Periazetabuläre Frakturen bei Hüftprothesen

Periazetabuläre Frakturen bei Hüftprothesen nehmen aufgrund der Überalterung und der zunehmenden Aktivität alter Menschen zu. Die periprothetischen Azetabulumfrakturen werden anhand der Einteilung von Letournel klassifiziert. Wenn beide Azetabulumpfeiler bei Hüftprothese betroffen sind, wird auch von einer Beckendiskontinuität gesprochen. Durch eine laterale Kompression können auch periazetabuläre Schambeinastfrakturen und/oder transiliakale Frakturen auftreten. Für die Therapieentscheidung (konservativ, alleinige Osteosynthese, Revisionshüfttotalprothese mit oder ohne zusätzliche Osteosynthese des Vorder- und/oder Hinterpfeilers) und die Zugangswahl bei operativer Versorgung werden patientenspezifische (Alter, Morbidität, Osteoporose, Aktivitätslevel des Patienten), frakturspezifische (Frakturtyp, Dislokationsausmaß, Impression des Doms oder der Hinterwand) und auch prothesenspezifische Faktoren (Art der implantierten Prothese [Hemiprothese vs. Totalprothese], Pfannenstabilität, Zeichen eines Prothesenabriebs, Ausmaß und Lokalisation einer azetabulären Lyse, Stabilität und Lysezeichen des Prothesenschafts) berücksichtigt. Bei akuten Beckendiskontinuitäten werden neben einer Osteosynthese des dorsalen Pfeilers zunehmend eine schnell ossär integrierbare Pfanne (Tantalum [„Trabecular Metal“: TM]) mit oder ohne Augment und/oder Allograft und allenfalls in einer sog. „Cup-Cage“-Technik (TM-Pfanne mit einem abstützenden Revisionsring [Burch-Schneider-Ring] analog zur Therapie von chronischen Beckendiskontinuitäten empfohlen. Bei großen Lysezonen und starken Dislokationen des vorderen Pfeilers und der quadrilateralen Fläche können intrapelvine Zugänge (modifizierter Stoppa- oder Pararectus-Zugang nach Keel) zur zusätzlichen Zuggurtungsosteosynthese des vorderen Pfeilers und Abstützung der quadrilateralen Fläche gewählt werden.

A unified approach to architecture conformance checking

Architectural decisions can be interpreted as structural and behavioral constraints that must be enforced in order to guarantee overarching qualities in a system. Enforcing those constraints in a fully automated way is often challenging and not well supported by current tools. Current approaches for checking architecture conformance either lack in usability or offer poor options for adaptation. To overcome this problem we analyze the current state of practice and propose an approach based on an extensible, declarative and empirically-grounded specification language. This solution aims at reducing the overall cost of setting up and maintaining an architectural conformance monitoring environment by decoupling the conceptual representation of a user-defined rule from its technical specification prescribed by the underlying analysis tools. By using a declarative language, we are able to write tool-agnostic rules that are simple enough to be understood by untrained stakeholders and, at the same time, can be can be automatically processed by a conformance checking validator. Besides addressing the issue of cost, we also investigate opportunities for increasing the value of conformance checking results by assisting the user towards the full alignment of the implementation with respect to its architecture. In particular, we show the benefits of providing actionable results by introducing a technique which automatically selects the optimal repairing solutions by means of simulation and profit-based quantification. We perform various case studies to show how our approach can be successfully adopted to support truly diverse industrial projects. We also investigate the dynamics involved in choosing and adopting a new automated conformance checking solution within an industrial context. Our approach reduces the cost of conformance checking by avoiding the need for an explicit management of the involved validation tools. The user can define rules using a convenient high-level DSL which automatically adapts to emerging analysis requirements. Increased usability and modular customization ensure lower costs and a shorter feedback loop.

Design and Implementation of a Laparoscope Calibration Method for Augmented Reality Navigation

Intraoperative laparoscopic calibration remains a challenging task. In this work we present a new method and instrumentation for intraoperative camera calibration. Contrary to conventional calibration methods, the proposed technique allows intraoperative laparoscope calibration from single perspective observations, resulting in a standardized scheme for calibrating in a clinical scenario. Results show an average displacement error of 0.52 ± 0.19 mm, indicating sufficient accuracy for clinical use. Additionally, the proposed method is validated clinically by performing a calibration during the surgery.

A randomized trial of the effects of the noble gases helium and argon on neuroprotection in a rodent cardiac arrest model.

BACKGROUND The noble gas xenon is considered as a neuroprotective agent, but availability of the gas is limited. Studies on neuroprotection with the abundant noble gases helium and argon demonstrated mixed results, and data regarding neuroprotection after cardiac arrest are scant. We tested the hypothesis that administration of 50% helium or 50% argon for 24 h after resuscitation from cardiac arrest improves clinical and histological outcome in our 8 min rat cardiac arrest model. METHODS Forty animals had cardiac arrest induced with intravenous potassium/esmolol and were randomized to post-resuscitation ventilation with either helium/oxygen, argon/oxygen or air/oxygen for 24 h. Eight additional animals without cardiac arrest served as reference, these animals were not randomized and not included into the statistical analysis. Primary outcome was assessment of neuronal damage in histology of the region I of hippocampus proper (CA1) from those animals surviving until day 5. Secondary outcome was evaluation of neurobehavior by daily testing of a Neurodeficit Score (NDS), the Tape Removal Test (TRT), a simple vertical pole test (VPT) and the Open Field Test (OFT). Because of the non-parametric distribution of the data, the histological assessments were compared with the Kruskal-Wallis test. Treatment effect in repeated measured assessments was estimated with a linear regression with clustered robust standard errors (SE), where normality is less important. RESULTS Twenty-nine out of 40 rats survived until day 5 with significant initial deficits in neurobehavioral, but rapid improvement within all groups randomized to cardiac arrest. There were no statistical significant differences between groups neither in the histological nor in neurobehavioral assessment. CONCLUSIONS The replacement of air with either helium or argon in a 50:50 air/oxygen mixture for 24 h did not improve histological or clinical outcome in rats subjected to 8 min of cardiac arrest.

Feasibility of stereotactic MRI-based image guidance for the treatment of vascular malformations: a phantom study.

PURPOSE Treatment of vascular malformations requires the placement of a needle within vessels which may be as small as 1 mm, with the current state of the art relying exclusively on two-dimensional fluoroscopy images for guidance. We hypothesize that the combination of stereotactic image guidance with existing targeting methods will result in faster and more reproducible needle placements, as well as reduced radiationexposure, when compared to standard methods based on fluoroscopy alone. METHODS The proposed navigation approach was evaluated in a phantom experiment designed to allow direct comparison with the conventional method. An anatomical phantom of the left forearm was constructed, including an independent control mechanism to indicate the attainment of the target position. Three interventionalists (one inexperienced, two of them frequently practice the conventional fluoroscopic technique) performed 45 targeting attempts utilizing the combined and 45 targeting attempts utilizing the standard approaches. RESULTS In all 45 attempts, the users were able to reach the target when utilizing the combined approach. In two cases, targeting was stopped after 15 min without reaching the target when utilizing only the C-arm. The inexperienced user was faster when utilizing the combined approach and applied significantly less radiation than when utilizing the conventional approach. Conversely, both experienced users were faster when using the conventional approach, in one case significantly so, with no significant difference in radiation dose when compared to the combined approach. CONCLUSIONS This work presents an initial evaluation of a combined navigation fluoroscopy targeting technique in a phantom study. The results suggest that, especially for inexperienced interventionalists, navigation may help to reduce the time and the radiation dose. Future work will focus on the improvement and clinical evaluation of the proposed method.

A Unified Approach to Architecture Conformance Checking

Software erosion can be controlled by periodically checking for consistency between the de facto architecture and its theoretical counterpart. Studies show that this process is often not automated and that developers still rely heavily on manual reviews, despite the availability of a large number of tools. This is partially due to the high cost involved in setting up and maintaining tool-specific and incompatible test specifications that replicate otherwise documented invariants. To reduce this cost, our approach consists in unifying the functionality provided by existing tools under the umbrella of a common business-readable DSL. By using a declarative language, we are able to write tool-agnostic rules that are simple enough to be understood by non-technical stakeholders and, at the same time, can be interpreted as a rigorous specification for checking architecture conformance

The Moldable Inspector

Object inspectors are an essential category of tools that allow developers to comprehend the run-time of object-oriented systems. Traditional object inspectors favor a generic view that focuses on the low-level details of the state of single objects. Based on 16 interviews with software developers and a follow-up survey with 62 respondents we identified a need for object inspectors that support different high-level ways to visualize and explore objects, depending on both the object and the current developer need. We propose the Moldable Inspector, a novel inspector model that enables developers to adapt the inspection workflow to suit their immediate needs by making the inspection context explicit, providing multiple interchangeable domain-specific views for each object, and supporting a workflow that groups together multiple levels of connected objects. We show that the Moldable Inspector can address multiple kinds of development needs involving a wide range of objects.

GTInspector: A Moldable Domain-Aware Object Inspector

Understanding the run-time behaviour of object-oriented applications entails the comprehension of run-time objects. Traditional object inspectors favor generic views that focus on the low-level details of the state of single objects. While universally applicable, this generic approach does not take into account the varying needs of developers that could benefit from tailored views and exploration possibilities. GTInspector is a novel moldable object inspector that provides different high-level ways to visualize and explore objects, adapted to both the object and the current developer need.