双源CT小肠造影双能量虚拟平扫的临床评估

目的：探讨64排双源 CT 小肠造影双能量虚拟平扫技术应用于临床的可行性。方法：采用双源 CT 机对39例患者进行小肠造影检查,常规行 CT 平扫以及动、静脉期对比增强双能量扫描（100 kVp／230 mAs 和 l40 kVp／178 mAs）。利用 Liver VNC 软件进行后处理,获得动、静脉期的虚拟平扫 CT 图像。以常规 CT 平扫图像作为标准,对虚拟平扫图像的质量进行评估,采用4级评分法：最高为4分（图像解剖细节清晰,完全能满足诊断）,最低为1分（图像模糊,不能满足诊断）。并对常规 CT 平扫、动、静脉期双能量 CT 扫描的辐射剂量进行比较。结果：39例中有腹部病变者25例,无明显异常者14例。与常规平扫图像比较,虚拟平扫图像上所有病灶均能显示,且病灶的范围、大小亦无明显差异;两位医师对虚拟平扫图像质量的评分均＞2分,两者的评分差异无统计学意义（P ＞0．05）。所有虚拟平扫图像完全能满足诊断要求。常规平扫、双能量动脉期、双能量静脉期扫描的剂量长度乘积（DLP）分别为（283．8750±57．1195）、（289．3750±53．1543）和（301．2917±55．3346）mGy·cm,三次扫描的 DLP 的差异无统计学意义（F ＝0．615,P ＝0．544）。结论：双源 CT 小肠造影检查时可仅进行双能量增强扫描,经后处理获得的虚拟平扫图像基本可取代常规 CT 平扫,从而可减少检查的辐射剂量。     

Effect of Display Resolution on Time to Diagnosis with Virtual Pathology Slides in a Systematic Search Task

Performing diagnoses using virtual slides can take pathologists significantly longer than with glass slides, presenting a significant barrier to the use of virtual slides in routine practice. Given the benefits in pathology workflow efficiency and safety that virtual slides promise, it is important to understand reasons for this difference and identify opportunities for improvement. The effect of display resolution on time to diagnosis with virtual slides has not previously been explored. The aim of this study was to assess the effect of display resolution on time to diagnosis with virtual slides. Nine pathologists participated in a counterbalanced crossover study, viewing axillary lymph node slides on a microscope, a 23-in 2.3-megapixel single-screen display and a three-screen 11-megapixel display consisting of three 27-in displays. Time to diagnosis and time to first target were faster on the microscope than on the single and three-screen displays. There was no significant difference between the microscope and the three-screen display in time to first target, while the time taken on the single-screen display was significantly higher than that on the microscope. The results suggest that a digital pathology workstation with an increased number of pixels may make it easier to identify where cancer is located in the initial slide overview, enabling quick location of diagnostically relevant regions of interest. However, when a comprehensive, detailed search of a slide has to be made, increased resolution may not offer any additional benefit.     

Interactive design of patient-oriented video-games for rehabilitation: concept and application

Purpose: Serious video-games are innovative tools used to train the motor skills of subjects affected by neurological disorders. They are often developed to train a specific type of patients and the rules of the game are standardly defined. A system that allows the therapist to design highly patient-oriented video-games, without specific informatics skills, is proposed.

Method: The system consists of one personal computer, two screens, a Kinect? sensor and a specific software developed here for the design of the video-games. It was tested with the collaboration of three therapists and six patients, and two questionnaires were filled in by each patient to evaluate the appreciation of the rehabilitative sessions.

Results: The therapists learned easily how to use the system, and no serious difficulties were encountered by the patients. The questionnaires showed an overall good satisfaction by the patients and highlighted the key-role of the therapist in involving the patients during the rehabilitative session.

Conclusions: It was found that the proposed system is effective for developing patient-oriented video-games for rehabilitation. The two main advantages are that the therapist is allowed to (i) develop personalized video-games without informatics skills and (ii) adapt the game settings to patients affected by different pathologies.

• Implications for rehabilitation

• Virtual reality and serious video games offer the opportunity to transform the traditional therapy into a more pleasant experience, allowing patients to train their motor and cognitive skills.

• Both the therapists and the patients should be involved in the development of rehabilitative solutions to be highly patient-oriented.

• A system for the design of rehabilitative games by the therapist is described and the feedback of three therapists and six patients is reported.

     

The exploration of population pharmacokinetic model for meropenem in augmented renal clearance and investigation of optimum setting of dose

In recent years, augmented renal clearance (ARC), in which renal function is excessively enhanced, has been reported, and its influence on β-lactam antibiotics has been investigated. In this study, we aimed to determine the optimum population pharmacokinetic model of meropenem in patients with sepsis with ARC, and evaluated dosing regimens based on renal function. Seventeen subjects (6 with ARC and 11 without) were enrolled in this study. Predicted meropenem concentrations were evaluated for bias and precision using the Bland–Altman method. To examine the dosing regimen, Monte Carlo simulation was performed to calculate the cumulative fraction of response (CFR). In patients with ARC, the bias (average of the predicted value and measured value residuals) of models constructed by Crandon et al. (2011), Roberts et al. (2009), and Jaruratanasirikul et al. (2015) were 5.96 μg/mL, 10.91 μg/mL, and 4.41 μg/mL, respectively. Following 2 g meropenem every 8 h (180 min infusion), CFR ≥ 90%, a criterion of success for empirical therapy, was achieved, even with creatinine clearance of 130–250 mL/min. For patients with sepsis and ARC, the model of Jaruratanasirikul et al. showed the highest degree of accuracy and precision and confirmed the efficacy of the meropenem dosing regimen in this patient population.     

Cultural empathy in physiotherapy students: a pre-test post-test study utilising virtual simulation

Objectives

To investigate how a virtual cultural simulation experience and guided reflection influenced physiotherapy students’ intrapersonal and interpersonal cultural empathy, and to explore students’ satisfaction with the learning experience.

Virtual Reality Rehabilitation With Functional Electrical Stimulation Improves Upper Extremity Function in Patients With Chronic Stroke: A Pilot Randomized Controlled Study

Objective

To compare virtual reality (VR) combined with functional electrical stimulation (FES) with cyclic FES for improving upper extremity function and health-related quality of life in patients with chronic stroke.

The Effects of Functional Training,Bicycle Exercise,and Exergaming on Walking Capacity of Elderly Patients With Parkinson Disease: A Pilot Randomized Controlled Single-blinded Trial

Objectives

To compare the effects of functional training, bicycle exercise, and exergaming on walking capacity of elderly with Parkinson disease (PD).