Virtual simulation of the postsurgical cosmetic outcome in patientswith pectus excavatum

Pectus excavatum is the most common congenital deformity of the anterior chest wall, in which several ribs and the sternum grow abnormally. Nowadays, the surgical correction is carried out in children and adults through Nuss technic. This technic has been shown to be safe with major drivers as cosmesis and the prevention of psychological problems and social stress. Nowadays, no application is known to predict the cosmetic outcome of the pectus excavatum surgical correction. Such tool could be used to help the surgeon and the patient in the moment of deciding the need for surgery correction. This work is a first step to predict postsurgical outcome in pectus excavatum surgery correction. Facing this goal, it was firstly determined a point cloud of the skin surface along the thoracic wall using Computed Tomography (before surgical correction) and the Polhemus FastSCAN (after the surgical correction). Then, a surface mesh was reconstructed from the two point clouds using a Radial Basis Function algorithm for further affine registration between the meshes. After registration, one studied the surgical correction influence area (SCIA) of the thoracic wall. This SCIA was used to train, test and validate artificial neural networks in order to predict the surgical outcome of pectus excavatum correction and to determine the degree of convergence of SCIA in different patients. Often, ANN did not converge to a satisfactory solution (each patient had its own deformity characteristics), thus invalidating the creation of a mathematical model capable of estimating, with satisfactory results, the postsurgical outcome

Thoracic wall reconstruction using ultrasound images to model/bend the thoracic prosthesis for correction of pectus excavatum

Pectus excavatum is the most common congenital deformity of the anterior thoracic wall. The surgical correction of such deformity, using Nuss procedure, consists in the placement of a personalized convex prosthesis into sub-sternal position to correct the deformity. The aim of this work is the CT-scan substitution by ultrasound imaging for the pre-operative diagnosis and pre-modeling of the prosthesis, in order to avoid patient radiation exposure. To accomplish this, ultrasound images are acquired along an axial plane, followed by a rigid registration method to obtain the spatial transformation between subsequent images. These images are overlapped to reconstruct an axial plane equivalent to a CT-slice. A phantom was used to conduct preliminary experiments and the achieved results were compared with the corresponding CT-data, showing that the proposed methodology can be capable to create a valid approximation of the anterior thoracic wall, which can be used to model/bend the prosthesis

Pectus Excavatum postsurgical outcome based on preoperative soft body dynamics simulation

Pectus excavatum is the most common congenital deformity of the anterior chest wall, in which an abnormal formation of the rib cage gives the chest a caved-in or sunken appearance. Today, the surgical correction of this deformity is carried out in children and adults through Nuss technic, which consists in the placement of a prosthetic bar under the sternum and over the ribs. Although this technique has been shown to be safe and reliable, not all patients have achieved adequate cosmetic outcome. This often leads to psychological problems and social stress, before and after the surgical correction. This paper targets this particular problem by presenting a method to predict the patient surgical outcome based on pre-surgical imagiologic information and chest skin dynamic modulation. The proposed approach uses the patient pre-surgical thoracic CT scan and anatomical-surgical references to perform a 3D segmentation of the left ribs, right ribs, sternum and skin. The technique encompasses three steps: a) approximation of the cartilages, between the ribs and the sternum, trough b-spline interpolation; b) a volumetric mass spring model that connects two layers - inner skin layer based on the outer pleura contour and the outer surface skin; and c) displacement of the sternum according to the prosthetic bar position. A dynamic model of the skin around the chest wall region was generated, capable of simulating the effect of the movement of the prosthetic bar along the sternum. The results were compared and validated with patient postsurgical skin surface acquired with Polhemus FastSCAN system

Assessment of 3D scanners for modeling Pectus Carinatum corrective bar

Pectus Carinatum (PC) is a chest deformity consisting on the anterior protrusion of the sternum and adjacent costal cartilages. Non-operative corrections, such as the orthotic compression brace, require previous information of the patient chest surface, to improve the overall brace fit. This paper focuses on the validation of the Kinect scanner for the modelling of an orthotic compression brace for the correction of Pectus Carinatum. To this extent, a phantom chest wall surface was acquired using two scanner systems – Kinect and Polhemus FastSCAN – and compared through CT. The results show a RMS error of 3.25mm between the CT data and the surface mesh from the Kinect sensor and 1.5mm from the FastSCAN sensor

Variations of the soft tissue thicknesses external to the ribs in Pectus Excavatum patients

Background: Surgical repair of pectus excavatum (PE) has become more popular due to improvements in the minimally invasive Nuss procedure. The pre-surgical assessment of PE patients requires Computerized Tomography (CT), as the malformation characteristics vary from patient to patient. Objective: This work aims to characterize soft tissue thickness (STT) external to the ribs among PE patients. It also presents a comparative analysis between the anterior chest wall surface before and after surgical correction. Methods: Through surrounding tissue segmentation in CT data, STT values were calculated at different lines along the thoracic wall, with a reference point in the intersection of coronal and median planes. The comparative analysis between the two 3D anterior chest surfaces sets a surgical correction influence area (SCIA) and a volume of interest (VOI) based on image processing algorithms, 3D surface algorithms, and registration methods. Results: There are always variations between left and right side STTs (2.54±2.05 mm and 2.95±2.97 mm for female and male patients, respectively). STTs are dependent on age, sex, and body mass index of each patient. On female patients, breast tissue induces additional errors in bar manual

Collecting system percutaneous access using real-time tracking sensors: first pig model in vivo experience

Purpose: Precise needle puncture of the renal collecting system is an essential but challenging step for successful percutaneous nephrolithotomy. We evaluated the efficiency of a new real-time electromagnetic tracking system for in vivo kidney puncture. Materials and Methods: Six anesthetized female pigs underwent ureterorenoscopy to place a catheter with an electromagnetic tracking sensor into the desired puncture site and ascertain puncture success. A tracked needle with a similar electromagnetic tracking sensor was subsequently navigated into the sensor in the catheter. Four punctures were performed by each of 2 surgeons in each pig, including 1 each in the kidney, middle ureter, and right and left sides. Outcome measurements were the number of attempts and the time needed to evaluate the virtual trajectory and perform percutaneous puncture. Results: A total of 24 punctures were easily performed without complication. Surgeons required more time to evaluate the trajectory during ureteral than kidney puncture (median 15 seconds, range 14 to 18 vs 13, range 11 to 16, p ¼ 0.1). Median renal and ureteral puncture time was 19 (range 14 to 45) and 51 seconds (range 45 to 67), respectively (p ¼ 0.003). Two attempts were needed to achieve a successful ureteral puncture. The technique requires the presence of a renal stone for testing. Conclusions: The proposed electromagnetic tracking solution for renal collecting system puncture proved to be highly accurate, simple and quick. This method might represent a paradigm shift in percutaneous kidney access techniques

Chronic stress disrupts neural coherence between cortico-limbic structures

Chronic stress impairs cognitive function, namely on tasks that rely on the integrity of cortico-limbic networks. To unravel the functional impact of progressive stress in cortico-limbic networks we measured neural activity and spectral coherences between the ventral hippocampus (vHIP) and the medial prefrontal cortex (mPFC) in rats subjected to short term stress (STS) and chronic unpredictable stress (CUS). CUS exposure consistently disrupted the spectral coherence between both areas for a wide range of frequencies, whereas STS exposure failed to trigger such effect. The chronic stress-induced coherence decrease correlated inversely with the vHIP power spectrum, but not with the mPFC power spectrum, which supports the view that hippocampal dysfunction is the primary event after stress exposure. Importantly, we additionally show that the variations in vHIP-to-mPFC coherence and power spectrum in the vHIP correlated with stress-induced behavioral deficits in a spatial reference memory task. Altogether, these findings result in an innovative readout to measure, and follow, the functional events that underlie the stress-induced reference memory impairments.

Neural Electrode Array Based on Aluminum: Fabrication and Characterization

A unique neural electrode design is proposed with 3 mm long shafts made from an aluminum-based substrate. The electrode is composed by 100 individualized shafts in a 10 × 10 matrix, in which each aluminum shafts are precisely machined via dicing-saw cutting programs. The result is a bulk structure of aluminum with 65 ° angle sharp tips. Each electrode tip is covered by an iridium oxide thin film layer (ionic transducer) via pulsed sputtering, that provides a stable and a reversible behavior for recording/stimulation purposes, a 40 mC/cm2 charge capacity and a 145 Ω impedance in a wide frequency range of interest (10 Hz-100 kHz). Because of the non-biocompatibility issue that characterizes aluminum, an anodization process is performed that forms an aluminum oxide layer around the aluminum substrate. The result is a passivation layer fully biocompatible that furthermore, enhances the mechanical properties by increasing the robustness of the electrode. For a successful electrode insertion, a 1.1 N load is required. The resultant electrode is a feasible alternative to silicon-based electrode solutions, avoiding the complexity of its fabrication methods and limitations, and increasing the electrode performance.

A Wireless EEG Acquisition Platform based on Embedded Systems

This paper proposes a wireless EEG acquisition platform based on Open Multimedia Architecture Platform (OMAP) embedded system. A high-impedance active dry electrode was tested for improving the scalp- electrode interface. It was used the sigma-delta ADS1298 analog-to-digital converter, and developed a “kernelspace” character driver to manage the communications between the converter unit and the OMAP’s ARM core. The acquired EEG signal data is processed by a “userspace” application, which accesses the driver’s memory, saves the data to a SD-card and transmits them through a wireless TCP/IP-socket to a PC. The electrodes were tested through the alpha wave replacement phenomenon. The experimental results presented the expected alpha rhythm (8-13 Hz) reactiveness to the eyes opening task. The driver spends about 725 μs to acquire and store the data samples. The application takes about 244 μs to get the data from the driver and 1.4 ms to save it in the SD-card. A WiFi throughput of 12.8Mbps was measured which results in a transmission time of 5 ms for 512 kb of data. The embedded system consumes about 200 mAh when wireless off and 400 mAh when it is on. The system exhibits a reliable performance to record EEG signals and transmit them wirelessly. Besides the microcontroller-based architectures, the proposed platform demonstrates that powerful ARM processors running embedded operating systems can be programmed with real-time constrains at the kernel level in order to control hardware, while maintaining their parallel processing abilities in high level software applications.

Automatic prebent customized prosthesis for pectus excavatum minimally invasive surgery correction

Pectus excavatum is the most common deformity of the thorax. A minimally invasive surgical correction is commonly carried out to remodel the anterior chest wall by using an intrathoracic convex prosthesis in the substernal position. The process of prosthesis modeling and bending still remains an area of improvement. The authors developed a new system, i3DExcavatum, which can automatically model and bend the bar preoperatively based on a thoracic CT scan. This article presents a comparison between automatic and manual bending. The i3DExcavatum was used to personalize prostheses for 41 patients who underwent pectus excavatum surgical correction between 2007 and 2012. Regarding the anatomical variations, the soft-tissue thicknesses external to the ribs show that both symmetric and asymmetric patients always have asymmetric variations, by comparing the patients’ sides. It highlighted that the prosthesis bar should be modeled according to each patient’s rib positions and dimensions. The average differences between the skin and costal line curvature lengths were 84 ± 4 mm and 96 ± 11 mm, for male and female patients, respectively. On the other hand, the i3DExcavatum ensured a smooth curvature of the surgical prosthesis and was capable of predicting and simulating a virtual shape and size of the bar for asymmetric and symmetric patients. In conclusion, the i3DExcavatum allows preoperative personalization according to the thoracic morphology of each patient. It reduces surgery time and minimizes the margin error introduced by the manually bent bar, which only uses a template that copies the chest wall curvature.

Finite element analysis of pectus carinatum surgical correction via a minimally invasive approach

Pectus carinatum (PC) is a chest deformity caused by a disproportionate growth of the costal cartilages compared to the bony thoracic skeleton, pulling the sternum towards, which leads to its protrusion. There has been a growing interest on using the ‘reversed Nuss’ technique as minimally invasive procedure for PC surgical correction. A corrective bar is introduced between the skin and the thoracic cage and positioned on top of the sternum highest protrusion area for continuous pressure. Then, it is fixed to the ribs and kept implanted for about 2–3 years. The purpose of this work was to (a) assess the stresses distribution on the thoracic cage that arise from the procedure, and (b) investigate the impact of different positioning of the corrective bar along the sternum. The higher stresses were generated on the 4th, 5th and 6th ribs backend, supporting the hypothesis of pectus deformities correction-induced scoliosis. The different bar positioning originated different stresses on the ribs’ backend. The bar position that led to lower stresses generated on the ribs backend was the one that also led to the smallest sternum displacement. However, this may be preferred, as the risk of induced scoliosis is lowered.

A comunicação multimédia e a construção mediada da mensagem

O objectivo da presente dissertação é a análise do desenvolvimento e utilização do acto de comunicar inserido num contexto da Cultura Digital. O processo de investigação procura a análise e compreensão da comunicação e das novas características conferidas à mensagem pelo factor multimédia. Reflecte-se sobre os modos como a prática comunicativa realizada com base no multimédia digital impulsiona uma nova forma de interacção comunicativa. A presente dissertação envolveu uma reflexão sobre a dinâmica relacional que se estabelece entre Comunicação, Design e Multimédia. Por um lado, procuram- -se definições estruturantes para a comunicação multimédia e a construção das suas mensagens, num processo mediado pela Semiótica e seu estudo de signos e ampliado pela Mediologia para um conceito de transmissão cultural. Por outro lado, apresenta- -se a Cultura Digital numa perspectiva histórica-evolutiva, contextualizando em termos tecnológicos e conceptuais o percurso que define a comunicação multimédia como a concebemos hoje. É, finalmente, analisado o novo espaço de comunicação digital, onde o design e arte multimédia se assumem como processo de investigação. O acto de comunicar entre indivíduos é um processo construído e adquirido. Além de tornar as mensagens em códigos úteis e compreensíveis, o multimédia é, fundamentalmente, comunicação, e as interacções resultantes deste processo reformulam o modelo de comunicação, tornando-o um campo de criação colectiva da mensagem.

PHB-PEO electrospun fiber membranes containing chlorhexidine for drug delivery applications

Fiber meshes of poly(hydroxybutyrate) (PHB) and poly(hydroxybutyrate)/ poly(ethylene oxide) (PHB/PEO) with different concentrations of chlorhexidine (CHX) were prepared by electrospinning, for assessment as a polymer based drug delivery system. The electrospun fibers were characterized at morphological, molecular and mechanical levels. The bactericidal potential of PHB and PHB/PEO electrospun fibers with and without CHX was investigated against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) by disk diffusion susceptibility tests. Electrospun fibers containing CHX exhibited bactericidal activity. PHB/PEO-1%CHX displayed higher CHX release levels and equivalent antibacterial activity when compared to PHB/PEO with 5 and 10 wt% CHX. Bactericidal performance of samples with 1 wt% CHX was assessed by Colony Forming Units (CFU), where a reduction of 100 % and 99.69 % against E. coli and S. aureus were achieved, respectively.

Effect of neutralization and cross-linking on the thermal degradation of chitosan electrospun membranes

Thermal degradation of as electrospun chitosan membranes and samples subsequently treated with ethanol and cross-linked with glutaraldehyde (GA) have been studied by thermogravimetry (TG) coupled with an infrared spectrometer (FTIR). The influence of the electrospinning process and cross-linking in the electrospun chitosan thermal stability was evaluated. Up to three degradation steps were observed in the TG data, corresponding to water dehydration reaction at temperatures below 100 ºC, loss of side groups formed between the amine groups of chitosan and trifluoroacetic acid between 150 – 270 ºC and chitosan thermal degradation that starts around 250 ºC and goes up to 400 ºC. The Kissinger model was employed to evaluate the activation energies of the electrospun membranes during isothermal experiments and revealed that thermal degradation activation energy increases for the samples processed by electrospinning and subsequent neutralization and cross-linking treatments with respect to the neat chitosan powder.

Automated image analysis of lung branching morphogenesis from microscopic images of fetal rat explants

Background: Regulating mechanisms of branching morphogenesis of fetal lung rat explants have been an essential tool for molecular research. This work presents a new methodology to accurately quantify the epithelial, outer contour and peripheral airway buds of lung explants during cellular development from microscopic images. Methods: The outer contour was defined using an adaptive and multi-scale threshold algorithm whose level was automatically calculated based on an entropy maximization criterion. The inner lung epithelial was defined by a clustering procedure that groups small image regions according to the minimum description length principle and local statistical properties. Finally, the number of peripheral buds were counted as the skeleton branched ends from a skeletonized image of the lung inner epithelial. Results: The time for lung branching morphometric analysis was reduced in 98% in contrast to the manual method. Best results were obtained in the first two days of cellular development, with lesser standard deviations. Non-significant differences were found between the automatic and manual results in all culture days. Conclusions: The proposed method introduces a series of advantages related to its intuitive use and accuracy, making the technique suitable to images with different lightning characteristics and allowing a reliable comparison between different researchers.