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Virtual reality (VR) stands as an innovative technology transforming our interactions with the digital world. Its integration into health care has proven advantageous for both patients and health care providers across multiple levels and modalities. Given that VR is becoming increasingly accessible and prevalent, health care providers should explore incorporating the technology into their practices, particularly within the pediatric population, which is becoming progressively more accustomed to the technology. This topic synopsis provides a broad discussion of the current literature, exploring current and probable future applications of VR in pediatric patient care, particularly in improving the hospital experience, facilitating education during hospitalizations, providing an alternative to pharmacological therapy for pain management, and enhancing mental health care practices.
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Explaining individual differences in vocabulary in autism is critical, as understanding and using words to communicate are key predictors of long-term outcomes for autistic individuals. Differences in audiovisual speech processing may explain variability in vocabulary in autism. The efficiency of audiovisual speech processing can be indexed via amplitude suppression, wherein the amplitude of the event-related potential (ERP) is reduced at the P2 component in response to audiovisual speech compared to auditory-only speech. This study used electroencephalography (EEG) to measure P2 amplitudes in response to auditory-only and audiovisual speech and norm-referenced, standardized assessments to measure vocabulary in 25 autistic and 25 nonautistic children to determine whether amplitude suppression (a) differs or (b) explains variability in vocabulary in autistic and nonautistic children. A series of regression analyses evaluated associations between amplitude suppression and vocabulary scores. Both groups demonstrated P2 amplitude suppression, on average, in response to audiovisual speech relative to auditory-only speech. Between-group differences in mean amplitude suppression were nonsignificant. Individual differences in amplitude suppression were positively associated with expressive vocabulary through receptive vocabulary, as evidenced by a significant indirect effect observed across groups. The results suggest that efficiency of audiovisual speech processing may explain variance in vocabulary in autism.
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Coronavirus disease 2019 (COVID-19) has been known to affect multiple organ systems, aside from the respiratory system. Increasing reports of post-infection neurological complications have been reported. Miller-Fisher syndrome, a rare variant of Guillain-Barré syndrome (GBS), has been reported after COVID-19 infection. We present the youngest known adult (26-year-old male) reported to have had COVID-19-associated Miller Fisher syndrome (MFS) with also the longest reported latency period (10 weeks) between infection and development of neurological symptoms (including dysphagia, horizontal diplopia, facial weakness, upper and lower extremity weakness, paresthesia). This is currently the second youngest reported case after the case of a seven-year-old child. The patient was treated with intravenous immunoglobulin and was ultimately transferred to a different facility for higher level of care. Most symptoms were resolved within four days. The patient reported resolution of neurologic symptoms with the exception of left-sided facial weakness at the one-year follow-up. As more reports of COVID-19-associated GBS and MFS appear in the future, we are likely to discover more variability than was previously known in GBS and MFS. With COVID-19 potentially affecting multiple systems, there could be increased variability to previously known conditions. Future studies may need to closely examine long-term follow-ups of patients previously diagnosed with COVID-19 as post-COVID complications become more prevalent.
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Autistic children show reduced multisensory integration of audiovisual speech stimuli in response to the McGurk illusion. Previously, it has been shown that adults can integrate sung McGurk tokens. These sung speech tokens offer more salient visual and auditory cues, in comparison to the spoken tokens, which may increase the identification and integration of visual speech cues in autistic children. Forty participants (20 autism, 20 non-autistic peers) aged 7-14 completed the study. Participants were presented with speech tokens in four modalities: auditory-only, visual-only, congruent audiovisual, and incongruent audiovisual (i.e., McGurk; auditory 'ba' and visual 'ga'). Tokens were also presented in two formats: spoken and sung. Participants indicated what they perceived via a four-button response box (i.e., 'ba', 'ga', 'da', or 'tha'). Accuracies and perception of the McGurk illusion were calculated for each modality and format. Analysis of visual-only identification indicated a significant main effect of format, whereby participants were more accurate in sung versus spoken trials, but no significant main effect of group or interaction effect. Analysis of the McGurk trials indicated no significant main effect of format or group and no significant interaction effect. Sung speech tokens improved identification of visual speech cues, but did not boost the integration of visual cues with heard speech across groups. Additional work is needed to determine what properties of spoken speech contributed to the observed improvement in visual accuracy and to evaluate whether more prolonged exposure to sung speech may yield effects on multisensory integration.
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Trastorno Autístico , Canto , Percepción del Habla , Niño , Humanos , Percepción Auditiva/fisiología , Ilusiones/fisiología , Percepción del Habla/fisiología , Percepción Visual/fisiología , AdolescenteRESUMEN
Children with autism show alterations in multisensory integration that have been theoretically and empirically linked with the core and related features of autism. It is unclear, however, to what extent multisensory integration maps onto features of autism within children with and without autism. This study, thus, evaluates relations between audiovisual integration and core and related autism features across children with and without autism. Thirty-six children reported perceptions of the McGurk illusion during a psychophysical task. Parents reported on participants' autistic features. Increased report of illusory percepts tended to covary with reduced autistic features and greater communication skill. Some relations, though, were moderated by group. This work suggests that associations between multisensory integration and higher-order skills are present, but in some instances vary according to diagnostic group.
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Trastorno del Espectro Autista , Trastorno Autístico , Ilusiones , Estimulación Acústica , Trastorno Autístico/diagnóstico , Niño , Comunicación , Humanos , Percepción VisualRESUMEN
Research shows that children with autism spectrum disorder (ASD) differ in their behavioral patterns of responding to sensory stimuli (i.e., sensory responsiveness) and in various other aspects of sensory functioning relative to typical peers. This study explored relations between measures of sensory responsiveness and multisensory speech perception and integration in children with and without ASD. Participants were 8-17 year old children, 18 with ASD and 18 matched typically developing controls. Participants completed a psychophysical speech perception task, and parents reported on children's sensory responsiveness. Psychophysical measures (e.g., audiovisual accuracy, temporal binding window) were associated with patterns of sensory responsiveness (e.g., hyporesponsiveness, sensory seeking). Results indicate that differences in multisensory speech perception and integration covary with atypical patterns of sensory responsiveness.
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Trastorno del Espectro Autista/fisiopatología , Percepción , Sensación , Adolescente , Niño , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVE: To quantify the effect of the new 2010 World Health Organization (WHO) semen analysis reference values on reclassifying previous semen analysis parameters and definition of patients with male factor infertility. DESIGN: A multi-institutional retrospective chart review. SETTING: University and private male infertility clinics. PATIENT(S): Men referred for infertility evaluation. INTERVENTION(S): Comparison of semen analysis values based on 2010 versus 1999 reference criteria. MAIN OUTCOME MEASURE(S): Quantification of the change based on individual sperm parameters and as a whole. RESULT(S): A total of 184 men had at least two semen analyses; 13 (7%), 17 (9.2%), 34 (18.4%), and 29 (15.7%) patients changed classification to being at or above the reference values by the 2010 criteria for semen volume, sperm concentration, motility, and morphology, respectively. A total of 501 men had one semen analysis on file; 40 (7.9%), 31 (6.2%), 50 (9.9%), and 74 (19.3%) would change classification for volume, concentration, motility, and morphology, respectively. Overall, 103 patients (15.1%) who had one or more parameter below the reference value on the original analysis were converted to having all parameters at or above the 2010 reference values. CONCLUSION(S): The 2010 reference values result in some infertile men being reclassified as fertile if status is based on semen analysis alone. This may lead to fewer men being referred for proper infertility evaluation or treatment.
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Infertilidad Masculina/diagnóstico , Guías de Práctica Clínica como Asunto , Medicina Reproductiva/normas , Análisis de Semen/métodos , Análisis de Semen/normas , Organización Mundial de la Salud , Humanos , Internacionalidad , Masculino , Valores de ReferenciaRESUMEN
OBJECTIVE: To determine the adherence by laboratories across the United States to the standard semen analysis guidelines and parameter reference ranges 10 years after being set by the World Health Organization (WHO) in 1999 and to compare compliance between regional laboratories vs. specialty assisted reproductive technology (ART) laboratories. DESIGN: Observational study. SETTING: Regional clinical and reproductive endocrinology andrology laboratories. INTERVENTION(S): Blank or deidentified semen analysis reports were collected from laboratories through direct contact or from reports received as part of clinical care for male infertility. MAIN OUTCOME MEASURE(S): Adherence to semen analysis reference range reporting as recommended by the 1999 WHO guidelines. RESULT(S): Semen analyses reports were collected from 111 laboratories from 31 different states. Of 111 laboratories, 26 (23%) reported all reference range parameters in accordance with the guidelines. Of 65 ART laboratories, 21 (32%) complied with all reference range parameters as outlined by the guidelines, vs. 5 of 46 non-ART laboratories (11%). Seventy percent of laboratories that did not report 1999 WHO parameters did so because of differences in reference values for normal morphology. CONCLUSION(S): Adherence to WHO 1999 semen analysis reference range guidelines has not been achieved by ART and non-ART laboratories 10 years after being introduced. Non-ART laboratories report reference ranges less accurately than ART laboratories.
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Técnicas de Laboratorio Clínico/normas , Infertilidad Masculina/diagnóstico , Análisis de Semen/normas , Organización Mundial de la Salud , Adhesión a Directriz , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Garantía de la Calidad de Atención de Salud/normas , Estándares de Referencia , Reproducibilidad de los Resultados , Factores de Tiempo , Estados UnidosRESUMEN
CONTEXT: The combination of testicular biopsy and clinical evaluation for male infertility is becoming progressively more important because new technologies allow men previously considered infertile to father children. Although most general pathologists are experienced with normal, neoplastic, and cryptorchid testicular specimens, the testicular biopsy for infertility requires understanding of a different set of diagnostic categories not otherwise commonly encountered. OBJECTIVE: To highlight a standardized nomenclature for germ cell abnormalities allowing for effective communication with the urologist and maximal clinical benefit from the biopsy. DATA SOURCES: Previously published consensus statements, review articles, peer-reviewed research publications, and abstracts. CONCLUSIONS: A practical approach to evaluating testicular biopsies for fertility and the clinical implications for each abnormality are herein outlined.
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Azoospermia/diagnóstico , Enfermedades Testiculares/diagnóstico , Testículo/patología , Artefactos , Biopsia , Humanos , Masculino , Manejo de Especímenes , Terminología como AsuntoRESUMEN
BACKGROUND: For patients with nonobstructive azoospermia, sperm retrieval rates remain modest. We describe the use of optical coherence tomography to improve retrieval rates and to decrease tissue destruction. METHODS: Four patients underwent diagnostic testicular biopsy and imaging with the Niris optical coherence tomography device. We performed a descriptive comparison between optical coherence tomographic images and conventional histology. RESULTS: The measured seminiferous tubule diameter differed by 16 mum between comparative imaging from optical coherence tomography and conventional histology using hematoxylin and eosin staining. CONCLUSION: We illustrate the usefulness of optical coherence tomography in the setting of testicular biopsy and the management of nonobstructive azoospermia.
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Giant cell fibroblastoma (GCF) is an uncommon fibroblastic tumor of childhood. Appearing as superficial, poorly circumscribed masses, they are characterized histologically by a mixture of cellular and angiectoid areas with empty cleft-like spaces, lined by spindle-shaped and multinucleated giant cells. We present a case of an 11-month-old boy with penile GCF treated with local excision. The patient presented with a recurrent penile mass 1 year later and underwent repeat excision. Pathologic examination confirmed recurrent GCF. GCF is a benign, but locally recurrent tumor, as demonstrated by our case. To our knowledge, no cases of penile involvement have been previously reported.
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Neoplasias del Pene/patología , Humanos , Lactante , Masculino , Neoplasias del Pene/cirugíaRESUMEN
PURPOSE: Some urologists who perform vasectomy reversals are not experienced with performing VE. A model to preoperatively identify patients who may require referral to an experienced VE surgeon was created (). We tested the model at multiple institutions. MATERIALS AND METHODS: The model had previously been designed in 483 patients who underwent vasectomy reversal at 1 institution (100% sensitive and 59% specific for predicting the need for VE). It was based on time since vasectomy and patient age. We tested it prospectively in 33 patients and retrospectively in a total of 312 at 6 other institutions. The predictive accuracy of the model was compared to using a simple duration from vasectomy cutoff alone, as is used in clinical practice. RESULTS: The model had 84% sensitivity and 58% specificity for detecting the need for VE in a total of 345 patients at 7 institutions. If using only a duration from vasectomy cutoff of 10 years to predict the need for VE, sensitivity was only 69%. At a cutoff of 4 years sensitivity was 99% but specificity was only 23%. Thus, the model performed better than any specific duration cutoff alone. CONCLUSIONS: The predictive model provides 84% sensitivity for detecting patients who may require VE during vasectomy reversal across 7 institutions (58% specificity). The model more accurately predicts the need for VE than using a specific duration from vasectomy cutoff alone.
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Redes Neurales de la Computación , Vasovasostomía/estadística & datos numéricos , Adulto , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
OBJECTIVES: To assess the feasibility of a multilayered robotic-assisted vasovasostomy (RAVV) in a rabbit model. Microscope-assisted vasovasostomy (MAVV) is a technically challenging procedure. Robotics may be a surgical adjunct that helps overcome the microsurgical challenges, which include fine suture, delicate instruments, and tremor. A recent survey revealed that most urologists use a multilayered technique for vasovasostomies. METHODS: A surgeon performed eight vasovasostomies with 10-0 suture and a two-layer technique using an in vivo rabbit model-four were MAVV using conventional microsurgical instrumentation and four were RAVV using the da Vinci robot. Performance measures and adverse haptic events were recorded. Patency was evaluated by passing a 2-0 Prolene suture through the anastomoses. RESULTS: The mean operating time for the total procedure and for the mucosal layer only was longer for RAVV than for MAVV (75 versus 42 minutes, P = 0.03 and 38 versus 23 minutes, P = 0.03, respectively). The needle passes required for the mucosal layer and the number of mucosal and muscularis sutures were similar in both groups (9.5 versus 8.8 passes, P = 0.34; 4 versus 4, P >0.99; and 7 versus 6.3, P = 0.2, respectively). Unlike MAVV, no tremor was appreciated during RAVV. No adverse haptic events were observed in either group. All anastomoses were patent, and all rabbits were free of any crush injury. CONCLUSIONS: A multilayered RAVV can be performed in an in vivo rabbit model. Although it was associated with increased operative times, the absence of adverse haptic events and comparable patency rates continue to suggest a role for robotics in microsurgery.
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Robótica , Vasovasostomía/instrumentación , Vasovasostomía/métodos , Animales , Estudios de Factibilidad , Modelos Animales , ConejosRESUMEN
PURPOSE: We devised a model to predict, preoperatively, the need for a vasoepididymostomy (VE) when performing a vasectomy reversal. Urologists could use it to identify those patients who need a referral to an experienced VE surgeon. MATERIALS AND METHODS: We performed a retrospective review of 483 patients who underwent vasectomy reversal by a single surgeon (AJT) including 393 vasovasostomies and 90 vasoepididymostomies. Selection was based on chart availability. Established criteria were used in deciding the type of reversal (eg gross appearance and microscopic examination of vasal fluid). Type of reversal, patient age and time since vasectomy were recorded. Univariate analysis revealed that patient age (p <0.001) and time since vasectomy (p <0.001) were significant predictors of reversal type. On multivariate logistic regression analysis, time since vasectomy (p <0.001) was the only significant independent predictor. We designed a linear regression algorithm based on time since vasectomy and patient age to predict if a VE would be performed. The model was designed using 433 patients and then tested on a separate randomly selected 50 patient group. The model was designed to be 100% sensitive in detecting patients requiring VE. RESULTS: In the test group the model was 100% sensitive in predicting VE with a specificity of 58.8%. The area under the ROC curves for the design and test groups was 0.8. Palm (PalmSource Inc., Sunnyvale, California) and Windows (Microsoft Corporation, Redmond, Washington) versions are available as free shareware from www.uroengineering.com. CONCLUSIONS: The model is 100% sensitivity in detecting those patients who may require a VE during vasectomy reversal (specificity of 58.8%). It may allow urologists to preoperatively identify these patients.
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Modelos Estadísticos , Vasovasostomía/métodos , Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Vasovasostomía/estadística & datos numéricosRESUMEN
PURPOSE: Laparoscopic dismembered pyeloplasty is now an effective option for ureteropelvic junction obstruction. We describe a novel laparoscopic technique of dismembered tubularized flap pyeloplasty for a difficult recurrent long ureteropelvic junction stricture. MATERIALS AND METHODS: A 73-year-old woman with ureteropelvic junction obstruction of a solitary left kidney had undergone failed multiple procedures, including open pyeloplasty, balloon incision endopyelotomy, retrograde balloon dilation and percutaneous endopyelotomy. Using a 4-port transperitoneal laparoscopic technique, the upper ureter was dissected, the scarred ureteropelvic junction stricture was excised and the dismembered ureteropelvic junction was closed with a stitch. A wide base renal pelvic flap was created and tubularized to bridge the 3 cm. upper ureteral defect. Laparoscopic intracorporeal freehand suturing was done to reconstruct the renal pelvis and upper ureter over a Double-J stent (Medical Engineering Corp., New York, New York). RESULTS: Total operative time was 4.5 hours and hospital stay was 4 days. The stent was removed 3 weeks later. At the 2-month followup the patient was asymptomatic. Excretory urography and diuretic renal scan confirmed a widely patent upper ureter with unobstructed drainage. CONCLUSIONS: Dismembered renal pelvis tubularized flap pyeloplasty can be successfully performed laparoscopically to bridge a long upper ureteral defect. This approach is feasible even in a ureteropelvic junction in which previous surgery has failed.