[Applications of Naked-Eye 3D Display Technology in Medical Field].

Naked-eye 3D display technology has excellent 3D visual effects and does not require wearable devices assistance. It can present the depth, position and complex structure information of 3D medical images, allowing viewers to obtain information about tissues and organs from different points, reducing cognitive load, contributing to medical teaching and opening up innovative methods for planning and diagnosis. Naked-eye 3D augmented reality display can display medical images in real 3D space, achieving virtual and real vision. It helps a lot to medical research. The applications of naked-eye 3D display technology in three major aspects of medical diagnosis, clinical surgery and rehabilitation training is reviewed in the study. It provides the direction for the subsequent research in medical field, thus assisting medical research and improving medical practice.

Research on augmented reality navigation of in vitro fenestration of stent-graft based on deep learning and virtual-real registration.

OBJECTIVES: In vitro fenestration of stent-graft (IVFS) demands high-precision navigation methods to achieve optimal surgical outcomes. This study aims to propose an augmented reality (AR) navigation method for IVFS, which can provide in situ overlay display to locate fenestration positions. METHODS: We propose an AR navigation method to assist doctors in performing IVFS. A deep learning-based aorta segmentation algorithm is used to achieve automatic and rapid aorta segmentation. The Vuforia-based virtual-real registration and marker recognition algorithm are integrated to ensure accurate in situ AR image. RESULTS: The proposed method can provide three-dimensional in situ AR image, and the fiducial registration error after virtual-real registration is 2.070 mm. The aorta segmentation experiment obtains dice similarity coefficient of 91.12% and Hausdorff distance of 2.59, better than conventional algorithms before improvement. CONCLUSIONS: The proposed method can intuitively and accurately locate fenestration positions, and therefore can assist doctors in performing IVFS.

The metabolism of pyrene by a novel Altererythrobacter sp. with in-situ co-substrates: A mechanistic analysis based on pathway, genomics, and enzyme activity.

Using co-substrates to enhance the metabolic activity of microbes is an effective way for high-molecular-weight polycyclic aromatic hydrocarbons removal in petroleum-contaminated environments. However, the long degradation period and exhausting substrates limit the enhancement of metabolic activity. In this study, Altererythrobacter sp. N1 was screened from petroleum-contaminated soil in Shengli Oilfield, China, which could utilize pyrene as the sole carbon source and energy source. Saturated aromatic fractions and crude oils were used as in-situ co-substrates to enhance pyrene degradation. Enzyme activity was influenced by the different co-substrates. The highest degradation rate (75.98%) was achieved when crude oil was used as the substrate because strain N1 could utilize saturated and aromatic hydrocarbons from crude oil simultaneously to enhance the degrading enzyme activity. Moreover, the phthalate pathway was dominant, while the salicylate pathway was secondary. Furthermore, the Rieske-type aromatic cyclo-dioxygenase gene was annotated in the Altererythrobacter sp. N1 genome for the first time. Therefore, the co-metabolism of pyrene was sustained to achieve a long degradation period without the addition of exogenous substrates. This study is valuable as a potential method for the biodegradation of high-molecular-weight polycyclic aromatic hydrocarbons.

Pilot Study of a Virtual Reality Educational Intervention for Radiotherapy Patients Prior to Initiating Treatment.

Virtual reality (VR) presents opportunities for innovative patient educational methods. This study used a combination of subjective questionnaires and objective physiological measures to investigate the impact of a VR radiotherapy (RT) educational system on patients' understanding and anxiety prior to commencing RT. Sixty patients were randomized to control (n = 30) and intervention (n = 30) groups prior to initiating RT. The control group received the standard nursing care process. The intervention group additionally participated in a detailed introduction to RT positioning, procedures, treatments, and other RT-related information via VR education. All patients completed a data collection from pre- and postintervention, which included questions on RT comprehension, anxiety-related scales, and objective physiological data reflecting the patient's psychological state, such as blood pressure, heart rate, and respiration. Both groups had high anxiety levels before the intervention, and there was no significant difference between the questionnaire and physiological data of the two groups. Following the intervention, anxiety scores (state-trait anxiety scale and visual analog scale) of the intervention group decreased significantly compared with those of the control group, and there was a significant decrease in systolic blood pressure (p < 0.05) and increase in cognitive score (p < 0.05). This study reports the positive impact of a virtual reality radiotherapy (VRRT) patient educational system on increasing patient RT comprehension and reducing anxiety. Further work is needed to improve the acceptability of the system to patients and to explore further the impact of VR education on patients' psychological and physical needs.

Association of common medical comorbidities with early renal damage in the Chinese tropics with essential hypertension.

BACKGROUND: Urine albumin/creatinine ratio (UACR) is an important marker of early renal damage (ERD) caused by hypertension. Recent studies showed that blood pressure was a significant inverse association with temperature and climate. The purposes of our study were sought to explore the association of common medical comorbidities with ERD, and find independent risk factors to ERD in Chinese tropics with essential hypertension. METHODS: From January 2018 to December 2019, we assessed UACR in a total of 599 hypertensive Chinese Hainan patients. We defined ERD as a UACR between 30 mg/g and 300 mg/g. We analysed differences between qualitative variables using the chi-squared (χ2) test. We calculated correlations between UACR and age, hypertension duration (HD), systolic blood pressure (SBP), and diastolic blood pressure (DBP) using the Spearman's rho test. To determine the odds ratio (OR), we evaluated binary logistic regression models. RESULTS: Among the 599 patients, 281 (46.9%) were found to have ERD. ERD and factors related to sex, body mass index (BMI), and SBP did not differ significantly (all, p>0.05). Our main findings showed that age, HD, and DBP were associated with ERD (p<0.01, respectively). Furthermore, age ≥ 65 years, HD ≥10 years, DBP ≥ 90 mmHg, SBP ≥ 160 mmHg, and diabetes differed significantly according to ERD status (p < 0.05, respectively). In multivariate analysis using stepwise regression, age (OR = 1.468), DBP (OR = 1.853), and diabetes (OR = 2.031) were significant independent predictors of ERD. The area under the receiver operating characteristic (ROC) curve was 0.677, and the sensitivity and specificity of the optimal cut-off value were 44.5 and 81.1%, respectively. CONCLUSIONS: Common medical comorbidities are associated with ERD; age, DBP, and diabetes are independent risk factors for ERD in patients with essential hypertension who live in the Chinese tropics. Early monitoring of the UACR, as well as control of blood glucose and DBP, can effectively delay ERD.

P-cresol degradation through Fe(III)-EDDS/H2O2 Fenton-like reaction enhanced by manganese ion: Effect of pH and reaction mechanism.

P-cresol is a highly toxic phenolic pollutant in coal chemical wastewater. The effective removal of p-cresol is of great significance to the ecological environment. In this study, the degradation of p-cresol by the Fe(III)-EDDS/H2O2 Fenton-like reaction modified by Mn2+ was investigated. The results showed that the removal rate of p-cresol could be significantly increased by the addition of Mn2+ under neutral and weakly alkaline conditions (pH 6.5-8.5). Acidic conditions (pH 3.5) were not conducive to the Fenton-like reaction. This is because a neutral or weakly alkaline environment is conducive to Mn2+-EDDS complex formation, which can produce O2·- to accelerate the reduction of Fe(III), and the efficiency of p-cresol degradation through a Fenton-like reaction catalyzed by the Fe(III)-EDDS complex is significantly improved. In addition, the degradation of EDDS through ·OH was reduced by O2·-, which maintained and stabilized the Mn2+-EDDS complex and Fe(III)-EDDS complex. Under neutral conditions, the optimal dosage of Fe(III) is 0.7 mM, and the optimal molar ratios are EDDS/Fe(III) = 1: 1, Mn2+/Fe(III) = 1: 1, and H2O2/Fe(III) = 15: 1. The addition of free radical clearance isopropanol and CHCl3 proved that ·OH was the main active substance in the p-cresol degradation process.

[Risk Analysis of Radiotherapy Implementation Process Based on Failure Mode and Effect Analysis].

OBJECTIVE: Providing a risk assessment method for the implementation of radiotherapy to identify possible risks in the implementation of the treatment process, and proposing measures to reduce or prevent these risks. METHODS: A multidisciplinary expert evaluation team was developed and the radiotherapy treatment process flow was drawn. Through the expert team, the failure mode analysis is carried out in each step of the flow chart. The results were summarized and the RPN (risk priority ordinal) score was obtained, and the quantitative evaluation results of the whole process risk were obtained. RESULTS: One hundred and six failure modes were obtained, risk assessment of RPN (20%) high risk failure model are 22 and severity S (≥ 8) high risk failure model are 27. The reasons for the failures were man-made errors or hardware and software failures. CONCLUSIONS: Failure mode and effect analysis can be used to evaluate the risk assessment of radiotherapy, and it provides a new solution for risk control in radiotherapy field.

Subjective and Objective Quantification of the Effect of Distraction on Physician's Workload and Performance During Simulated Laparoscopic Surgery.

BACKGROUND Distracting interference cognitive tasks place undeniable pressure on the minds of people who need high precision and attention during the tasks, such as those tasks performed during surgery; these tasks might affect current surgical procedures. We measured the effect of additional cognitive tasks on the mental load of the physician by measuring the mean change in pupil size, blink rate, and subjective assessment during surgery. MATERIAL AND METHODS We recruited 24 participants with different levels of laparoscopic surgery to perform a complete appendectomy using a standardized virtual reality laparoscopic surgery simulator. The participants then performed the cognitive task (arithmetic problem), after that they performed an appendectomy surgery task while completing the cognitive task on the simulator. All participants wore trackers to monitor pupil size and blink rate during surgery and the cognitive task. The National Aeronautics and Space Administration (NASA) Task Load Index (TLX) score also recorded performance parameters during the surgical mission. RESULTS The double-task pupil size and the blink rate were significantly increased compared to the single-task observation, and the associated increase in psychological load might have been affected by surgical performance, and the performance parameters were also statistically significant. However, for the aforementioned parameters, experienced surgeons had some differences compared with inexperienced surgeons, but these differences did not reach statistical significance. CONCLUSIONS Distracted cognitive task stimulation in the operating room can increase the surgeon's psychological burden while also affecting their operational skills, thereby threatening patient safety; reduced cognitive costs might be obtained by improving or managing cognitive deficits.

Characterization of cometabolic degradation of p-cresol with phenol as growth substrate by Chlorella vulgaris.

To investigate the potential application of Chlorella vulgaris in the treatment of coal gasification wastewater, the characteristics of phenol and p-cresol cometabolism by Chlorella vulgaris were studied, including phenol degradation, ammonia nitrogen removal, antioxidant enzyme activities, and phenol hydroxylase activity. The results showed that the highest tolerable concentrations of phenol and p-cresol for Chlorella vulgaris were 800 and 400 mg/L, respectively. During cometabolism, phenol at low concentrations (100 mg/L) significantly promoted the degradation of p-cresol. Meanwhile, the removal efficiency of ammonia nitrogen was approximately 60% and was not affected by variations in phenol concentration. Furthermore, the cometabolism of phenol and p-cresol was enhanced by improvement of phenol hydroxylase activity of Chlorella vulgaris after the addition of NaHCO3 as an exogenous nutrient. Therefore, Chlorella vulgaris has a great potential for the biochemical treatment of coal gasification wastewater.

A Usability Study of 3 Radiotherapy Systems: A Comparative Evaluation Based on Expert Evaluation and User Experience.

BACKGROUND The complex user interface design of radiotherapy treatment delivery systems can lead to use error and patient harm. In this study, we present the results of a comparison of 3 radiotherapy treatment delivery systems now used in China. MATERIAL AND METHODS We conducted a comprehensive usability study of 3 radiotherapy treatment delivery systems. Expert evaluation was performed through heuristic evaluation with 3 human-factors experts and 1 experienced radiation therapist for each system. User experience was assessed through perceived system usability and workload, using the National Aeronautics and Space Administration Task Load Index and the Post-Study System Usability Questionnaire. RESULTS For the expert evaluation, 47 usability problems were identified for Varian Trilogy, 75 for Elekta Precise, and 37 for Shinva XHA600E. Most problems were classified as major and minor usability problems, and were found in the process of patient setup and setup verification. For the user experience, radiation therapists presented a lower workload for Varian Trilogy compared to Elekta Precise (P<0.01) and Shinva XHA600E (P<0.01), and a lower workload for Elekta Precise compared to Shinva XHA600E (P=0.020). Radiation therapists perceived a higher system usability for Varian Trilogy compared to Shinva XHA600E (P<0.01), and a higher system usability for Elekta Precise compared to Shinva XHA600E (P<0.01). CONCLUSIONS This research provides valuable data on how 3 radiotherapy treatment delivery systems compare. The results of this study may be useful for hospital equipment procurement decisions, and designing next-generation products to improve patient safety.

Comprehensive Evaluation of User Interface for Ventilators Based on Respiratory Therapists' Performance, Workload, and User Experience.

BACKGROUND Poor ergonomic design of ventilators can result in human errors. In this study, we evaluated the ergonomics of ventilators through respiratory therapists' performance, workload, and user experience. MATERIAL AND METHODS Sixteen respiratory therapists were recruited to this usability study of 3 ventilators. Participants had to perform 7 tasks on each ventilator. Respiratory therapists' performance was measured by task errors of all tasks for each participant. Workload was measured by objective measurement (blink rate and duration) and by subjective measurement (NASA-TLX). User experience was assessed by the USE Questionnaire. RESULTS For task errors, significant differences were found among ventilators (p<0.05) and the Evital 4 received higher task errors when compared to the Servo I (p<0.05). For blink rate, significant differences were found in tasks of starting the ventilator, ventilator monitoring values recognition, ventilator setting parameters modification, alarm parameter recognition, and resetting among ventilators (p<0.05). Furthermore, blink duration was also found to be significant differently in tasks of starting the ventilator, mode and setting parameters recognition, ventilator monitoring values recognition, ventilator mode modification, and alarm parameter recognition and resetting, as well as in the average of all tasks (p<0.05). For perceived workload, the Evital 4 received higher NASA-TLX scores among ventilators. For user experience, the Servo I received the highest scores on the USE Questionnaire among the ventilators. CONCLUSIONS The study provides a comprehensive evaluation method of user interface based on respiratory therapists' performance, workload, and user experience. In addition, this study suggests that the ergonomic design of the Evital 4 is poor. Finally, we found that eye motion (blink rate and duration) may be useful to assess the ergonomics of a user interface.

Ergonomic Assessment of the Mental Workload Confronted by Surgeons during Laparoscopic Surgery.

Although the mental workload confronted by laparoscopic surgeons is rather high, there is presently no reliable, established method for evaluating this workload. In the present study, four evaluation indices of eye movement metrics were applied to evaluate surgeons' mental workload. Correlations between these indices and National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores were also explored. Sixteen participants were recruited to complete four laparoscopic procedures. Eye movement was recorded during the tasks, and NASA-TLX scales were also introduced for subjective evaluation. The data were analyzed using R 3.3.2. Significant differences in the mental workload of each task were observed. Statistically significant correlations between mean pupil diameter change and NASA-TLX scores were also observed. The correlation coefficients were 0.763, 0.675, 0.405, and 0.547, and the P values correspondingly were 0.001, 0.004, 0.12, and 0.028, respectively. The results clarify that the mental workload of laparoscopic surgeons is dependent on the specific demands of the operation. Appropriate objective physiological indices can be used to identify the mental workload state of the surgeon.

Usability Study of the User-Interface of Intensive Care Ventilators Based on User Test and Eye-Tracking Signals.

BACKGROUND The aim of this study was to evaluate the ergonomics of the user-interface for 3 intensive care ventilators, and identify usability problems leading to user errors. MATERIAL AND METHODS Sixteen respiratory therapists were recruited to perform 6 specific user-interface operational tasks on ventilators. Data (task completion time, pupil diameter, average slope of pupil diameter change, and subjective evaluation) were collected through objective measurement, questionnaires, and an eye-tracking instrument. RESULTS For task completion time, there were significant differences among ventilators in recognition tasks of ventilator mode and settings (P<0.05), modification of ventilator modes and recognizing (P<0.05) and changing alarm settings (P<0.05). A mean of 15±2 task failures was observed for each ventilator. For the change of pupil diameter, a significant difference was observed between ventilators (except task 2, P<0.05). For average slope of pupil diameter change, a significant difference was also observed between ventilators (except task 2, P<0.05). The Servo I showed a better correlation between task completion time and pupil diameter change. The subjective evaluation results were clear: Evital 4 received worst scores in terms of friendliness of user-interface, information display and safety (respectively, P<0.05). CONCLUSIONS The present study provided valuable evidence to indicate the ergonomic of ventilators now used in China. With the result of this study, we can infer that the Evital 4 were poorly ergonomic designed. Furthermore, the study also demonstrated that eye-tracking can be a promising tool to evaluate the ergonomics of the user-interface.

Author Correction: Correlative Evaluation of Mental and Physical Workload of Laparoscopic Surgeons Based on Surface Electromyography and Eye-tracking Signals.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

Quantitative Evaluations of the Effects of Noise on Mental Workloads Based on Pupil Dilation during Laparoscopic Surgery.

Noise can exert undeniable pressure on human minds, especially during tasks that require high precision and attention, such as those performed during surgery. To investigate whether auditory stimuli increases mental loads during laparoscopic surgery, we examined the effects of operating room (OR) noises and music by measuring mean changes in pupil sizes and subjectively assessing performances during surgery. We recruited 24 subjects with varying laparoscopic surgery experience levels to perform complete appendectomy using a laparoscopic simulator. Wearable eye trackers were worn by all subjects to monitor pupil sizes during surgery, and surgical tasks were performed under conditions of silence, background OR noise, and music. National Aeronautics and Space Administration-Task Load Index scores and performance parameters were also recorded during surgical tasks. Noise distractions were associated with significant increases in pupil sizes compared with those observed in silence, and the related increases in mental loads may have affected surgical performance. However, more experienced operators had smaller changes in pupil sizes because of auditory disturbances than moderately experienced surgeons. Noise stimulation in the OR increases surgeon's mental workload and performance. Auditory regulation of the OR may be better standardized using data from studies of the effects of acoustic stimulation in the OR, and mental stresses during surgery could be considered in a more humane manner. Further investigations are necessary to determine the cognitive consequences of various auditory stimuli.

Correlative Evaluation of Mental and Physical Workload of Laparoscopic Surgeons Based on Surface Electromyography and Eye-tracking Signals.

Surgeons' mental and physical workloads are major focuses of operating room (OR) ergonomics, and studies on this topic have generally focused on either mental workload or physical workload, ignoring the interaction between them. Previous studies have shown that physically demanding work may affect mental performance and may be accompanied by impaired mental processing and decreased performance. In this study, 14 participants were recruited to perform laparoscopic cholecystectomy (LC) procedures in a virtual simulator. Surface electromyography (sEMG) signals of the bilateral trapezius, bicipital, brachioradialis and flexor carpi ulnaris (FCU) muscles and eye-tracking signals were acquired during the experiment. The results showed that the least square means of muscle activity during the LC phases of surgery in an all-participants mixed effects model were 0.79, 0.81, and 0.98, respectively. The observed muscle activities in the different phases exhibited some similarity, while marked differences were found between the forearm bilateral muscles. Regarding mental workload, significant differences were observed in pupil dilation between the three phases of laparoscopic surgery. The mental and physical workloads of laparoscopic surgeons do not appear to be generally correlated, although a few significant negative correlations were found. This result further indicates that mental fatigue does markedly interfere with surgeons' operating movements.

[Study of Human Error Analysis in Medical Devices Clinical Application].

This paper introduces the concept of human error in medical devices during clinical application, the importance of human error research in medical device quality management has been discussed, the general flow of human error analysis in medical device based on the clinical use environment has been presented, which has great significance for prevention and reduction human errors caused by medical devices clinical use.

[Study of Medical Devices Use-related Risk Based on Human Factors Engineering].

This article briefly introduced human factors engineering concepts and depicts the risk management process for addressing use-related hazards, explained the important role of human factors engineering in elimination or reduction of use-related hazards, and provides the general process of medical devices use-related risk study. Some advices are given to eliminate or reduce of use-related hazards of medical devices.

The Prevalence of and Risk Factors Associated with Musculoskeletal Disorders among Sonographers in Central China: A Cross-Sectional Study.

OBJECTIVE: Studies from industrialized countries show that musculoskeletal disorders (MSD) occur commonly in sonographers. However, little is known about sonographers in China, where the awareness of ergonomics and MSD, workload, and available equipment/facilities may differ. We aimed to investigate the prevalence of MSD and associated risk factors in sonographers in central China. METHODS: A cross-sectional survey was conducted with 381 sonographers from 14 randomly selected tertiary hospitals in Hubei province, central China. Musculoskeletal symptoms (using the Nordic Questionnaire) and risk factors (mostly derived from the Health Benefit Trust survey instrument and the Dutch Musculoskeletal Questionnaire) were recorded. Multivariate logistic regression was used to quantify associations between risk factors and MSD. RESULTS: The 12-month period prevalence of MSD was 98.3%, being highest in the neck (93.5%) and shoulder (92.2%), followed by the lower back (83.2%), wrist/hand, upper back, and elbow. Factors contributing to neck pain were psychological fatigue, shoulder abduction and trunk bend-and-twist posture. Height-adjustable tables and chairs were protective factors. Shoulder pain was associated with female sex, health status, mental stress, shoulder abduction, and trunk bend-and-twist posture. Height-adjustable chairs and the awareness of adjusting the workstation before scanning were protective factors. Elbow pain was associated with health status and height-adjustable tables. Wrist/hand pain was associated with female sex, bending the wrist, and working with obese patients. Upper back pain was associated with shoulder abduction, height-adjustable chairs, and device location. Lower back pain was associated with the number of scans performed per day, awkward postures, bending the trunk, twisting or bending the neck forward, and using a footrest. CONCLUSIONS: This study suggests a high prevalence of MSD in sonographers in central China. Hence, it is necessary to improve the awareness of MSD by training, and the ergonomics of their current work environment by addressing physical workload, and psychological and equipment/facility-related factors.