基于VOXEL-MAN操作平台肩(骨谬)穴的力反馈研究

目的:通过在肩(骨谬)穴周围组织三维重建的基础上,探讨在该穴进针时的力学虚拟,便于初学者对穴位进针有感性认识.方法:在VOXEL-MAN操作平台中,通过对肩(骨谬)穴相关组织进行分割和数学建模的方式进行重建,即视觉再现;并构建力学模型,与虚拟人相关数据相融合,即触觉再现;联通视觉再现模块和触觉再现模块,实现力反馈仪和虚拟人操作平台之间数据交流.结果:在Linux系统下,通过力反馈仪,操作者可以体验肩(骨谬)穴进针时,针尖穿过各组织以及均匀提插时的力学变化.结论:在VOXEL-MAN操作平台的基础上,通过力反馈仪可以较为完美地再现肩(骨谬)穴进针时视觉和触觉的变化,以便于初学者临摹学习和应用.     

Response requirements modulate tactile spatial congruency effects

Several recent studies have provided support for the view that tactile stimuli/events are remapped into an abstract spatial frame of reference beyond the initial somatotopic representation present in the primary somatosensory cortex. Here, we demonstrate for the first time that the extent to which this remapping of tactile stimuli takes place is dependent upon the particular demands imposed by the task that participants have to perform. Participants in the present study responded to either the elevation (up vs. down) or to the anatomical location (finger vs. thumb) of vibrotactile targets presented to one hand, while trying to ignore distractors presented simultaneously to the other hand. The magnitude and direction of the target–distractor congruency effect was measured as participants adopted one of two different postures with each hand (palm-up or palm-down). When the participants used footpedal responses (toe vs. heel; Experiment 1), congruency effects were determined by the relative elevation of the stimuli in external coordinates (same vs. different elevation), regardless of whether the relevant response feature was defined externally or anatomically. Even when participants responded verbally (Experiment 2), the influence of the relative elevation of the stimuli in external space, albeit attenuated, was still observed. However, when the task involved responding with the stimulated finger (four-alternative forced choice; Experiment 3), congruency effects were virtually eliminated. These findings support the view that tactile events can be remapped according to an abstract frame of reference resulting from multisensory integration, but that the frame of reference that is used while performing a particular task may depend to a large extent on the nature of the task demands.     

Poke and pop: Tactile–visual synchrony increases visual saliency

The majority of studies investigating interactions between vision and touch have typically explored single events, presenting one object at a time. The present study investigates how tactile–visual interactions affect competition between multiple visual objects in more dynamic cluttered environments. Participants searched for a horizontal or vertical line segment among distractor line segments of various orientations, all continuously changing color. Search times and search slopes were substantially reduced when the target color change was accompanied by a tactile signal. These benefits were observed even though the tactile signal was uninformative about the location, orientation, or color of the visual target. We conclude that tactile–visual synchrony guides attention in multiple object environments by increasing the saliency of the visual event.     

Preparatory states in crossmodal spatial attention: spatial specificity and possible control mechanisms

We used event-related functional magnetic resonance imaging to study the neural correlates of endogenous spatial attention for vision and touch. We examined activity associated with attention-directing cues (central auditory pure tones), symbolically instructing subjects to attend to one hemifield or the other prior to upcoming stimuli, for a visual or tactile task. In different sessions, subjects discriminated either visual or tactile stimuli at the covertly attended side, during bilateral visuotactile stimulation. To distinguish cue-related preparatory activity from any modulation of stimulus processing, unpredictably on some trials only the auditory cue was presented. The use of attend-vision and attend-touch blocks revealed whether preparatory attentional effects were modality-specific or multimodal. Unimodal effects of spatial attention were found in somatosensory cortex for attention to touch, and in occipital areas for attention to vision, both contralateral to the attended side. Multimodal spatial effects (i.e. effects of attended side irrespective of task-relevant modality) were detected in contralateral intraparietal sulcus, traditionally considered a multimodal brain region; and also in the middle occipital gyrus, an area traditionally considered purely visual. Critically, all these activations were observed even on cue-only trials, when no visual or tactile stimuli were subsequently presented. Endogenous shifts of spatial attention result in changes of brain activity prior to the presentation of target stimulation (baseline shifts). Here, we show for the first time the separable multimodal and unimodal components of such preparatory activations. Additionally, irrespective of the attended side and modality, attention-directing auditory cues activated a network of superior frontal and parietal association areas that may play a role in voluntary control of spatial attention for both vision and touch. Electronic Publication     

Time course of haptic stabilization of posture

Contact of the index finger with a stable surface greatly attenuates postural sway in blindfolded subjects. The time course of postural stabilization was measured after subjects made finger contact with a surface. Subjects (n=12) were tested standing in a heel-to-toe stance in 25 s duration trials. The subject stood with the index finger above but not contacting a laterally placed surface, and made finger contact when cued midway through the trial. Fingertip contact forces stabilized with a time constant of less than 0.5 s and postural stabilization occurred rapidly following fingertip contact. Sway amplitude of center of pressure of the feet decreased by half with a time constant of less than 1.6 s. The stereotypical pattern of force changes at the fingertip leading correlated changes in center of pressure by ~300 ms was evident within the first 0.5 s of finger contact. We conclude that the fingertip can serve as a sensory-motor probe that is stabilized nearly immediately on contact with a surface and that from the moment of contact the fingertip contributes sensory signals used to control sway.     

Role of force cues in the haptic estimations of a virtual length

This study investigated whether and how the force cues play a role in the haptic perception of length. We assumed that the introduction of a dynamic disruption during haptic exploration generated by a haptic display would lead to a systematic bias in the estimation of a virtual length. Two types of “opposition” disruption (“elastic” and “viscous”) were proposed in Experiments 1 and 2, and two types of “traction” disruption (“fluid” and “full”) in Experiments 3 and 4. In all experiments, blindfolded adults were asked to compare two lengths of virtual rods explored with the right index. Results revealed an underestimation of the length with elastic and viscous opposition disruptions and an overestimation of this length with fluid and full-traction disruptions. No systematic bias in the estimation was observed in the “control” sessions in which the active exploration of the segment was “normal” (i.e. not disrupted). These results suggest that the forces produced during exploratory movements are used as a relevant cue in the haptic length estimation.     

Coming Together Through Touch: The Experiences of Parents of Children With Disabilities Learning the Principles of Massage

This paper describes pilot testing of an intervention designed to provide parents of children with disabilities with the basic skills of touch therapy. The aims were 1) to gain a greater understanding of parents’ experience of caring for a child before attending the intervention and 2) to determine whether the intervention was acceptable and perceived to be of value by parents. The sample comprised sixteen parents (three couples, 9 mothers, 1 grandmother) and 13 children. The intervention comprised 8 weekly 1 ‐hour sessions, during which one therapist provided instruction in touch therapy to one parent‐child dyad. Data were collected through interviews with parents before the intervention and at 4 months. Results of pretest interviews revealed that parents’ experiences of caring for children with disabilities reflected that described in the literature (e.g., wide ranging impact on family, career and leisure activities). Furthermore, parents felt they suffered from insufficient information and support in attempts to manage their child's condition at home. Results of the post‐test interviews suggest that both parents and children found the experience of touch therapy enjoyable. Parents reported benefiting in terms of having something positive to offer, feeling more confident in their own abilities and feeling closer to their child. Children were reported to have improved sleep patterns, more relaxed muscles and improved bowel functioning. In conclusion, findings suggest that increasing parental resources in relation to their contribution to their child's care might be achieved through training in simple touch therapy techniques that can be used in the home environment.     

乳腺癌前哨淋巴结术中印片细胞学评估

目的评价印片细胞学在乳腺癌前哨淋巴结活检术中的病理诊断价值。方法选择105例早期乳腺癌患者行前哨淋巴结活检,其中成功101例。沿前哨淋巴结长轴每隔2～3 mm剖开,每个剖面均进行印片细胞学检查,印片使用HE染色,印片后的淋巴结分别送石蜡切片,将印片结果与石蜡的HE染色结果进行比对比较。结果105例患者前哨淋巴结活检的检出率为96.2%(101/ 105),101例患者中共检出202枚前哨淋巴结。在常规石蜡切片作为诊断标准时,前哨淋巴结术中印片细胞学的敏感性、特异性、准确性、阳性及阴性预测值分别为92.1%、98.8%、97.5%、94.6%和98.2%,101例患者的印片敏感性、特异性、准确性、阳性及阴性预测值分别为89.3%、98.6%、96.0%、96.2%和96.0%。将术中印片结果与进一步的连续切片结果进行比对,前哨淋巴结印片的敏感性、特异性、准确性、阳性及阴性预测值分别为83.3%、98.8%、95.5%、94.6%和95.8%,101例患者的印片敏感性、特异性、准确性、阳性及阴性预测值分别为81.3%、100.0%、94.1%、100.0%和92.0%。结论印片细胞学对乳腺癌前哨淋巴结术中病理诊断有较高的价值,可以准确提供术中诊断信息,与石蜡切片有很高的一致性。     

Cytologic evaluation of lumpectomy margins in patients with ductal carcinoma in situ: Clinical outcome

Backround: Breast conservation therapy is controversial for ductal carcinoma in situ (DCIS) due to recently reported high recurrence rates. We believe that cytologic evaluation of lumpectomy margins improves efficiency and leads to a lower recurrence rate following lumpectomy for DCIS. Methods: A prospectively accrued database of 1255 breast cancer patients at the H. Lee Moffitt Cancer Center and Research Institute was found to have 218 patients with DCIS (17.4%). Of those 218 cases, 114 were treated with lumpectomy, axillary dissection, and radiation therapy; the remaining 104 patients were treated with mastectomy with or without reconstruction. Imprint cytology was used to evaluate all lumpectomy margins. Permanent sections and imprint cytology were reviewed by the same pathologist. Results: All lumpectomy specimens (116 tumors in 114 patients) were evaluated. The median follow up was 57.5 months (range 2–110 months). One hundred and three patients with 104 tumors were selected on the basis of pure DCIS (with or without microinvasion), and treated with lumpectomy, axillary dissection and radiation therapy. Of the 104 tumors utilizing attempted breast conservation therapy, 7 (6.6%) required mastectomy. There were 6 recurrences (6.1%) with a median time for recurrence of 47.5 months (range 27–85 months); four recurrences were comedo and two were noncomedo at original diagnosis. Conclusions: The determination of lumpectomy margins in DCIS patients using imprint cytology leads to an overall recurrence rate of 6.1% with reduction in operative time, and re-excision rate. Significant recurrence rates were associated with microinvasion and multifocal tumors (28%) versus simple DCIS at 5 years. Breast conservation therapy and surgical margin determination with imprint cytology for DCIS is a cost-effective and reliable method of treatment for simple DCIS.     

游泳及抚触对新生儿神经行为影响的研究

目的探讨新生儿游泳及抚触对新生儿早期干预的疗效。方法选取正常剖宫产新生儿80例为研究对象,根据自愿原则分为游泳组40例和对照组40例,对比两组神经行为评分情况。结果两组新生儿生后第2天、第10天的神经行为评分无明显差异,于第20天后出现显著差异;通过游泳干预刺激后,新生儿的神经行为评分显著提高,生后30 d评分差异有显著性意义。结论新生儿游泳对新生儿神经系统有良好的改善作用。