Preliminary clinical trial in percutaneous nephrolithotomy using a real-time navigation system for percutaneous kidney access

Background: Precise needle puncture of renal calyces is a challenging and essential step for successful percutaneous nephrolithotomy. This work tests and evaluates, through a clinical trial, a real-time navigation system to plan and guide percutaneous kidney puncture. Methods: A novel system, entitled i3DPuncture, was developed to aid surgeons in establishing the desired puncture site and the best virtual puncture trajectory, by gathering and processing data from a tracked needle with optical passive markers. In order to navigate and superimpose the needle to a preoperative volume, the patient, 3D image data and tracker system were previously registered intraoperatively using seven points that were strategically chosen based on rigid bone structures and nearby kidney area. In addition, relevant anatomical structures for surgical navigation were automatically segmented using a multi-organ segmentation algorithm that clusters volumes based on statistical properties and minimum description length criterion. For each cluster, a rendering transfer function enhanced the visualization of different organs and surrounding tissues. Results: One puncture attempt was sufficient to achieve a successful kidney puncture. The puncture took 265 seconds, and 32 seconds were necessary to plan the puncture trajectory. The virtual puncture path was followed correctively until the needle tip reached the desired kidney calyceal. Conclusions: This new solution provided spatial information regarding the needle inside the body and the possibility to visualize surrounding organs. It may offer a promising and innovative solution for percutaneous punctures.

Evaluating the Guimarães 2012 European Capital of Culture: National and International Tourists’ Behaviors and Perceptions

In 2012, Guimarães hosted the European Capital of Culture (ECOC). An evaluation of this event was needed because public, private, and community funds were involved. This analysis considers tourists as external and independent stakeholders who assessed the cultural activities developed during the event as well as the attributes of the city. The main objectives of the research conducted were to assess the visitors` motivations during the hosting of the Guimarães ECOC 2012, their perceptions towards the city and if national and international visitors kept different perceptions of it. For two months, in the summer of 2012, a survey was applied to 390 visitors. The results revealed that hosting the 2012 ECOC was a major contribution towards attracting new visitors to the city (though many of the visitors stayed only for a short period of time). Based on tourists’ perceptions, the tangible heritage was clearly detached from the set of attributes associated to Guimarães, whereas the intangible heritage was less noted. The Portuguese tourists seem to be more prone to value the tangible heritage than the foreign tourists. Overall, Guimarães received a very positive evaluation relating to the city’s image and, as stated by tourists, visiting it was declared to be highly recommended. Following the obtained empirical results, the need for changing the city’s promoted image emerges, which has been too centered on its tangible heritage. In doing so, it is believed that there will be longer overnight stays by visitors.