MRI检查中发生幽闭恐惧症的心理疏导对策探讨

目的:探讨MRI检查中发生幽闭恐惧症患者的心理特征及其心理疏导对策。方法:根据Marks的4条诊断幽闭恐惧症的标准,选择2008年1月~2011年6月在我院磁共振室检查的102例出现不同程度幽闭恐惧症且MRI检查无法顺利完成的患者,分析其临床症状,查找检查失败发生的原因,并进行心理疏导、改善检查环境、家属陪同检查、优化扫描时间、程序以及口服镇静药物等方法保证检查的顺利完成。对干预前后患者的生命体征和检查中不适症状发生情况的差异进行比较。结果:102例发生幽闭恐惧症的患者通过心理疏导、改善检查环境、家属陪同检查、优化扫描时间、程序以及口服镇静药物等方法实施有效的护理干预,第二次检查成功87例,第三次成功10例,5例患者放弃检查,有效率达95.1%,干预后患者的生命体征:呼吸、脉搏、收缩压、舒张压等较干预前有明显的减轻;检查中不适症状:心悸、头晕、窒息感、压抑感等在干预后也明显减轻,各项指标的干预前后的变化有统计学差异,P0.05。结论:积极有效的心理疏导护理可缓解MRI检查中幽闭恐惧症的不适症状,使多数患者顺利完成MRI检查。     

小地老虎飞行肌的超微结构与飞行能力的研究

电镜观察的结果表明,小地老虎Agrotis ypsilon Rottem。的飞行肌具有十分发达的肌原纤维与线粒体;肌原纤维的收缩率较小,说明肌纤维对翅的高频振荡有很强的适应能力;在吊飞状态下,翅振频率高达100—120赫兹,飞速为7,500米/小时,一次能持续飞行10多小时。飞行时的呼吸率较静息时增加100倍左右,胸温升高5—9℃,每小时消耗脂肪5毫克。起飞的临界温度为8℃,其飞速随温度升高而提高。     

白背飞虱飞行能力的研究

本文采用微机测试系统研究了白背飞虱成虫的飞行能力及其与日龄的关系。成虫飞行能力个体间变异很大,可以分为多种类型。通过比较雌成虫卵巢发育和吊飞飞行能力,为白背飞虱迁飞型给出了可靠指标。长翅型成虫持续飞行10分钟以上定为迁飞型,短于10分钟者定为非迁飞型。在拥挤迁出条件下,长翅型成虫在羽化后3～5天飞行能力最强。最长的一头雌成虫飞行持续1715分钟,达36529.5米。雌成虫的飞行能力随卵巢发育而下降,呈卵子发生一飞行共轭现象。     

城市绿地暴露与人群健康效应研究

城市绿地是城市绿色基础设施和基于自然解决方案的主要载体,为人群提供了多种生态系统服务,关注人群健康和绿地布局的城市绿地暴露研究已经成为城市生态学、城市可持续发展等学科的前沿热点。目前国内外城市绿地暴露与人群健康研究仍处在兴起的初步发展状态,缺乏有效和公认的研究范式。尝试通过暴露科学的视角,研究城市绿地暴露及其人群健康效应的研究的热点领域:(1)从城市人群的绿地暴露特征来看,绿地暴露研究与现有旨在预防和减少环境污染暴露风险的传统环境健康研究的视角有显著不同,其目标是充分理解人群的绿地暴露特征及其产生健康效应的机制,鼓励和提高人群与绿地的有效和有益接触,服务于城市绿地和健康社区营造的科学规划和决策。(2)从城市绿地暴露的量化表征来看,现有的多种绿地暴露评价指标包括绿地可得性、绿地可及性和绿地可视性等多是表征了绿地的供给状况,并非直接的绿地暴露过程描述,未来可以结合城市人群的绿地暴露时空动态模式,参照总暴露数学方程来综合量化不同途径、访问周期、暴露时长等因素。(3)从城市绿地暴露的人群健康效应机制来看,现有绿地暴露的健康效应机制研究获得的通用理论性成果还不多,面临的挑战主要是:不同绿地健康效应研究采用的暴露特征指标不同,绿地暴露特征影响人群健康存在显著的尺度性,以及缺乏统一的绿地暴露健康效应调查方法。绿地在城市规划和建设中的作用尤其突出,但绿地的人群健康促进功能在我国城市规划和建设中还鲜有应用,作为城市生态学与环境风险、公共健康以及可持续发展的交叉前沿领域,相关成果将为指导健康导向的可持续城市/社区规划与建设提供直接的科学依据与理论支撑。     

文拉法辛联合团体人际心理疗法对社交恐惧症患者心理状态、自我效能感和社会功能的影响

摘要 目的：探讨团体人际心理疗法联合文拉法辛对社交恐惧症（SAD）患者心理状态、自我效能感和社会功能的影响。方法：选取2017年4月~2020年4月期间我院收治的98例SAD患者,根据奇偶数法将患者分为对照组49例和联合组49例。对照组给予文拉法辛治疗,联合组在对照组的基础上联合团体人际心理疗法治疗,对比两组SAD症状改善情况、心理状态、自我效能感和社会功能。结果：两组干预后社交回避、社交苦恼评分均下降,且联合组低于对照组（P<0.05）。两组干预后焦虑自评量表（SAS)、抑郁自评量表（SDS)评分均下降,且联合组低于对照组（P<0.05）。两组干预后表达积极、管理沮丧、管理生气自我效能感评分均升高,且联合组高于对照组（P<0.05）。两组干预后社会功能缺陷筛选量表（SDSS）、社会适应能力评定量表（SAFE）评分均降低,且联合组低于对照组（P<0.05）。结论：团体人际心理疗法联合文拉法辛治疗SAD患者,可缓解其抑郁、焦虑症状,提高自我效能感及社会功能,疗效较好。     

黄地老虎飞行能力研究

黄地老虎Agrotis segetum是一种重要的农业迁飞性害虫,研究飞行生物学对明确其迁飞机理有重要意义。本项研究利用昆虫飞行磨系统对黄地老虎的飞行能力进行了测定。对实验室种群飞行能力的测定结果表明:1日龄成虫的飞行能力最弱;3日龄飞行能力最强,其24 h平均飞行时间、平均飞行距离和平均飞行速率分别达到12.16±0.74 h、48.94±3.40 km和3.76±0.12 km/h。雌蛾与雄蛾间的各项飞行参数均无显著差异,但处女成虫平均飞行距离和平均飞行速率均显著高于已交配个体。对渤海湾野外迁飞种群飞行能力的测定显示,早季节北迁个体和晚季节回迁个体的平均飞行时间和平均飞行距离无显著差异,但皆显著低于实验室种群。黄地老虎具有较强的飞行能力,日龄和交配是影响其飞行能力的关键因素。     

香梨优斑螟飞行能力的研究

香梨优斑螟 Euzophera pyriella Yang是新疆果树重要的蛀果蛀干害虫,严重制约着香梨产业的发展。本研究通过昆虫飞行磨系统测定了香梨优斑螟成虫的飞行能力,结果表明2~5日龄香梨优斑螟飞行能力较强,4日龄飞行能力最强;吊飞14 h,平均飞行距离14.37±1.35 km,平均飞行时间9.40±0.55 h,平均飞行速度1.59± 0.08 km/h 。雄成虫飞行距离显著远于雌成虫,但飞行时间和速度差异不显著。雌雄成虫取食补充营养后飞行能力均有提高,但飞行距离和速度差异不显著。不同交配状态的香梨优斑螟飞行能力测定结果显示,未交配成虫飞行速度和飞行距离均高于已交配成虫,但飞行时间差异不明显。研究结果可为深入阐明香梨优斑螟飞行生物学和扩散机制提供科学依据。     

虚拟现实技术应用于运动障碍康复的研究

概述了近年来虚拟现实技术在运动障碍康复中的应用。介绍了该技术在运动障碍康复领域的四个重点研究方向：康复机器人、虚拟人、基于触觉反馈和力反馈的虚拟现实康复平台以及游戏机Wii的应用和新进展。最后总结了虚拟现实应用于运动障碍康复的优势及面临的主要挑战。     

铅中毒的暴露生物标志物

铅是严重威胁人类健康的一种环境污染物,尤其对儿童神经系统的发育以及学习记忆等产生不良的影响.因此,铅毒性的早期预防、早期诊断以及早期治疗尤为重要.生物标志物是公共卫生领域尤其是环境医学领域的一个研究热点,选择合适的生物标志物对于开展铅毒性的生物监测,实现铅生物效应的早期预警、早期干预等都具有重要的作用.本文就现有的主要铅暴露生物标志物的现状作一归纳.     

铅中毒的暴露生物标志物

铅是严重威胁人类健康的一种环境污染物,尤其对儿童神经系统的发育以及学习记忆等产生不良的影响。因此,铅毒性的早期预防、早期诊断以及早期治疗尤为重要。生物标志物是公共卫生领域尤其是环境医学领域的一个研究热点,选择合适的生物标志物对于开展铅毒性的生物监测,实现铅生物效应的早期预警、早期干预等都具有重要的作用。本文就现有的主要铅暴露生物标志物的现状作一归纳。     

Mechanisms of Virtual Reality Exposure Therapy: The Role of the Behavioral Activation and Behavioral Inhibition Systems

J. A. Gray’s (1975) theory distinguishes between two motivational systems, which he refers to as the behavioral activation system (BAS) and the behavioral inhibition system (BIS). D. C. Fowles (1980) has shown that heart rate responses reflect activity of the BAS, and electrodermal responses reflect activity of the BIS. Both BAS and BIS are reliably activated during in-vivo exposure to fearful situations (F. H. Wilhelm & W. T. Roth, 1998). However, due to the constraints imposed by virtual reality (VR), we hypothesized that VR exposure to fearful situations would activate the BIS alone. To test this hypothesis, a VR free-standing elevator simulation was presented to participants selected for high and low fear of heights. As predicted, the high-anxious group strongly responded electrodermally (effect size d = 1.53), but showed only minimal HR elevations during exposure (d = 0.12), and little other cardiovascular or respiratory changes. The low-anxious control group showed little electrodermal and HR reactivity (d = 0.28 and 0.12). A comparison with data from a previous study demonstrated that this pattern was in stark contrast to the large electrodermal and cardiovascular response observed during situational in-vivo exposure outside the laboratory. We conclude that the BIS, but not BAS, is selectively activated during VR exposure, causing discordance between self-report and commonly used physiological measures of anxiety. Results are discussed within the framework of E. B. Foa & M. J. Kozak’s (1986) emotional processing theory of fear modification, suggesting different mechanisms underlying VR and in-vivo exposure treatments.     

综述与专论: 认知行为疗法和虚拟现实疗法干预神经性疼痛的作用及机制

神经性疼痛（neuropathic pain，NP）是由外周或中枢躯体感觉系统的损伤或疾病导致的疼痛。药物治疗在镇痛中占据重要地位，但是过量药物治疗往往会引起严重的副作用，或在可耐受剂量下仅提供了部分的疼痛缓解。认知行为疗法（cognitive-behavioral therapy，CBT）和虚拟现实（virtual reality，VR）干预作为新的、非侵入性的，以及更为安全的疼痛替代治疗方法引起了广泛的关注。CBT和VR疗法可通过转移注意力、改变神经可塑性和神经环路，以及调节促炎和抗炎因子水平缓解神经性疼痛。本文旨在对神经性疼痛的发病机制以及CBT和VR疗法的镇痛效果和机制做出解析，从而为神经性疼痛的治疗干预提供重要的理论指导。     

基于Virtools的医院网络虚拟实验室建设

网络虚拟实验室为现代医学提供了新的实验和教学手段,虚拟现实软件Virtools为网络虚拟实验室提供了可行的技术支持。文章在介绍了网络虚拟实验室概念、功能、特性和Virtools的使用特点后,提出利用Virtools开发医院网络虚拟实验室的过程和方法。     

A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders

In virtual reality exposure therapy (VRET) for anxiety disorders, sense of presence in the virtual environment is considered the principal mechanism that enables anxiety to be felt. Existing studies on the relation between sense of presence and level of anxiety, however, have yielded mixed results on the correlation between the two. In this meta-analysis, we reviewed publications on VRET for anxiety that included self-reported presence and anxiety. The comprehensive search of the literature identified 33 publications with a total of 1196 participants. The correlation between self-reported sense of presence and anxiety was extracted and meta-analyzed. Potential moderators such as technology characteristics, sample characteristics including age, gender and clinical status, disorder characteristics and study design characteristics such as measurements were also examined. The random effects analysis showed a medium effect size for the correlation between sense of presence and anxiety (r = .28; 95% CI: 0.18–0.38). Moderation analyses revealed that the effect size of the correlation differed across different anxiety disorders, with a large effect size for fear of animals (r = .50; 95% CI: 0.30–0.66) and a no to small effect size for social anxiety disorder (r = .001; 95% CI: −0.19–0.19). Further, the correlation between anxiety and presence was stronger in studies with participants who met criteria for an anxiety disorder than in studies with a non-clinical population. Trackers with six degrees of freedom and displays with a larger field of view resulted in higher effect sizes, compared to trackers with three degrees of freedom and displays with a smaller field of view. In addition, no difference in effect size was found for the type of presence measurement and the type of anxiety measurement. This meta-analysis confirms the positive relation between sense of presence and anxiety and demonstrates that this relation can be affected by various moderating factors.     

Anatomical Model Uncertainty for RF Safety Evaluation of Metallic Implants Under MRI Exposure

The Virtual Population (ViP) phantoms have been used in many dosimetry studies, yet, to date, anatomical phantom uncertainty in radiofrequency (RF) research has largely been neglected. The objective of this study is to gain insight, for the first time, regarding the uncertainty in RF‐induced fields during magnetic resonance imaging associated with tissue assignment and segmentation quality and consistency in anatomical phantoms by evaluating the differences between two generations of ViP phantoms, ViP1.x and ViP3.0. The RF‐induced 10g‐average electric (E‐) fields, tangential E‐fields distribution along active implantable medical devices (AIMD) routings, and estimated AIMD heating were compared for five phantoms that are part of both ViP1.x and ViP3.0. The results demonstrated that differences exceeded 3 dB (?29%, +41%) for local quantities and 1 dB (±12% for field, ±25% for power) for integrated and volume‐averaged quantities (e.g., estimated AIMD‐heating and 10 g‐average E‐fields), while the variation across different ViP phantoms of the same generation can exceed 10 dB (?68% and +217% for field, ?90% and +900% for power). In conclusion, the anatomical phantom uncertainty associated with tissue assignment and segmentation quality/consistency is larger than previously assumed, i.e., 0.6 dB or ±15% (k = 1) for AIMD heating. Further, multiple phantoms based on different volunteers covering the target population are required for quantitative analysis of dosimetric endpoints, e.g., AIMD heating, which depend on patient anatomy. Phantoms with the highest fidelity in tissue assignment and segmentation should be used, as these ensure the lowest uncertainty and possible underestimation of exposure. To verify that the uncertainty decreases monotonically with improved phantom quality, the evaluation of differences between phantom generations should be repeated for any improvement in segmentation. Bioelectromagnetics. 2019;40:458–471. © 2019 Bioelectromagnetics Society     

Using Virtual Reality to Study Alcohol Intoxication Effects on the Neural Correlates of Simulated Driving

The use of virtual reality in the form of simulated tasks can provide a realistic environment in which to study complex naturalistic behaviors. Many of the behavioral effects of alcohol intoxication are well known, but there is relatively little imaging evidence examining how alcohol exposure might transiently modulate brain function, especially in the context of task performance. In this review, we provide a brief synopsis of previous work using functional magnetic resonance imaging (fMRI) to study the neural correlates of alcohol intoxication. We describe in detail two studies from our published work, the first involving a visual perception paradigm, and the second involving virtual reality through a naturalistic behavior; simulated driving. Participants received single-blind individualized doses of beverage alcohol designed to produce blood alcohol content (BAC) of 0.04 and 0.08 or placebo. Subjects were fMRI scanned after training to asymptote performance. In both studies we found specific circuits that were differentially modulated by alcohol, we revealed both global and local effects of alcohol, and we examined relationships between behavior, brain function, and alcohol blood levels.     

虚拟现实平衡训练联合神经肌肉电刺激对前交叉韧带重建术后患者膝关节功能、腘绳肌肌力和步行功能的影响

摘要 目的：探讨虚拟现实平衡训练联合神经肌肉电刺激（NMES）对前交叉韧带重建术（ACLR）后患者膝关节功能、腘绳肌肌力和步行功能的影响。方法：选择2019年8月~2021年12月期间我院收治的前交叉韧带（ACL）损伤患者96例,并成功实施ACLR,采用随机数字表法分为对照组（n=48,常规康复训练、虚拟现实平衡训练）和研究组（n=48,常规康复训练、虚拟现实平衡训练联合NMES干预）。对比两组膝关节功能优良率、膝关节功能、腘绳肌肌力和步行功能。结果：研究组的临床膝关节功能优良率93.75%（45/48）高于对照组68.75%（33/48）,差异有统计学意义（P<0.05）。两组干预后膝关节功能评分、膝关节活动度对均升高,且研究组高于对照组（P<0.05）。两组干预后患侧腘绳肌等长肌力升高,且研究组高于对照组（P<0.05）,两组干预后健侧腘绳肌等长肌力对比无明显差异（P>0.05）。两组干预后步长、步速升高,且研究组高于对照组,患侧摆动相降低,且研究组低于对照组（P<0.05）。两组干预后被动活动察觉阀值、进行被动角度再生试验降低,且研究组低于对照组（P<0.05）。结论：虚拟现实平衡训练联合NMES应用于ACLR术后患者的疗效显著,有助于其膝关节功能恢复,提高腘绳肌肌力,改善步行功能。     

原发性肝癌患者TACE术后癌症复发恐惧的影响因素及认知行为疗法的治疗效果研究

摘要 目的：探讨原发性肝癌（PHC）患者肝动脉化疗栓塞术（TACE）术后癌症复发恐惧（FCR）情的影响因素,同时观察认知行为疗法在FCR患者中的治疗效果。方法：选择上海交通大学医学院附属仁济医院2020年9月-2022年4月期间收治的400例行TACE的PHC患者作为研究对象。根据自制量表获取所有患者的一般资料,采用恐惧疾病进展简化量表（FoP-Q-SF）评估癌症患者FCR,采用单因素和多因素Logistic回归分析FCR发生的影响因素。针对存在FCR的患者,将其按照随机数字表法分为对照组（n=128）和研究组（n=128）,对照组接受常规干预,研究组在对照组的基础上接受认知行为疗法干预,观察认知行为疗法在FCR患者中的治疗效果。结果：本院选取的400例PHC患者TACE术后FoP-Q-SF评分为（38.43±5.29）分,其中总分≥34分256例,总分＜34分144例。单因素分析结果显示,PHC患者TACE术后FCR与家庭人均月收入、性别、临床病理分期、年龄、术后时间、婚姻状况、TACE治疗次数、疾病应对方式、文化程度、社会支持度有关（P<0.05）。多因素Logistic回归分析显示,TACE治疗次数≥10次、年龄偏低、疾病应对方式为消极应对、文化程度为小学及其以下、社会支持度低、家庭人均月收入＜3000元、临床病理分期为III期是PHC患者TACE术后FCR发生的危险因素（P<0.05）。干预后,两组FoP-Q-SF、焦虑自评量表（SAS）与抑郁自评量表（SDS）评分均下降,且研究组低于对照组（P<0.05）。结论：年龄偏低、文化程度为小学及其以下、TACE治疗次数≥10次、疾病应对方式为消极应对、社会支持度低、家庭人均月收入＜3000元、临床病理分期为III期是PHC患者TACE术后FCR发生的危险因素。针对存在TACE术后FCR的PHC患者给予认知行为疗法,可有效减轻FCR程度,减轻抑郁焦虑状况。     

Development of a Data Management Tool for Investigating Multivariate Space and Free Will Experiences in Virtual Reality

Virtual reality (VR) has become mature enough to be successfully used in clinical applications such as exposure therapy, pain distraction, and neuropsychological assessment. However, we now need to go beyond the outcome data from this research and conduct the detailed scientific investigations required to better understand what factors influence why VR works (or doesn’t) in these types of clinical applications. This knowledge is required to guide the development of VR applications in the key areas of education, training, and rehabilitation and to further evolve existing VR approaches. One of the primary assets obtained with the use of VR is the ability to simulate the complexity of real world environments, within which human performance can be tested and trained. But this asset comes with a price in terms of the capture, quantification and analysis of large, multivariate and concurrent data sources that reflect the naturalistic behavioral interaction that is afforded in a virtual world. As well, while achieving realism has been a main goal in making convincing VR environments, just what constitutes realism and how much is needed is still an open question situated firmly in the research domain. Just as in real “reality,” such factors in virtual reality are complex and multivariate, and the understanding of this complexity presents exceptional challenges to the VR researcher. For certain research questions, good behavioral science often requires consistent delivery of stimuli within tightly controlled lab-based experimental conditions. However, for other important research questions we do not want to constrain naturalistic behavior and limit VR’s ability to replicate real world conditions, simply because it is easier to study human performance with traditional lab-based methodologies. By doing so we may compromise the very qualities that comprise VR’s unique capacity to mimic the experiences and challenges that exist in everyday life. What is really needed to address scientific questions that require natural exploration of a simulated environment are more usable and robust tools to instrument, organize, and visualize the complex data generated by measurements of participant behaviors within a virtual world. This paper briefly describes the rationale and methodology of an initial study in an ongoing research program that aims to investigate human performance within a virtual environment where unconstrained “free will” exploratory behavior is essential to research questions that involve the relationships between physiology, emotion, and memory. After a discussion of the research protocol and the types of data that were collected, we describe a novel tool that was borne from our need to more efficiently capture, manage, and explore the complex data that was generated in this research. An example of a research participant’s annotated display from this data management and visualization tool is then presented. It is our view that this tool provides the capacity to better visualize and understand the complex data relationships that may arise in VR research that investigates naturalistic free will behavior and its impact on other human performance variables.