安全性及近期效果。方法 回顾性分析南方医科大学珠江医院肝胆外科2019年4月至2020年8月期间完成的3例增强现实联合ICG分子荧光影像导航肝门部胆管癌根治术病人的临床资料,收集病人薄层CT数据,构建三维模型后制定个体化手术方案。术前24～72 h根据肝功能情况经外周静脉注射ICG,术中利用腹腔镜增强现实手术导航系统,采集实时手术影像,再通过视频采集卡输入笔记本电脑,在增强现实手术导航系统中实现将三维模型投影到手术视频,实现术中情况与术前三维模型实时融合导航,指导手术治疗。结果 3例病人构建三维可视化模型后,均成功行增强现实导航技术联合ICG分子荧光影像技术指导下肝门部胆管癌根治术。Bismuth-Corlette三维可视化分型Ⅲb型2例、Ⅳa型1例,1例罕见的门静脉右前支缺如变异。Ⅲb型2例行左半肝切除联合左侧尾状叶切除术、Ⅳa型1例行右半肝联合全尾状叶切除术。手术时间分别为420、410、380 min,术中出血量分别为360、310、250 mL,术后住院时间分别为9、8、8 d。术后出现少量胸腔积液1例,经内科治疗后康复出院,围手术期无肝功能衰竭及死亡病例。结论 增强现实导航技术联合ICG分子荧光影像在肝门部胆管根治性术中应用效果良好、安全可行、值得进一步探索。