ABSTRACT
Resumen OBJETIVO: Evaluar las diferencias en los desenlaces de los ejercicios del módulo de habilidades motoras básicas del simulador Simbionix LAP Mentor entre un grupo de residentes de Ginecología y otro de especialistas en cirugía laparoscópica. MATERIALES Y MÉTODOS: Estudio observacional, prospectivo, longitudinal y comparativo efectuado de diciembre de 2019 a enero de 2020 en el Hospital Español de México. Se seleccionaron médicos residentes de Ginecología y especialistas en la misma rama con experiencia diversa en cirugía laparoscópica. Se evaluaron, con un programa de adiestramiento mediante simulación de alta fidelidad, los ejercicios del módulo de habilidades motoras básicas de un sistema de realidad virtual. Para las variables con distribución normal se aplicó la prueba de t de Student y la de U de Mann-Whitney para las variables que no cumplieron el criterio de normalidad. RESULTADOS: Se incluyeron 31 participantes: el grupo de especialistas (n = 19) y el de residentes (n = 12). Se encontraron diferencias significativas entre residentes y especialistas en el ejercicio 3-coordinación ojo-mano (4.45 seg, IC95%: 0.167-8.73; p < 0.05) y en el ejercicio 5-tracción y engrapado de mangueras con fugas (29.58 seg, IC95%: -42.99 -14.00; p < 0.001), a favor del grupo de especialistas. En los ejercicios 7-corte y ejercicio 8-fulguración no hubo diferencias significativas entre uno y otro grupo. CONCLUSIONES: El simulador de realidad virtual Simbionix LAP Mentor detecta diferencias entre grupos de ginecoobstetras con diferente experiencia en cirugía ginecológica de mínima invasión y residentes de la especialidad.
Abstract OBJECTIVE: To evaluate the differences in the outcomes of the exercises of the basic motor skills module of the Simbionix LAP Mentor simulator between a group of gynecology residents and another group of already graduated specialists. MATERIALS AND METHODS: Observational, prospective, longitudinal and comparative study carried out from December 2019 to January 2020 at the Hospital Español de México. Gynecology residents and specialists in the same branch with diverse experience in laparoscopic surgery were selected. The exercises of the basic motor skills module of a virtual reality system were evaluated with a high-fidelity simulation training program. The Student's t test was applied for variables with normal distribution and the Mann-Whitney U test for variables that did not meet the normality criterion. RESULTS: Thirty-one participants were included: the specialist group (n = 19) and the resident group (n = 12). Significant differences between residents and specialists were found in exercise 3-eye-hand coordination (4.45 sec, 95%CI: 0.167-8.73; p < 0.05) and in exercise 5-pulling and stapling of leaking hoses (29.58 sec, 95%CI: -42.99 -14.00; p < 0.001), in favor of the specialist group. In exercise 7-cutting and exercise 8-fulguration there were no significant differences between one group and the other. CONCLUSIONS: The Simbionix LAP Mentor virtual reality simulator detects differences between groups of obstetrician-gynecologists with different experience in minimally invasive gynecologic surgery and residents of the specialty.
ABSTRACT
Applying Morenian concepts to the literary structure of the novel A Christmas Carol by Charles Dickens reveals a psychodrama internal to the story in which the characters function as director, protagonist and auxiliaries. The public readings by Dickens between 1853-1870 allowed the story's transgression from psychodrama into sociodrama directed by Dickens and around poverty and labour - central themes and social issues throughout all of history. The use of surplus reality during catharsis generates the energy of this dynamic, complex "virtual system" which is maintained after the audience returns to "group mode" (their own lives) with post-performance processing as shown by contemporary newspaper articles and reports on the story's impact.
A aplicação de conceitos de Moreno à estrutura literária da novela Conto de Natal de Charles Dickens revela um psicodrama interno da história em que os personagens funcionam como diretor, protagonista e auxiliares. As leituras públicas de Dickens entre 1853-1870 permitiram a transgressão da história de Psicodrama em sociodrama dirigido por Dickens em torno da pobreza e do trabalho - temas centrais e questões sociais de todos os tempos da história. O uso da realidade suplementar durante catarse gera a energia desse dinâmico e complexo "sistema virtual", mantida após o público retornar ao "modo de grupo" (suas próprias vidas) com processamento pós-desempenho como mostrado por artigos e relatórios de jornais da época sobre o impacto da história.
Aplicar conceptos de Moreno a la estructura literaria de la novela Conto de Navidad de Charles Dickens revela un psicodrama interno a la historia en que los personajes funcionan como director, protagonista y auxiliares. Las lecturas públicas de Dickens entre 1853-1870 permiten transgresión de la historia del psicodrama en sociodrama dirigida por Dickens y alrededor de la pobreza y el trabajo - temas básicos de la historia y cuestiones sociales de todos los tiempos. El uso de la realidad suplementar durante la catarsis genera la energía de este dinámico y complejo "sistema virtual" que se mantiene después de que el público vuelva a "modo de grupo" (su vida) con el funcionamiento post procesamiento como se muestra por artículos periodísticos contemporâneos y los informes sobre el impacto de la historia.
ABSTRACT
Objective To establish a 3D atlas of Letournel-Judet classifications of acetabular fractures which provides remote access on the web through hypertext markup language (HTML) and virtual reality modeling language (VRML) for efficient remote diagnosis. Methods Firstly,different Letournel-Judet classifications of acetabular fracture were simulated based on 3D reconstruction models of healthy volunteers via Mimics software.The files of VRML format were exported after geometry modeling.Secondly,The.wrl files were edited by adding nodes of Sensor,Route,and Script to the files to make the static scene respond to users' interaction.Finally,the homepage of 3D atlas was established with the Dreamweaver software.Results The 3D atlas of Letournel-Judet classifications of acetabular fractures was established which can be accessed online.These virtual worlds can be browsed via the Internet and hyperlinked with the World Wide Web. Conclusion The 3D atlas of Letournel-Judet classifications of acetabular fractures can be easily and convenicntly used by surgeons for consultation in clinical diagnosis of an acetabular fracture.
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Objective To study the efficacy of percutaneous ablative therapy for malignant liver lesions under real-time virtual guidance. Methods Percutaneous ablations were applied to 76 patients with 125 malignant liver lesions under the guidance of a real time virtual system (RVS). 64. 8% (81/ 125) lesions were undetectable on conventional ultrasound (US). The time spent on image fusion and the local treatment response were studied. Results The average time taken to synchronize the ultrasound and CT images was (19. 2±12. 8) min (range 5～55 min). Complete ablations were achieved in 86. 4% (38/44) of distinctly visualized lesions and in 91. 6% (74/81) of poorly visualized lesions on US. No treatment associated complications were found. Conclusion Ablation assisted by RVS and CT was safe and efficacious, especially for lesions undetectable by conventional ultrasound.