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

Real-time 3D interactive segmentation of echocardiographic data through user-based deformation of B-spline explicit active surfaces

Image segmentation is an ubiquitous task in medical image analysis, which is required to estimate morphological or functional properties of given anatomical targets. While automatic processing is highly desirable, image segmentation remains to date a supervised process in daily clinical practice. Indeed, challenging data often requires user interaction to capture the required level of anatomical detail. To optimize the analysis of 3D images, the user should be able to efficiently interact with the result of any segmentation algorithm to correct any possible disagreement. Building on a previously developed real-time 3D segmentation algorithm, we propose in the present work an extension towards an interactive application where user information can be used online to steer the segmentation result. This enables a synergistic collaboration between the operator and the underlying segmentation algorithm, thus contributing to higher segmentation accuracy, while keeping total analysis time competitive. To this end, we formalize the user interaction paradigm using a geometrical approach, where the user input is mapped to a non-cartesian space while this information is used to drive the boundary towards the position provided by the user. Additionally, we propose a shape regularization term which improves the interaction with the segmented surface, thereby making the interactive segmentation process less cumbersome. The resulting algorithm offers competitive performance both in terms of segmentation accuracy, as well as in terms of total analysis time. This contributes to a more efficient use of the existing segmentation tools in daily clinical practice. Furthermore, it compares favorably to state-of-the-art interactive segmentation software based on a 3D livewire-based algorithm.

Performance management framework: the fit between PM framework adopted in Portuguese local government and the Otley’s framework

Purpose/objectives: This paper seeks to investigate whether performance management (PM) framework adopted in Portuguese local government (PLG) fit the Otley’s PM framework (1999). In particularly, the research questions are (1) whether PM framework adopted in PLG (SIADAP) fit the Otley´s framework, and (2) how local politicians (aldermen) see the operation of performance management systems (PMS) in PLG (focusing on the goal-setting process and incentive and reward structures). Theoretical positioning/contributions: With this paper we intend to contribute to literature on how the Otley’s PM framework can guide empirical research about the operation of PMS. In particular, the paper contributes to understand the fit between PMS implemented in PLG and the Otley´s PM framework. The analysis of this fit can be a good contribution to understand if PMS are used in PLG as a management tool or as a strategic response to external pressures (based on interviews conducted to aldermen). We believe that the Otley’s PM framework, as well as the extended PM framework presented by Ferreira and Otley (2009), can provide a useful research tool to understand the operation of PMS in PLG. Research method: The first research question is the central issue in this paper and is analyzed based on the main reforms introduced by Portuguese government on PM of public organizations (like municipalities). On the other hand, interviews conducted on three larger Portuguese municipalities (Oporto, Braga, and Matosinhos) show how aldermen see the operation of PMS in PLG, highlighting the goals setting process with targets associated and the existing of incentive and reward structures linked with performance. Findings: Generally we find that formal and regulated PM frameworks in PLG fit the main issues of the Otley’s PM framework. However, regarding the aldermen perceptions about PMS in practice we find a gap between theory and practice, especially regarding difficulties associated with the lack of a culture of goals and targets setting and the lack of incentive and reward structures linked with performance.

Targeting lactate transport suppresses in vivo breast tumour growth

Background: Most cancers, including breast cancer, have high rates of glucose consumption, associated with lactate production, a process referred as “Warburg effect”. Acidification of the tumour microenvironment by lactate extrusion, performed by lactate transporters (MCTs), is associated with higher cell proliferation, migration, invasion, angiogenesis and increased cell survival. Previously, we have described MCT1 up-regulation in breast carcinoma samples and demonstrated the importance of in vitro MCT inhibition. In this study, we performed siRNA knockdown of MCT1 and MCT4 in basal-like breast cancer cells in both normoxia and hypoxia conditions to validate the potential of lactate transport inhibition in breast cancer treatment. Results: The effect of MCT knockdown was evaluated on lactate efflux, proliferation, cell biomass, migration and invasion and induction of tumour xenografts in nude mice. MCT knockdown led to a decrease in in vitro tumour cell aggressiveness, with decreased lactate transport, cell proliferation, migration and invasion and, importantly, to an inhibition of in vivo tumour formation and growth. Conclusions: This work supports MCTs as promising targets in cancer therapy, demonstrates the contribution of MCTs to cancer cell aggressiveness and, more importantly, shows, for the first time, the disruption of in vivo breast tumour growth by targeting lactate transport.