Using computed tomography colonography in patients at high risk of colorectal cancer – a prospective study in a university hospital in South America

OBJECTIVES:

The purpose of our study was to report the results of the implementation of computed tomography colonography in a university hospital setting serving a Brazilian population at high risk of colorectal cancer.

METHODS:

After creating a computed tomography colonography service in our institution, 85 patients at high risk of colorectal cancer underwent computed tomography colonography followed by a same-day optical colonoscopy from September 2010 to May 2012. The overall accuracy of computed tomography colonography in the detection of lesions ≥6 mm was compared to that of optical colonoscopy (direct comparison). All colonic segments were evaluated using quality imaging (amount of liquid and solid residual feces and luminal distension). To assess patient acceptance and preference, a questionnaire was completed before and after the computed tomography colonography and optical colonoscopy. Fisher''s exact test was used to measure the correlations between colonic distension, discomfort during the exam, exam preference and interpretation confidence.

RESULTS:

Thirteen carcinomas and twenty-two lesions ≥6 mm were characterized. The sensitivity, specificity and accuracy of computed tomography colonography were 100%, 98.2% and 98.6%, respectively. Computed tomography colonography was the preferred method of investigation for 85% of patients. The preparation was reported to cause only mild discomfort for 97.6% of patients. According to the questionnaires, there was no significant relationship between colonic distension and discomfort (p>0.05). Most patients (89%) achieved excellent bowel preparation. There was a statistically significant correlation between the confidence perceived in reading the computed tomography colonography and the quality of the preparation in each colonic segment (p≤0.001). The average effective radiation dose per exam was 7.8 mSv.

CONCLUSION:

It was possible to institute an efficient computed tomography colonography service at a university hospital that primarily assists patients from the public health system, with high accuracy, good acceptance and effective radiation doses. Our results seem to be comparable to other centers of excellence and fall within acceptable published guidelines, showing that a successful computed tomography colonography program can be reproduced in a South American population screened in a university hospital.     

分娩护理虚拟仿真实验项目的设计与应用

目的 探讨分娩护理虚拟仿真实验教学项目的设计和应用.方法 以教学内容为基础,利用3D虚拟仿真技术,构建分娩护理虚拟仿真教学系统,学习内容涵盖第一产程护理、第二产程护理、第三产程护理3个模块.在护理本科妇产科护理课程及助产方向的助产学课程中应用,对该系统在2015级121名护理本科生中的应用情况及效果进行分析.结果 学生在线操作时长平均1.39 h.学生对虚拟仿真系统及教学模式的主观评价分别为平均94.24%持赞成或中立态度、88.84%持赞成或中立态度.结论 该教学项目的设计和实施,为今后虚拟仿真实验教学在护理专业各课程教学中的开展提供了借鉴.     

Evaluation of an interactive virtual surgical rotation during the COVID‐19 pandemic

ObjectiveTo evaluate medical student and attending surgeon experiences with a novel interactive virtual Otolaryngology ‐ Head and Neck Surgery (OHNS) medical student elective during the COVID‐19 pandemic.Study DesignA virtual OHNS elective was created, with three components: (1) interactive virtual operating room (OR) experience using live‐stream video‐conferencing, (2) telehealth clinic, (3) virtual didactics.SettingOHNS Department at the University of Pennsylvania (May 2020 to June 2020).MethodsSix medical students from the University of Pennsylvania; five attending otolaryngologists. Two surveys were designed and distributed to participating medical students and attending surgeons. Surveys included 5‐point Likert scale items, with 1 indicating “not at all” and 5 indicating “very much so”.ResultsResponse rate was 100% for both surveys. Students on average rated the educational value of the telehealth experience as 4.2 ± 1.2, and the virtual OR experience as 4.0 ± 0.6. Most students (n = 5, 83%) indicated that they had enough exposure to faculty they met on this rotation to ask for a letter of recommendation (LOR) for residency if needed, while attending surgeons had an average response of 3.0 ± 1.0 when asked how comfortable they would feel writing a LOR for a student they met through the rotation. A majority of students (n = 4, 67%) felt they connected enough with faculty during the rotation to ask for mentorship. Half the students (n = 5, 50%) indicated that the rotation allowed them to evaluate the department''s culture either “extremely well” or “somewhat well”.ConclusionsOverall, participating students described this innovative virtual surgical rotation as an educationally and professionally valuable experience. With the continued suspension of visiting student rotations due to the COVID‐19 pandemic, this virtual model may have continued relevance to medical education.     

Extended,virtual and augmented reality in thoracic surgery: a systematic review

 Open in a separate windowOBJECTIVESExtended reality (XR), encompassing both virtual reality (VR) and augmented reality, allows the user to interact with a computer-generated environment based on reality. In essence, the immersive nature of VR and augmented reality technology has been warmly welcomed in all aspects of medicine, gradually becoming increasingly feasible to incorporate into everyday practice. In recent years, XR has become increasingly adopted in thoracic surgery, although the extent of its applications is unclear. Here, we aim to review the current applications of XR in thoracic surgery.METHODSA systematic database search was conducted of original articles that explored the use of VR and/or augmented reality in thoracic surgery in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to December 2020.RESULTSOur search yielded 1494 citations, of which 21 studies published from 2007 to 2019 were included in this review. Three main areas were identified: (i) the application of XR in thoracic surgery training; (ii) preoperative planning of thoracic procedures; and (iii) intraoperative assistance. Overall, XR could produce progression along the learning curve, enabling trainees to reach acceptable standards before performing in the operating theatre. Preoperatively, through the generation of 3D-renderings of the thoracic cavity and lung anatomy, VR increases procedural accuracy and surgical confidence through familiarization of the patient’s anatomy. XR-assisted surgery may have therapeutic use particularly for complex cases, where conventional methods would yield inadequate outcomes due to inferior accuracy.CONCLUSIONXR represents a salient step towards improving thoracic surgical training, as well as enhancing preoperative planning and intraoperative guidance.     

Postural instability according to virtual reality program

Background: The popularity of virtual reality (VR) grew rapidly. Short guidelines with a lack of emphasis on safe use appears prior to usage. It is necessary for the user to realize how much potentially dangerous VR is.

Aims/objectives: The aim of this study is to investigate the effect of VR on balance in normal people.

Materials and methods: Mean equilibrium score (MES) of 15 adults who have normal sense of balance were obtained by using the sensory organization test (SOT). Conditions 1 and 2 were performed. Multiple VR programs were classified as three levels (Easy, Average, and Challenging) by the visual analog scale. Further SOT tests were performed during watching VR programs. MES of each test was used for statistical analysis.

Results: MES of condition 1 was significantly higher than condition 2. Although there was no statistical difference between Eye open and Easy program (p?=?.097), MES of average and Challenging programs showed significantly decreased scores compared to Eye open. In addition, MES of Average and Challenging programs were significantly decreased than that of Easy program.

Conclusions and significance: VR can cause postural imbalance to users. It is necessary to establish quantifiable and objective methods to measure imbalance caused by VR use.     

Guía práctica para el debriefing online: revisión exploratoria y análisis de cursos con simulación clínica a distancia

IntroductionMany debriefing skills used when people are present in the same physical space translate poorly into virtual space. The objective was to develop a practical guide to recognize and manage online debriefing challenges.MethodsFocus group interviews, with facilitators who participated in distance-based simulation training courses, in combination with a scoping literature review were used to obtain qualitative data. Results were categorized using the Debriefing Assessment for Simulation in Healthcare ©.ResultsBetween July 2020 and March 2021, 12 facilitators trained 296 doctors and nurses from Spain and Latin America during 52 courses, 2 to 9.5 hours long, including 2 to 5 simulation cases each. Between 2014 and 2021, 12 out of 304 articles were selected for review.ConclusionsThe methods used have allowed to design a practical guide grounded on a simulation specific framework.     

基于虚拟现实技术的脊柱三维仿真模型的建立及应用

目的 建立基于虚拟现实技术的计算机辅助三维立体脊柱虚拟模型,构建出适用于虚拟手术中实时复杂交互的脊柱三维仿真模型. 方法 对高分辨率的人体64排CT切片数据进行感兴趣区域图像分割和边缘提取,采用面绘制技术对提取的轮廓序列进行三维数据生成,对重建的模型根据实时交互的需要进行优化. 结果 重建出的脊柱模型保持了较高的几何分辨率和光滑性,读入虚拟手术系统后,在实时交互下能表现出较好的解剖精确性和实时绘制的真实感.结论基于人体切片数据重建出的三维模型可较好地适用于虚拟手术中的复杂交互操作.     

Placental protein 13 (galectin-13) has decreased placental expression but increased shedding and maternal serum concentrations in patients presenting with preterm pre-eclampsia and HELLP syndrome

Placental protein 13 (PP13) is a galectin expressed by the syncytiotrophoblast. Women who subsequently develop preterm pre-eclampsia have low first trimester maternal serum PP13 concentrations. This study revealed that third trimester maternal serum PP13 concentration increased with gestational age in normal pregnancies (p < 0.0001), and it was significantly higher in women presenting with preterm pre-eclampsia (p = 0.02) and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome (p = 0.01) than in preterm controls. Conversely, placental PP13 mRNA (p = 0.03) and protein, as well as cytoplasmic PP13 staining of the syncytiotrophoblast (p < 0.05) was decreased in these pathological pregnancies compared to controls. No differences in placental expression and serum concentrations of PP13 were found at term between patients with pre-eclampsia and control women. In contrast, the immunoreactivity of the syncytiotrophoblast microvillous membrane was stronger in both term and preterm pre-eclampsia and HELLP syndrome than in controls. Moreover, large syncytial cytoplasm protrusions, membrane blebs and shed microparticles strongly stained for PP13 in pre-eclampsia and HELLP syndrome. In conclusion, parallel to its decreased placental expression, an augmented membrane shedding of PP13 contributes to the increased third trimester maternal serum PP13 concentrations in women with preterm pre-eclampsia and HELLP syndrome.     

发展迅速的远程医疗

远程医疗是医疗保健技术、远程通讯技术和信息科学等学科的结合。远程医疗因其广阔的发展前景 ,而得到广泛的关注。本文就其发展概况、应用等方面作一概述 ,同时也指出了它所带来的一些不容忽视的问题     

心脏三维超声虚拟内窥镜系统导航与介入方法研究

目的通过心脏三维超声虚拟内窥镜系统导航和介入方法研究,旨在探索并建立复杂型先心病虚拟现实环境下观察的规范化"路径"和介入方法。方法采用体绘制技术重建心腔内表面的三维图像,并置感兴趣的心内结构于可视化显示窗中心,键盘操作与人工导航结合使三维重建图像沿着视线方向前进,产生被观察心内结构目标不断靠近观察者和放大的多帧图像。结果系统通过控制鼠标、键盘立体定位,结合VanPraagh"节段分析法"对感兴趣区域观察,使操作者在虚拟心脏内漫游,实现部分心内畸形结构的诊断。对诊断房、室间隔缺损者,应用虚拟介入装置模拟ASD、VSD介入治疗。结论三维超声虚拟内窥镜为先天性心脏病临床诊断、术前模拟介入、手术计划、外科手术导航及计算机辅助医学教学提供了一种新方法。