El metaverso en el mundo de la salud: el futuro presente. Desafíos y oportunidades / The metaverse in the world of health: The present future. Challenges and opportunities

La Organización Mundial de la Salud define la salud digital como la incorporación de tecnologías de información y comunicación para mejorar la salud. En los últimos años, se vio una fuerte aceleración en la adopción de estas herramientas digitales, lo que impactó de lleno en los modelos asistenciales tradicionales. Actualmente, estamos observando el surgimiento de un gran entorno virtual inmersivo llamado metaverso. Su aparición genera nuevas y desafiantes oportunidades en la salud. En este artículo se exploran algunos conceptos relacionados con este campo, se dan ejemplos concretos de su aplicación en pediatría, se mencionan algunas experiencias en el ámbito hospitalario para finalmente adentrarse en los desafíos y oportunidades que emergen.

The World Health Organization has defined "digital health" as the use of information and communication technologies to improve health. In recent years, there has been a strong acceleration in the adoption of these digital tools, which has had a major impact on traditional healthcare models. We are currently witnessing the emergence of a large immersive virtual environment called the "metaverse." Its emergence creates new and challenging opportunities in health care. This article explores some metaverse-related concepts, provides specific examples of its use in pediatrics, describes experiences in the hospital setting, and finally delves into the resulting challenges and opportunities.

Application of MRI-based image navigation and target selection in transcranial magnetic stimulation treatment / 中国组织工程研究

BACKGROUND:In clinical application,the therapeutic effect of transcranial magnetic stimulation depends on the ability to accurately target the areas of the brain that need to be stimulated.In recent years,with the development of neuronavigation systems,mobile augmented reality technology,and the new methods of processing magnetic resonance imaging(MRI)data,the accuracy of stimulus target localization and the optimization of target selection are expected to improve further. OBJECTIVE:To review the principle of MRI-based image navigation and its application in transcranial magnetic stimulation and summarize the roles of different modal MRI data analyses in guiding the selection of target areas for transcranial magnetic stimulation. METHODS:An online computer search for relevant literature was performed in PubMed,CNKI database and WanFang database,with the keywords"transcranial magnetic stimulation,coil positioning,neuronavigation,augmented reality,magnetic resonance,theory."Finally,63 documents were included for review. RESULTS AND CONCLUSION:Among the traditional methods of positioning transcranial magnetic stimulation coils,the"5 cm rule"and the international electroencephalogram 10-20 positioning method are the most commonly used.These methods have the advantages of simplicity and economy,but they rely too much on the operator's experience and there were technical differences between operators.The neuronavigation system,which is based on stereotactic technology,is the guiding method for positioning transcranial magnetic stimulation coils with the highest visual degree and accuracy.It achieves visual positioning through MRI data acquisition,3D brain reconstruction,head model registration and stereogeometric positioning.It has high application value in clinical treatment and scientific research,but it cannot be promoted in medical institutions due to its high cost.For various medical institutions,mobile augmented reality is a cost-effective and efficient alternative to the neuronavigation system,which achieves visual positioning of brain tissue under the scalp through MRI data acquisition,2D/3D image construction,virtual image and real brain image superposition.It has the advantages of directly visualization and low cost,and is expected to be popularized and applied in primary medical units.Although the superiority of clinical efficacy of visual coil positioning over the electroencephalogram 10-20 localization strategy has not yet been fully demonstrated,with the progress of brain MRI data analysis,visual positioning is expected to further optimize the target selection strategy of transcranial magnetic stimulation therapy and to improve the response rate and individuation degree of transcranial magnetic stimulation treatment.This is a promising and challenging research direction in the future.

Augmented reality navigation assisted design of chimeric twin-paddled anterolateral thigh perforator flap in reconstruction of soft tissue defects in extremities: a report of 8 cases / 中华显微外科杂志

Objective:To investigate the feasibility and clinical effects of the application of augmented reality (AR) navigation on assisted design of the chimeric twin-paddled anterolateral thigh perforator flap (ALTPF) in reconstruction of soft tissue defects in extremities.Methods:From June 2017 to June 2023, 8 patients with soft tissue defects in extremities received reconstruction of chimeric twin-paddled ALTPF designed with the assistance of AR navigation in Department of Hand & Foot Microsurgery Orthopaedics, Guigang City People’s Hospital. All of them were traffic accidents or machine injuries, with 3 cases of calf, 2 cases of ankle, 1 case of foot, and 2 cases of hand defects. All the wounds were wide or irregular (defect sized 14 cm×14 cm-25 cm×13 cm). The images of bilateral thighs were acquired by CT angiography preoperatively. The dominant side and dominant perforators were selected. Three dimensional reconstruction was performed by Mimics software. AR technology was applied to guide the design and harvest of the chimeric twin-paddled ALTPF. Flap area was 15 cm × 16 cm to 26 cm × 14 cm. The donor site was sutured directly. Follow-up with outpatient visits or WeChat images and videos at 1, 3, 6 and 12 months postoperatively to record the appearance, colour, texture, recurrence of infection, and knee extension function of the flap donor site.Results:According to the preoperative design, the perforator flaps were harvested and transferred in all the 8 patients. All flaps survived and the recipient and donor sites healed in one stage. All patients entered postoperative follow-up for 3 to 12 (mean, 8.6)months. The colour and texture of the flaps were excellent, and the appearance of donor and recipient sites was satisfactory. Two patients with hand injuries were evaluated using the brief Michigan Hand Outcomes Questionnaire (MHQ), with scores of 43.74 and 81.25, respectively. Six patients with lower limb injuries were evaluated using the Maryland foot score, with scores of 2 excellent, 3 good and 1 fair.Conclusion:The application of AR navigation can effectively assist the design of a chimeric twin-paddled ALTPF. It also provides an effective basis for clinical personalised flap design.

Augmented reality navigation system for assisting CT-guided puncture of pulmonary nodules in dog models / 中国介入影像与治疗学

Objective To observe the value of augmented reality(AR)navigation system for assisting CT-guided puncture of pulmonary nodules in dog models.Methods Five healthy dogs were selected,and 4 target lung rings were implanted in each dog to build pulmonary nodule models.Deferring to crossover design,CT-guided punctures were performed with or without AR navigation 2 and 4 weeks after successful modeling,respectively,while punctures with AR navigation were regarded as AR group and the others as conventional group,respectively.The time duration of puncturing,the times of CT scanning,of needle adjustment,and the deviation distance between needle pinpoint to the center of pulmonary nodule shown on three-dimensional reconstruction were compared between groups.Results The duration time of puncture in AR group and conventional group was(13.62±5.11)min and(20.16±4.76)min,respectively.In AR group,the times of CT scanning,of needle adjustment,and the deviation distance was 2.40±0.50,2.75±0.44 and(2.94±1.92)mm,respectively,while in conventional group was 3.10±0.64,3.70±0.57 and(4.90±3.38)mm,respectively.The introduction of AR navigation was helpful to shortening the duration of puncture,reducing times of CT scanning and needle adjustment,also decreasing positioning error of needle pinpoint(all P＜0.05).In contrast,the variance of puncture sequences and dogs had no obvious effect on the results(both P＞0.05).Conclusion AR navigation system could improve accuracy and efficiency in CT-guided puncture of pulmonary nodules in dog models.

Applications and advances of digital technology in spinal surgery: from 3d printing to large language model / 中华创伤骨科杂志

With advancement of science and technology and consequent increasing demands, digital technology has become more and more important in the field of spinal surgery. It provides spinal surgeons with more information, support and assistance to improve the diagnostic accuracy, surgical efficiency, surgical safety, and surgical quality. It also offers new possibilities and opportunities for education, communication, and doctor-patient interaction in medicine. This article reviews the applications and advances of digital technology in the field of spinal surgery, mainly covering 3D printing, surgical navigation, virtual reality and augmented reality, surgical robots, and artificial intelligence. It also analyzes the latest research progress at home and abroad, limitations and challenges, and the future development trends of digital technology.

Uso de tecnologias baseadas em realidade virtual e aumentada na saúde e enfermagem: revisão integrativa

Objetivo: Determinar o uso de tecnologias baseadas em realidade virtual ou realidade aumentada na área da saúde para a população em geral. Material e Método: Revisão integrativa realizada nas bases de dados MEDLINE/PubMed, CINAHL, LILACS, Web of Science e Scopus. Foram incluídos artigos completos, sem recorte temporal, em português, inglês e espanhol que respondessem à questão norteadora. Resultados: Foram incluídos 65 estudos. As principais finalidades do uso de tecnologias baseadas em realidade virtual ou realidade aumentada foram: alívio da dor, da ansiedade e do medo; educacional (simulação e orientação); reabilitação e neurorreabilitação; promoção da saúde mental/ bem-estar psicológico; auxílio em procedimentos e apoio ao planejamento/cirurgia pré-operatória. Conclusão: Destacamos o amplo uso dessas tecnologias na área da saúde e como elas têm se mostrado benéficas em diferentes contextos clínicos, favorecendo a promoção, a prevenção e a reabilitação da saúde da população.

Objective: To determine the use of technologies based on virtual reality or augmented reality in the area of health for the general population. Material and Method: Integrative review conducted in MEDLINE/ PubMed, CINAHL, LILACS, Web of Science and Scopus databases. Full articles were included, without time frame, in Portuguese, English and Spanish that answered the guiding question. Results: 65 studies were included. The main purposes of the use of virtual reality or augmented reality-based technologies were: pain, anxiety and fear relief; educational (simulation and guidance); rehabilitation and neurorehabilitation; promoting mental health/psychological well-being; assisting in procedures and supporting preoperative planning/surgery. Conclusion: We highlight the wide use of these technologies in the health area and how beneficial they have proven to be in different clinical contexts, favoring the promotion, prevention and rehabilitation of the population's health.

Objetivo: Determinar el uso de tecnologías basadas en realidad virtual o realidad aumentada en el área de la salud para la población general. Material y Método: Revisión integrativa realizada en las bases de datos MEDLINE/PubMed, CINAHL, LILACS, Web of Science y Scopus. Se incluyeron artículos completos, sin marco temporal, en portugués, inglés y español que respondieron a la pregunta orientadora. Resultados: Se incluyeron 65 estudios. Los principales propósitos del uso de tecnologías basadas en realidad virtual o realidad aumentada fueron: alivio del dolor, la ansiedad y el miedo; carácter educativo (simulación y orientación); rehabilitación y neurorrehabilitación; promover la salud mental/bienestar psicológico; ayudar en procedimientos y apoyo a la planificación/cirugía preoperatoria. Conclusión: Se resalta el amplio uso de estas tecnologías en el área de la salud y lo beneficiosas que han demostrado ser en diferentes contextos clínicos, favoreciendo la promoción, prevención y rehabilitación de la salud de la población.

Application of multi-modal neuroimaging three-dimensional reconstruction and virtual reality in neurosurgical specialists training / 中华医学教育探索杂志

Neurosurgery is considered as one of the most difficult areas in the field of medicine, and the complexity of nervous system is a leading cause. Therefore, it demands neurosurgeons possess basic knowledge, spatial thinking, and practical experiences. Here, we introduce a rapid developing technique applying multi-modal neuroimaging reconstruction and virtual reality, which constitutes a novel learning model for boosting the growth of neurosurgeons. The incorporation of multi-modal neuroimaging and virtual reality builds a bridge from two-dimensional image to actual surgical view. Neurosurgeons are able to perform surgical planning and simulation with naked eyes under the constructed three-dimensional hologram. The technique also provides evidence of accurate localization and guidance for operation. Therefore, multi-modal neuroimaging reconstruction and virtual reality are expected to tremendously promote the progress of young trainees, and can further enhance their all-round abilities. In short, this revolutionary learning model would impact the neurosurgical specialists training profoundly.

Development and application of the virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology / 中华放射医学与防护杂志

Objective:To investigate the necessity and feasibility of the virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology in the clinical application of radiotherapy.Methods:This study developed a 3D virtual operation and interactive system using the Unity3D engine, tools including 3Dmax and Maya, and the SQL database. The scenes in the system were produced using the currently popular next-generation production process. Targeting the priorities and difficulties in the implantation of fiducial markers, the system developed in this study allowed for simulated demonstration and training based on 12 steps and 10 knowledge points. Internal tests and remote evaluation tests were adopted in this system to obtain the test result of each subject. Then, the application value of the system was analyzed based on the test result.Results:As of May 1, 2022, the system had received 2 409 views and 425 test participants, with an test completion rate of 100% and an experiment pass rate of 96.5%. Moreover, this system won unanimous praise from 167 users, primarily including the students majoring in multilevel medical imaging technology and medical imaging science from the Fujian Medical University, as well as the radiotherapy-related staff of this university.Conclusions:The virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology can be applied to the teaching of students and the training of related professionals.

Effect of mirror therapy with augmented reality on attention of stroke patients / 中国康复理论与实践

ObjectiveTo investigate the effect of mirror therapy with augmented reality on attention of stroke patients. MethodsFrom January, 2020 to December, 2022, 60 stroke patients in the First People's Hospital of Changzhou were randomly divided into control group (n = 30) and observation group (n = 30). Both groups received routine occupational therapy, and the observation group received mirror therapy with augmented reality additionally, for four weeks. They were assessed with Digit Span Test (DST), Digit Cancellation Test (D-CAT3 and D-CAT3P), Symbol Digit Modalities Test (SDMT) and Paced Auditory Serial Addition Test (PASAT) before and after treatment. ResultsBefore treatment, there was no significant difference in the scores of the DST, D-CAT3, D-CAT3P, SDMT and PASAT between two groups (P > 0.05). After treatment, all the indexes improved in the observation group (|t| > 3.663, P < 0.01), and improved more in the observation group than in the control group (|t| > 2.037, P < 0.05). ConclusionThe mirror therapy with augmented reality could effectively improve attention of stroke patients in the short term.

Effect of augmented reality training based on enriched environment on walking function after stroke / 中国康复理论与实践

ObjectiveTo observe the effect of augmented reality training based on enriched environment on walking dysfunction after stroke. MethodsFrom January, 2021 to June, 2022, 36 stroke patients in the Affiliated Suzhou Hospital of Nanjing University Medical School were randomly divided into control group (n = 18) and experimental group (n = 18). Both groups received conventional rehabilitation treatment. The control group was supplemented with conventional walking training, and the experimental group was supplemented with augmented reality training based on enriched environment, for four weeks. They were assessed with Berg Balance Scale (BBS), Timed Up and Go Test (TUGT), 10-meter walk test (10MWT) and Barthel Index (BI) before and after treatment, and the gait parameter was compared. ResultsNo adverse event occurred during treatment. After treatment, the BBS score, TUGT time, 10MWT speed, BI, gait speed, gait frequency and the proportion of single-leg support on the affected side significantly improved in both groups (|t| > 5.161, P < 0.001). All the above indexes were better in the experimental group than in the control group (|t| > 2.106, P < 0.05), except for BI (t = 1.099, P = 0.282). ConclusionAugmented reality training based on enriched environment could improve the walking function of paitents after stroke, which is better than conventional walking training.

Research progress of virtual reality and augmented reality technology in colorectal surgery / 中国医学装备

With the rapid development of artificial intelligence and deep learning,virtual reality(VR)and augmented reality(AR)technologies have been widely used in the medical field with their unique advantages.Despite the rapid advances of techniques in colorectal surgery,the risk of colorectal surgery remained high due to the complexity of colorectal anatomy,and the burden of postoperative symptoms remained high.VR and AR technologies can help overcome some of these challenges.The application of VR and AR in colorectal surgery was reviewed,including education and training,surgical assistance,patient education,symptom management,etc.,in order to provide references for clinical application of VR and AR in colorectal surgery.

Assessment of a high-fidelity, virtual reality-based, manual small-incision cataract surgery simulator: A face and content validity study

Purpose: To establish the face and content validity of the HelpMeSee Eye Surgery Simulator � a virtual reality-based cataract surgery simulator for manual small-incision cataract surgery (MSICS). Methods: The face and content validity were assessed on the sclero-corneal tunnel construction course. A questionnaire with 11 questions focused on the visual realism, with resemblance to real life surgery, and the training value of the simulator was developed. Thirty-five experienced MSICS surgeons participated in the study. Responses were recorded using a seven-point scoring system. Results: Overall, 74.3% (26/35) of the respondents agreed that the overall visual representation of the eye and the instruments in the simulator were realistic. The task of injecting a visco-elastic through the paracentesis was reported to be the most visually realistic task with a mean score of 5.78 (SD: 1.09; range: 2�. With regard to content validity, 77.1% (27/35) of the subjects felt agreed that the errors and complications represented throughout the entire tunnel construction module were similar to those encountered in real life; the task of entering the anterior chamber with the keratome had a mean score of 5.54 (SD: 0.98; range 1�, being rated the highest in that aspect. Overall, 94.3% (33/35) of the subjects agreed that the simulator would be useful in developing hand� eye co-ordination. A similar number of 94.3% (33/35) agreed that based on their experience, they would recommend cataract surgical training on this simulator. Conclusion: The results suggest that the HelpMeSee Eye Surgery Simulator appears to have sufficient face and content validity for cataract surgical training.

Educação alimentar e nutricional para crianças, guiada por aplicativo / Food and nutrition education for children, app-guided / Educación alimentaria y nutricional para niños, guiada por app

Introdução:A formação dos hábitos alimentares ocorre,principalmente,nos primeiros anos de vida. Nesse período, recomenda-se o aleitamento materno e a introdução de alimentos adequados. Esses fatores associados a um estilo de vida saudável são importantes para a prevenção da obesidade infantil. Para que essas informações cheguem ao público-alvoe para que o processo de Educação Alimentar e Nutricional seja mais eficaz, recursos tecnológicos são cada vez mais importantes.Objetivo:O objetivo foi elaborar o designinstrucional do aplicativo AlimentAR, usando Realidade Aumentada,direcionado para Educação Alimentar e Nutricional com crianças de até dois anos. Metodologia:A metodologia utilizada para o conceito de designinstrucional seguiu cinco etapas:Análise, Design, Desenvolvimento, Implementação e Avaliação. A etapa de análise incluiu diagnóstico situacional e/ou identificação de problemas que necessitam de intervenção. No processo de design, o foco estava na estrutura e nos objetivos educacionais. No desenvolvimento, ocorreu seleção de conteúdo, formatação, elaboração de recursos didáticos e storyboard(esboço sequencial de desenhos). As etapas de implementação e avaliação serão tratadas em estudo posterior. Resultados:Neste sentido, o designinstrucional foi desenvolvido de forma sistemática seguindo metodologia proposta. O produto prevê projeção de imagens de alimentosusando Realidade Aumentada, de acordo com necessidade nutricional da criança, considerando o Guia Alimentar para Crianças até 2 anos e a Ficha de Marcador de Consumo Alimentar para crianças até seis meses e crianças de seis a 23 meses.Conclusões:Conclui-se que a utilização da Realidade Aumentadaassociada à abordagem transdisciplinar pode ser uma possível estratégia para a elaboração de instrumento de Educação Alimentar e Nutricionalcom foco na formação de hábitos alimentares saudáveis e prevenção da obesidade infantil (AU).

Introduction:The formation of eating habits occurs mainly in the first years of life. During this period, breastfeeding and the introduction of adequate foods are recommended. These factors associated with a healthy lifestyle are important for the prevention of childhood obesity. In order for these recommendations to reach the target audience and for the process of Food and Nutrition Education to be more effective, technological resources areincreasingly being used. Objective:The objective of this study was to elaborate an instructional design for an application called AlimentAR, using Augmented Reality aimed at Food and Nutrition Education with children up to two years old. Methodology:Themethodology used for the instructional design concept followed five stages: Analysis, Design, Development, Implementation and Evaluation. The analysis stage included situational diagnosis and/or identification of problems that require intervention. In thedesign process, the focus was on educational structure and objectives. In the development, there was content selection, formatting, elaboration of didactic resources and storyboard (sequential sketch of drawings). The implementation and evaluation stages will be dealt with in a later study. Results:The instructional design was developed systematically following the proposed methodology. The product provides projection of food images in Augmented Reality, according to the child's nutritional need, considering the Food Guide for Children up to 2 years and the Food Intake Sheet for children up to six months and children from six to 23 months. Conclusions:In summary,the use of Augmented Reality associated with the transdisciplinary approach may be a possible strategy for the elaboration of an Food and Nutrition Educationinstrument focused on the formation of healthy eating habits and the prevention of childhood obesity (AU).

Introducción: La formación de hábitos alimentarios ocurre, principalmente,en los primeros años de vida. En este periodo, es recomendable la lactancia materna y la introducción de alimentos adecuados. Estos factores asociados a un formade vida saludable,son fundamentalespara prevenir la obesidad infantil. Para que estas informaciones alcancen al público objetivo y que el proceso de Educación Alimentaria y Nutricional sea más efectivo, los recursos son cada vez más importantes. Objetivo: El objetivo fue la elaboración de undiseño instruccional delaplicativoAlimentAR, utilizando Realidad Aumentada dirigido a Educación Alimentaria y Nutricionalcon niños hasta 2 años de edad.Metodología: El elaboración del diseño instruccional comprendióel Análisis, elDiseño, elDesarrollo, laImplementación y laEvaluación. La etapa de análisis incluyóel diagnóstico situacional y/o laidentificación de problemas que exigíanintervención. En el proceso de diseño, el foco de atención se centróen la estructura y enlos objetivos educativos. En la fase dedesarrollo seseleccionaron el contenido, el formateo, la elaboraciónde recursos didácticos y elstoryboard(ilustraciones en forma secuencial). Las etapas de implementación y evaluación serán tratadas en un estudioposterior. Resultados: En este sentido, el diseño instruccional fue desarrollado de forma sistemática siguiendo la metodología propuesta. El producto suministraproyección de imágenes de alimentos medianteRealidad Aumentada, conformea la necesidad nutricional del niño, considerando la Guía Alimentaria para Niños hasta 2 años de edad y la Ficha Marcador de Consumo Alimentariopara niños hasta 6 meses y de 6 a 23 meses de edad. Conclusiones: Se concluye que la aplicación de Realidad Aumentadaasociadaal enfoque transdisciplinario puede revelarse como una posible estrategia para la elaboración de un instrumento Educación Alimentaria y Nutricionalencaminadaa la formación de hábitos alimentarios saludables yala prevención de la obesidad infantil (AU).

Augmented reality in interventional radiology education: a systematic review of randomized controlled trials

ABSTRACT BACKGROUND: Augmented reality (AR) involves digitally overlapping virtual objects onto physical objects in real space so that individuals can interact with both at the same time. AR in medical education seeks to reduce surgical complications through high-quality education. There is uncertainty in the use of AR as a learning tool for interventional radiology procedures. OBJECTIVE: To compare AR with other learning methods in interventional radiology. DESIGN AND SETTING: Systematic review of comparative studies on teaching techniques. METHODS: We searched the Cochrane Library, MEDLINE, Embase, Tripdatabase, ERIC, CINAHL, SciELO and LILACS electronic databases for studies comparing AR simulation with other teaching methods in interventional radiology. This systematic review was performed in accordance with PRISMA and the BEME Collaboration. Eligible studies were evaluated using the quality indicators provided in the BEME Collaboration Guide no. 11, and the Kirkpatrick model. RESULTS: Four randomized clinical trials were included in this review. The level of educational evidence found among all the papers was 2B, according to the Kirkpatrick model. The Cochrane Collaboration tool was applied to assess the risk of bias for individual studies and across studies. Three studies showed an improvement in teaching of the proposed procedure through AR; one study showed that the participants took longer to perform the procedure through AR. CONCLUSION: AR, as a complementary teaching tool, can provide learners with additional skills, but there is still a lack of studies with a higher evidence level according to the Kirkpatrick model. SYSTEMATIC REVIEW REGISTRATION NUMBER: DOI 10.17605/OSF.IO/ACZBM in the Open Science Framework database.

Virtual and Augmented Reality in Cardiac Surgery

Abstract Virtual and augmented reality can be defined as a three-dimensional real-world simulation allowing the user to directly interact with it. Throughout the years, virtual reality has gained great popularity in medicine and is currently being adopted for a wide range of purposes. Due to its dynamic anatomical nature, permanent drive towards decreasing invasiveness, and strive for innovation, cardiac surgery depicts itself as a unique environment for virtual reality. Despite substantial research limitations in cardiac surgery, the current literature has shown great applicability of this technology, and promising opportunities.

Immersive photoreal new-age innovative gameful pedagogy for e-ophthalmology with 3D augmented reality

Augmented reality (AR) has come a long way from a science?fiction concept to a science?based reality. AR is a view of the real, physical world in which the elements are enhanced by computer?generated inputs. AR is available on mobile handsets, which constitutes an essential e?learning platform. Today, AR is a real technology and not a science?fiction concept. The use of an e?ophthalmology platform with AR will pave the pathway for new?age gameful pedagogy. In this manuscript, we present a newly innovated AR program named "Eye MG AR" to simplify ophthalmic concept learning and to serve as a new?age immersive 3D pedagogical tool for gameful learning.

Application value of stereotactic digital navigation system assisted three-dimensional lapa-roscopic total mesorectal excision for rectal cancer / 中华消化外科杂志

Objective:To investigate the application value of stereotactic digital naviga-tion system assisted three-dimensional (3D) laparoscopic total mesorectal excision (TME) for rectal cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of a healthy volunteer recruited by the Second Affiliated Hospital of Army Medical University and 3 patients who underwent stereotactic digital navigation system assisted 3D laparoscopic TME for rectal cancer in the Second Affiliated Hospital of Army Medical University from May to September 2019 were collected. The healthy volunteer was male, aged 25 years. Of the 3 rectal cancer patients, there were 2 males and 1 female, with the age of 48 years, 63 years and 67 years, respectively. Ten special patches were placed at the anterior superior iliac spine, pubic tubercle and pubic symphysis of the volunteer's bilateral inguen as skin reference points in intraoperative localization and system registration. On the day of operation, patients were placed 10 special patches as skin reference points according to the test results of the volunteer and were completed the enhanced scan of totally abdominal computed tomography examination. Seven fixed anatomical markers in the abdominal cavity of the patients, including abdominal aortic bifurcation, sacrum scapula, bilateral anterior superior iliac spine, bilateral intersection of ureter and iliac artery and median point of peritoneal reflection, were selected for verifying the accuracy of the correspondence between the instrument tip and the system image. Patients underwent 3D laparoscopic TME for rectal cancer assisted by stereotactic digital navigation system. Observation indicators: (1) test results; (2) surgical situations; (3) accuracy of stereotactic digital navigation system. Measurement data with normal distribution were represented as Mean± SD. Results:(1) Test results. The 10 skin reference points of the volunteer were successfully registered in the stereotactic digital navigation system, with the registration error of 2.8 mm. (2) Surgical situations. All the 3 patients underwent stereo-tactic digital navigation system assisted 3D laparoscopic TME for rectal cancer successfully. The operation time of the 3 patients were 193 minutes, 175 minutes, 210 minutes, respectively, in which the set time of the stereotactic digital navigation system were 34 minutes, 25 minutes, 45 minutes, respectively. The volume of intraoperative blood loss of the 3 patients were 60 mL, 30 mL, 80 mL, respectively. Results of postoperative pathological examination showed 3 patients with adenocar-cinoma, including 1 case with mucinous adenocarcinoma. The tumor diameter and the numbers of lymph nodes dissected of the 3 patients were 2.3 cm, 1.5 cm, 4.0 cm and 12, 12, 13, respectively. No patient had lymph node metastasis. The 3 patients in preoperative clinical TNM stage cT3bN0M0, stage cT4aN1M0, stage cT3bN1M0 were in yield pathological TNM stage ypT1N0M0, stage ypT4aN0M0, stage ypT2N0M0 after neoaduvant chemotherapy, respectively. No patient had complication, and the duration of postoperative hospital of the 3 patients was 7 days, 6 days, 7 days, respectively. (3) Accuracy of stereotactic digital navigation system. The registration errors of the skin reference points were 2.8 mm, 2.6 mm, 2.9 mm and the accuracy errors of the abdominal cavity reference points were (2.5±0.4)mm, (2.3±0.7)mm, (2.6±0.6)mm for the 3 patients.Conclusion:The stereotactic digital navigation system assisted 3D laparoscopic TME for rectal cancer is safe and feasible.

On the application effect of mobile augmented reality technology in the teaching of neuroanatomy / 中华医学教育探索杂志

Objective:To explore the application of mobile augmented reality (mAR) technology in the teaching of neuroanatomy, and to observe its effect on students' academic performance and cognitive load.Methods:By collecting and designing various neuroanatomy multimedia teaching resources (graphics, animations and videos), using augmented reality (AR) marker-based image recognition technology, the multimedia resources were placed at the tags in the traditional book pages to make the books interactive. And various multimedia resources were combined with traditional printed books through mobile devices. Forty students were randomized into the experimental group or the control group. The experimental group was taught with mAR multimedia materials, and the control group adopted traditional teaching methods. After a 6-hour course was completed, all students had a unified test, and the academic performance test and the PAAS(platform-as-a-service) cognitive load scale were used for data collection and analysis. The variance analyses (MANOVA and ANOVA) were used for significance testing.Results:One-way MANOVA test was used to determine the learning effect of mAR on academic performance and cognitive load. The results showed that there was a significant difference between the experimental group and the control group ( P<0.05). The univariate ANOVA test found that the experimental group students who learned neuroanatomy through mAR had better test scores than the control group students. In addition, compared with the control group students, the cognitive load of students in experimental group was significantly reduced, with statistical significance (all P<0.05). Conclusion:Through the teaching practice, we found that using mAR to learn neuroanatomy helps students improve their academic performance while reducing their cognitive load.

Eficacia contrastada de la Realidad Aumentada en el aprendizaje de la reanimación cardiopulmonar / Compared effectiveness of Augmented Reality in learning cardiopulmonary resuscitation

Introducción: La incidencia de la tecnología en la educación ha propiciado el desarrollo de nuevos recursos innovadores para afrontar los procesos de enseñanza y aprendizaje, por lo que la Realidad Aumentada se muestra como una de las tecnologías con mayor proyección, tanto en el sector educativo, en general, como en la educación médica, en particular. Objetivo: Determinar el nivel de eficacia de una metodología sustentada en Realidad Aumentada frente a una tradicional en el aprendizaje de la reanimación cardiopulmonar, en dos grupos de estudiantes universitarios. Métodos: El estudio comenzó en el curso 2017-2018. Se estableció un diseño experimental con grupo control, de tipo descriptivo y correlacional, en una muestra de 58 discentes de un centro universitario de España. Se desplegó un programa formativo en dos grupos con metodologías diferentes -Realidad Aumentada frente a tradicional-. Se empleó un cuestionario -derivado de la Escala de Autoeficacia general en reanimación cardiopulmonar- validado por el método Delphi y de pertinente fiabilidad (α = 0,86) para recoger los datos. Resultados: La metodología innovadora con Realidad Aumentada aplicada en el grupo experimental obtuvo mejores resultados en la motivación, la participación, la interacción con los contenidos, el rol activo de los participantes y mayores resultados de aprendizaje sobre el grupo que siguió una metodología tradicional sin empleo de la tecnología educativa. Conclusiones: Los hallazgos demostraron la eficacia de la Realidad Aumentada en el aprendizaje de las pautas de reanimación cardiopulmonar en discentes universitarios. Por tanto, se recomienda el uso de esta tecnología educativa para alcanzar la efectividad en el aprendizaje de este tipo de contenidos relacionados con la educación sanitaria(AU)

Introduction: The impact of technology on education has led to the development of new innovative resources to cope with the teaching and learning processes, a reason why augmented reality is shown as one of the technologies with the greatest projection, both in the educational sector, in general, as well as in medical education, in particular. Objective: To identify the level of effectiveness of a methodology based on augmented reality compared to a traditional one in learning cardiopulmonary resuscitation, in two groups of university students. Methods: The study began in the academic year 2017-2018. An experimental design of descriptive and correlational type and with a control group was established in a sample of 58 students from a university center in Spain. A training program was implemented in two groups with different methodologies: augmented reality versus a traditional one. A questionnaire, derived from the Generalized Self-Efficacy Scale in cardiopulmonary resuscitation, validated using the Delphi method with relevant reliability α=0.86, was used to collect the data. Results: The innovative methodology with augmented reality applied in the experimental group showed better results regarding motivation, participation, interaction with the contents, and the active role of the participants; as well as higher learning results over the group that followed a traditional methodology without using any educational technologies. Conclusions: The findings showed the effectiveness of augmented reality in learning cardiopulmonary resuscitation guidelines among university students. Therefore, the use of this educational technology is recommended to achieve effectiveness in learning this type of content related to health education(AU)

Augmented reality technology combined with Doppler ultrasound in repair of soft tissue defect around ankle with posterior tibial artery perforator flap / 中华显微外科杂志

Objective:To investigate the clinical value of augmented reality (AR) technology combined with Doppler ultrasound in repairing soft tissue defects around ankle with posterior tibial artery perforator flap.Methods:From June, 2017 to June, 2020, 13 patients with soft tissue defects around ankle were repaired with the posterior tibial artery perforator flap sized 3.0 cm×7.0 cm-5.0 cm×10.0 cm. Preoperative CTA scan was performed to obtain the 3-dimensional image of the blood supply of the donor site. The origin and direction of blood supply, length of pedicle, diameter and the location of perforator were determined. An image fusion software based on Android mobile phone was used from the body surface to realize the navigation by AR, and to mark the locations of the points where blood vessels ran and passed by. At the same time, Doppler ultrasound was employed to confirm the navigation. The optimal puncture fulcrum was used as the flap rotation point in design of the flap. After the flap had been designed, the flap was harvested and the defect was repaired. Outpatient clinic follow-up was performed to evaluate the survival of flap and the function of ankle.Results:All 13 flaps survied without vascular issues. After 6-16 (average 10) months follow-up, all flaps survived. The flaps appeared soft with good blood supply. The colour of the repaired sites were basically the same as normal skin. According to American Orthopedic Foot and Ankle Society (AOFAS) , the ankle function was excellent in 9 patients and good in 4 patients. There was no obvious scar formation on the donor sites.Conclusion:The application of AR technology combined with Doppler ultrasound in the surgical planning of posterior tibial artery perforator flap has advantages in easy to operate in clinical practice. It can reduce the risk of surgery, and has significance in clinical practice.