OBJECTIVE The authors aimed to evaluate the technical feasibility of a mixed-reality neuronavigation (MRN) system with a wearable head-mounted device (HMD) and to determine its clinical application and accuracy. METHODS A semiautomatic registration MRN system on HoloLens smart glasses was developed and tested for accuracy and feasibility. Thirty-seven patients with intracranial lesions were prospectively identified. For each patient, multimodal imaging–based holograms of lesions, markers, and surrounding eloquent structures were created and then imported to the MRN HMD. After a point-based registration, the holograms were projected onto the patient's head and observed through the HMD. The contour of the holograms was compared with standard neuronavigation (SN). The projection of the lesion boundaries perceived by the neurosurgeon on the patient's scalp was then marked with MRN and SN. The distance between the two contours generated by MRN and SN was measured so that the accuracy of MRN could be assessed. RESULTS MRN localization was achieved in all patients. The mean additional time required for MRN was 36.3 ± 6.3 minutes, in which the mean registration time was 2.6 ± 0.9 minutes. A trend toward a shorter time required for preparation was observed with the increase of neurosurgeon experience with the MRN system. The overall median deviation was 4.1 mm (IQR 3.0 mm–4.7 mm), and 81.1% of the lesions localized by MRN were found to be highly consistent with SN (deviation < 5.0 mm). There was a significant difference between the supine position and the prone position (3.7 ± 1.1 mm vs 5.4 ± 0.9 mm, p = 0.001). The magnitudes of deviation vectors did not correlate with lesion volume (p = 0.126) or depth (p = 0.128). There was no significant difference in additional operating time between different operators (37.4 ± 4.8 minutes vs 34.6 ± 4.8 minutes, p = 0.237) or in localization deviation (3.7 ± 1.0 mm vs 4.6 ± 1.5 mm, p = 0.070). CONCLUSIONS This study provided a complete set of a clinically applicable workflow on an easy-to-use MRN system using a wearable HMD, and has shown its technical feasibility and accuracy. Further development is required to improve the accuracy and clinical efficacy of this system.

Objective The purpose of this study is to understand the distribution of syndrome types, the data of four diagnostic information variables, and the correlative degree and diagnostic value of four diagnosis indexes and syndromes in patients with the recovery period of ischemic stroke through clinical case data. Methods This study developed a unified clinical case collection table, following the clinical research design, measurement, and evaluation methods, using Chi-Square test, logistic regression analysis, and diagnostic test evaluation methods for data screening, analysis, and testing. Results According to the comprehensive comparison, analysis, and evaluation, the study concluded that the specificity, sensitivity, positive likelihood ratio, positive predictive value, negative predictive value, accuracy, and Youden index of “thick fur, slippery pulse” was the highest. Conclusion “thick fur, slippery pulse” is the best combination to diagnose the phlegm-stasis in channels during the recovery period of ischemic stroke.

Background: Glioma is the most common type of brain tumor because of the destructiveness of the disease itself and the side effects of treatment, patients often leave symptoms of neurological defects. At present, rehabilitation treatment is not popular in glioma patients. There is a lack of definite evidence to prove the benefits of rehabilitation therapy for glioma patients. The purpose of this meta-analysis is to determine whether rehabilitation therapy can significantly improve the prognosis of neurological function and improve the quality of life of patients with glioma. Methods: The articles about rehabilitation treatment of glioma in Cochrane, PubMed, and Embase, Web of Science, and Medline database from January 1990 to May 2020 were searched. Before rehabilitation as the control group, after rehabilitation as the experimental group. The Functional Independence Measure (FIM) was used as the outcome index, including total FIM, motor FIM, and cognitive FIM. Use STATA12.0 for meta-analysis. Results: A total of 8 articles were included in the study, with a total of 375 glioma patients. Meta-analysis of total FIM (SMD = 0.96, 95%CI = 0.66–1.26, P < .001), motor FIM (SMD = 0.75, 95%CI = 0.54–0.96, P < .001) and cognitive FIM (SMD = 0.35, 95%CI = 0.19–0.50, P < .001) indicated that the neurological function of rehabilitation was significantly improved in total, motor and consciousness. Conclusion: The published studies show that rehabilitation therapy can improve the functional prognosis and quality of life of glioma patients. More attention should be paid to the therapeutic value of rehabilitation for glioma patients in the future. PROSPERO registration number: PROSPERO CRD42020188740.

OBJECTIVE A clear, stable, suitably located vision field is essential for port surgery. A scope is usually held by hand or a fixing device. The former yields fatigue and requires lengthy training, while the latter increases inconvenience because of needing to adjust the scope. Thus, the authors innovated a novel robotic system that can recognize the port and automatically place the scope in an optimized position. In this study, the authors executed a preliminary experiment to test this system’s technical feasibility and accuracy in vitro. METHODS A collaborative robotic (CoBot) system consisting of a mechatronic arm and a 3D camera was developed. With the 3D camera and programmed machine vision, CoBot can search a marker attached to the opening of the surgical port, followed by automatic alignment of the scope’s axis with the port’s longitudinal axis so that optimal illumination and visual observation can be achieved. Three tests were conducted. In test 1, the robot positioned a laser range finder attached to the robot’s arm to align the sheath’s center axis. The laser successfully passing through two holes in the port sheath’s central axis defined successful positioning. Researchers recorded the finder’s readings, demonstrating the actual distance between the finder and the sheath. In test 2, the robot held a high-definition exoscope and relocated it to the setting position. Test 3 was similar to test 2, but a metal holder substituted the robot. Trained neurosurgeons manually adjusted the holder. The manipulation time was recorded. Additionally, a grading system was designed to score each image captured by the exoscope at the setting position, and the scores in the two tests were compared using the rank-sum test. RESULTS The CoBot system positioned the finder successfully in all rounds in test 1; the mean height errors ± SD were 1.14 mm ± 0.38 mm (downward) and 1.60 mm ± 0.89 mm (upward). The grading scores of images in tests 2 and 3 were significantly different. Regarding the total score and four subgroups, test 2 showed a more precise, better-positioned, and more stable vision field. The total manipulation time in test 2 was 20 minutes, and for test 3 it was 52 minutes. CONCLUSIONS The CoBot system successfully acted as a robust scope holding system to provide a stable and optimized surgical view during simulated port surgery, providing further evidence for the substitution of human hands, and leading to a more efficient, user-friendly, and precise operation.