声触诊组织成像量化技术在乳腺实性病灶中的临床应用研究

目的 探讨声触诊组织成像量化技术（VTIQ）在乳腺实性病灶中的临床应用价值。方法 对238例患有乳腺肿块的患者（乳腺实性病灶254个）进行常规二维超声检查及声触诊组织量化技术（VTIQ）检查,所有病灶都通过穿刺活检或手术得到病理结果。分析乳腺良性病灶组、恶性病灶组各弹性指标的差异,包括VTIQ成像速度模式图及乳腺病灶的剪切波速度值Vmax、Vmin、Vmean,并绘制三者受试者工作特征（ROC）曲线,确定诊断界点值,评估VTIQ技术诊断乳腺良恶性病灶的诊断效能。结果 VTIQ成像中,乳腺实性病灶所显示的速度模式彩色编码图可分为五种类型：均匀型、欠均匀型、杂乱型、扩散型、硬环型。均匀型、欠均匀型多见于乳腺良性病灶,杂乱型、扩散型、硬环型多见于乳腺恶性病灶。VTIQ成像剪切波速度指标Vmax、Vmin、Vmean在诊断乳腺良恶性病灶中均具有较高的诊断效能,经综合判断,Vmean可作为诊断乳腺良恶性病灶的最佳指标,诊断界点值为4.84m/s。结论 VTIQ技术应用于乳腺实性病灶良恶性诊断时具有较高的诊断效能,Vmean可作为乳腺良恶性病灶诊断的可靠评价指标,Vmax、Vmin可作为特殊乳腺病灶的辅助评价指标。     

虚拟现实技术对弱视儿童视功能的影响

目的探讨虚拟现实技术在弱视儿童视功能检查与治疗中的临床效果。方法选取医院2019年5月—2020年3月经检查收治的100例弱视患儿(200只眼)为研究对象,按照基础资料组间均衡可比的原则分为对照组和观察组,各组50例(100眼)。对照组实施国际标准视力表进行常规远近视力检查及传统治疗方法,观察组在对照组基础上实施虚拟现实技术,比较两组患儿治疗后视功能水平。结果治疗后观察组患儿在同时视功能方面与对照组差异无统计学意义(P>0.05);观察组在融合、立体视功能、动态立体视功能方面明显优于对照组,差异有统计学意义(P<0.05)。结论对弱视患儿视功能检查与治疗过程采用虚拟现实技术,可有效提升检查及治疗效果,改善视功能。     

Identification of potential inhibitors of Zika virus NS5 RNA-dependent RNA polymerase through virtual screening and molecular dynamic simulations

Zika virus (ZIKV) is one of the mosquito borne flavivirus with several outbreaks in past few years in tropical and subtropical regions. The non-structural proteins of flaviviruses are suitable active targets for inhibitory drugs due to their role in pathogenicity. In ZIKV, the non-structural protein 5 (NS5) RNA-Dependent RNA polymerase replicates its genome. Here we have performed virtual screening to identify suitable ligands that can potentially halt the ZIKV NS5 RNA dependent RNA polymerase (RdRp). During this process, we searched and screened a library of ligands against ZIKV NS5 RdRp. The selected ligands with significant binding energy and ligand-receptor interactions were further processed. Among the selected docked conformations, top five was further optimized at atomic level using molecular dynamic simulations followed by binding free energy calculations. The interactions of ligands with the target structure of ZIKV RdRp revealed that they form strong bonds within the active sites of the receptor molecule. The efficacy of these drugs against ZIKV can be further analyzed through in-vitro and in-vivo studies.     

Diagnosis of Thyroid Nodules Using Virtual Touch Tissue Quantification Value and Anteroposterior/Transverse Diameter Ratio

This paper proposes an effective approach to differential diagnosis of thyroid nodules using a hierarchical classification model based on the Virtual Touch tissue quantification (VTQ) value and anteroposterior/transverse diameter (A/T) ratio. One hundred twenty nodules (92 benign, 28 malignant) were analyzed using this approach by combining the quantitative elastic characteristic with the conventional sonographic feature. First, nodules were classified as benign (VTQ values <2.27 m/s), malignant (VTQ values >2.73 m/s) and indeterminate (2.27 m/s ≤ VTQ values ≤2.73 m/s) using two cutoff points selected on the basis of receiver operating characteristic analysis. Second, the indeterminate nodules were separated into malignant and benign nodules using an A/T ratio ≥1. The advantage of this approach was that it could alleviate the limitation of an overlap in VTQ values between benign and malignant nodules. According to the pathologic results, the accuracy of this approach was 95%. The proposed approach may potentially improve diagnostic accuracy.     

二维超声、实时组织弹性成像及声触诊组织量化技术诊断乳腺浸润性导管癌

目的 探讨二维超声(2D-US)、实时组织弹性成像(UE)及声触诊组织量化(VTQ)技术对乳腺浸润性导管癌(IDC)的诊断价值。方法 对188例患者共213个乳腺病灶术前分别行2D-US、UE及VTQ检查,对各病灶2D-US声像图表现进行超声乳腺影像报告数据系统(BI-RADS-US)分类,UE采用5级评分法判断结节性质,VTQ技术定量测定结节内剪切波速度(SWV)。绘制ROC曲线,比较2D-US、UE、SWV曲线下面积(AUC)。结果 2D-US诊断IDC的敏感度为82.35%(126/153),特异度为71.67%(43/60),准确率为79.34%(169/213)。UE诊断IDC的敏感度为86.27%(132/153),特异度为73.33%(44/60),准确率为82.63%(176/213)。良性及恶性结节的SWV别为(3.09±1.26)m/s、(6.83±2.18)m/s(P<0.05);以3.59 m/s作为诊断恶性病灶的最佳截断值,VTQ诊断IDC的敏感度为86.93%(133/153),特异度为76.67%(46/60),准确率为84.04%(179/213)。2D-US、UE、SWV诊断乳腺IDC的AUC分别为0.811、0.843、0.899,差异有统计学意义(P<0.01)。结论 US、UE及VTQ均有助于鉴别诊断乳腺良性结节及乳腺IDC,UE优于2D-US,VTQ可获得客观的量化指标,重复性好,优于UE和2D-US。     

声触诊组织量化技术评估经颈静脉肝内门体分流术联合胃冠状静脉栓塞术疗效

目的 探讨应用声触诊组织量化(VTQ)技术测量脾脏剪切波速度(SSWV)无创评价经颈静脉肝内门体分流术(TIPS)联合胃冠状静脉栓塞术(GCVE)疗效的价值。方法 将19例接受TIPS联合GCVE治疗的肝硬化门静脉高压患者分为A(13例,接受1次治疗)、B(6例,首次治疗后因支架闭塞再次接受治疗)两组。应用VTQ技术分别与治疗前1天、治疗后6天测量SSWV,以脉冲波多普勒测量门静脉主干血流速度(PVV)、脾静脉主干血流速度(SVV)。于TIPS联合GCVE治疗过程中,以直接测压法测量支架植入前及植入后的门静脉压(PPG),并进行统计分析。结果 TIPS联合GCVE治疗后,A、B两组PPG均较治疗前明显减低(P均<0.05);SSWV均较治疗前明显减低,PVV、SVV均较治疗前明显升高(P均<0.05)。A、B两组治疗前及治疗后SSWV均与PPG呈正相关(P均<0.05),PVV、SVV均与PPG无相关性(P均>0.05)。结论 应用VTQ技术所测SSWV与PPG存在相关性,可作为TIPS联合GCVE治疗前后监测门静脉压力的无创定量评估指标。     

声触诊组织量化鉴别诊断甲状腺实性结节的良恶性

目的 探讨声触诊组织量化技术(VTQ)在甲状腺实性结节良恶性鉴别诊断中的应用价值。方法 采用VTQ技术测量经病理证实的101例患者共129个甲状腺实性结节及周边甲状腺组织剪切波速度(SWV),以病理诊断为金标准,绘制SWV诊断甲状腺实性恶性结节的ROC曲线,获得结节SWV诊断恶性结节的最佳截点。结果 甲状腺实性恶性结节的SWV[(3.15±1.91)m/s]大于良性结节[(2.06±0.54)m/s,P<0.01]。以SWV=2.43 m/s为截点诊断甲状腺实性恶性结节的敏感度、特异度分别为67.80%(40/59)、91.43%(64/70)。甲状腺恶性结节与周边甲状腺组织SWV比值(1.56±0.86)大于良性结节与周边甲状腺组织SWV比值(1.00±0.29,P<0.01)。结论 VTQ技术可量化甲状腺结节硬度,对鉴别诊断甲状腺实性结节具有较高的应用价值。     

声触诊组织定量技术鉴别诊断甲状腺良恶性结节

目的 探讨声触诊组织定量成像(VTQ)鉴别诊断甲状腺良恶性结节的价值。方法 收集48例经手术或穿刺病理证实的甲状腺结节患者,均行常规超声及VTQ检查,获得结节及结节周围组织的剪切波速度(SWV),采用ROC曲线进行统计学分析。结果 良性结节及其周围组织的SWV分别为(2.05±0.25)m/s 、(1.78±0.26)m/s(95%CI:1.68~1.88 m/s),恶性结节及其周围组织SWV分别为(3.57±1.29)m/s(95%CI:3.06~4.09 m/s)、(1.85±0.29)m/s(95%CI:1.73~1.96 m/s)。良性结节与恶性结节、良性结节与其周围组织、恶性结节与其周围组织间SWV的差异均有统计学意义(P均<0.001),而良性结节周围组织与恶性结节周围组织间SWV的差异无统计学意义(P=0.5006)。应用SWV诊断甲状腺恶性结节的ROC曲线下面积为0.9927,截断值为2.416 m/s,敏感度、特异度、阳性预测值、阴性预测值、阳性似然比及阴性似然比分别为88.89%(24/27)、96.43%(27/28)、96.00%(24/25)、90.00%(27/30)、24.89及0.12。结论 VTQ检查能够通过SWV值反映出结节及其周围组织的硬度,在对甲状腺结节良恶性的鉴别诊断中具有重要价值。     

Real-time modulation of visual feedback on human full-body movements in a virtual mirror: development and proof-of-concept

Background

Virtual reality (VR) provides interactive multimodal sensory stimuli and biofeedback, and can be a powerful tool for physical and cognitive rehabilitation. However, existing systems have generally not implemented realistic full-body avatars and/or a scaling of visual movement feedback. We developed a “virtual mirror” that displays a realistic full-body avatar that responds to full-body movements in all movement planes in real-time, and that allows for the scaling of visual feedback on movements in real-time. The primary objective of this proof-of-concept study was to assess the ability of healthy subjects to detect scaled feedback on trunk flexion movements.

Methods

The “virtual mirror” was developed by integrating motion capture, virtual reality and projection systems. A protocol was developed to provide both augmented and reduced feedback on trunk flexion movements while sitting and standing. The task required reliance on both visual and proprioceptive feedback. The ability to detect scaled feedback was assessed in healthy subjects (n = 10) using a two-alternative forced choice paradigm. Additionally, immersion in the VR environment and task adherence (flexion angles, velocity, and fluency) were assessed.

Results

The ability to detect scaled feedback could be modelled using a sigmoid curve with a high goodness of fit (R² range 89-98%). The point of subjective equivalence was not significantly different from 0 (i.e. not shifted), indicating an unbiased perception. The just noticeable difference was 0.035 ± 0.007, indicating that subjects were able to discriminate different scaling levels consistently. VR immersion was reported to be good, despite some perceived delays between movements and VR projections. Movement kinematic analysis confirmed task adherence.

Conclusions

The new “virtual mirror” extends existing VR systems for motor and pain rehabilitation by enabling the use of realistic full-body avatars and scaled feedback. Proof-of-concept was demonstrated for the assessment of body perception during active movement in healthy controls. The next step will be to apply this system to assessment of body perception disturbances in patients with chronic pain.     

Feasibility study of the BrightBrainer™ integrative cognitive rehabilitation system for elderly with dementia

Purpose: To describe the development of BrightBrainer? integrative cognitive rehabilitation system and determine clinical feasibility with nursing home-bound dementia patients. Method: BrightBrainer cognitive rehabilitation simulations were first played uni-manually, then bimanually. Participants sat in front of a laptop and interacted through a game controller that measured hand movements in 3D, as well as flexion of both index fingers. Interactive serious games were designed to improve basic and complex attention (concentration, short-term memory, dual tasking), memory recall, executive functioning and emotional well-being. Individual simulations adapted automatically to each participant’s level of motor functioning. The system underwent feasibility trials spanning 16 sessions over 8 weeks. Participants were evaluated pre- and post-intervention, using standardized neuropsychological measures. Computerized measures of movement repetitions and task performance were stored on a remote server. Results: Group analysis for 10 participants showed statistically significant improvement in decision making (p?p?p?p?p?Conclusions: Preliminary findings demonstrate utility within an advanced dementia population, suggesting that it will be beneficial to evaluate BrightBrainer through controlled clinical trials and to investigate its application in other clinical populations.

• Implications for Rehabilitation

• It is possible to improve cognitive function in older low-functioning patients. Integrative rehabilitation through games combining cognitive (memory, focusing, executive function) and physical (bimanual whole arm movement, grasping, task sequencing) elements is enjoyable for this population.

• The severity of depression in these elderly can be reduced through virtual reality bimanual games.

• The number of upper extremity active repetitions performed in the process of solving cognitive problems with the BrightBrainer? system is 600. This number is 18 times (1875%) larger than those observed by other researchers in conventional physical or occupational rehabilitation sessions.