Planning and assessment techniques for spine surgeries

The rate of diagnosis and treatment of degenerative spine disorders is increasing, increasing the need for surgical intervention. Posterior spine fusion is one surgical intervention used to treat various spine degeneration pathologies To minimize the risk of complications and provide patients with positive outcomes, preoperative planning and postsurgical assessment are necessary. This PhD aimed to investigate techniques for the surgical planning and assessment of spine surgeries. Three main techniques were assessed: stereophotogrammetric motion analysis, 3D printing of complex spine deformities and finite element analysis of the thoracolumbar spine. Upon reviewing the literature on currently available spine kinematics protocol, a comprehensive motion analysis protocol to measure the multi-segmental spine motion was developed. Using this protocol, the patterns of spine motion in patients before and after posterior spine fixation was mapped. The second part investigated the use of virtual and 3D printed spine models for the surgical planning of complex spine deformity correction. Compared to usual radiographic images, the printed model allowed optimal surgical intervention, reduced surgical time and provided better surgeon-patient communication. The third part assessed the use of polyetheretherketone rods auxiliary to titanium rods to reduce the stiffness of posterior spine fusion constructs. Using a finite element model of the thoracolumbar spine, the rods system showed a decrease in the overall stress of the uppermost instrumented vertebra when compared to regular fixation approaches. Finally, a retrospective biomechanical assessment of a lumbopelvic reconstruction technique was investigated to assess the patients' gait following the surgery, the implant deformation over the years and the extent of bony fusion between spine and implant. In conclusion, this thesis highlighted the need to provide surgeons with new planning and assessment techniques to better understand postsurgical complications. The methodologies investigated in this project can be used in the future to establish a patient-specific planning protocol.

Numerical and experimental analysis of 3D printed smart structures and systems

Three dimensional (3D) printers of continuous fiber reinforced composites, such as MarkTwo (MT) by Markforged, can be used to manufacture such structures. To date, research works devoted to the study and application of flexible elements and CMs realized with MT printer are only a few and very recent. A good numerical and/or analytical tool for the mechanical behavior analysis of the new composites is still missing. In addition, there is still a gap in obtaining the material properties used (e.g. elastic modulus) as it is usually unknown and sensitive to printing parameters used (e.g. infill density), making the numerical simulation inaccurate. Consequently, the aim of this thesis is to present several work developed. The first is a preliminary investigation on the tensile and flexural response of Straight Beam Flexures (SBF) realized with MT printer and featuring different interlayer fiber volume-fraction and orientation, as well as different laminate position within the sample. The second is to develop a numerical analysis within the Carrera' s Unified Formulation (CUF) framework, based on component-wise (CW) approach, including a novel preprocessing tool that has been developed to account all regions printed in an easy and time efficient way. Among its benefits, the CUF-CW approach enables building an accurate database for collecting first natural frequencies modes results, then predicting Young' s modulus based on an inverse problem formulation. To validate the tool, the numerical results are compared to the experimental natural frequencies evaluated using a digital image correlation method. Further, we take the CUF-CW model and use static condensation to analyze smart structures which can be decomposed into a large number of similar components. Third, the potentiality of MT in combination with topology optimization and compliant joints design (CJD) is investigated for the realization of automated machinery mechanisms subjected to inertial loads.

Digital 3D reconstruction as a research environment in art and architecture history: uncertainty classification and visualisation

The dissertation addresses the still not solved challenges concerned with the source-based digital 3D reconstruction, visualisation and documentation in the domain of archaeology, art and architecture history. The emerging BIM methodology and the exchange data format IFC are changing the way of collaboration, visualisation and documentation in the planning, construction and facility management process. The introduction and development of the Semantic Web (Web 3.0), spreading the idea of structured, formalised and linked data, offers semantically enriched human- and machine-readable data. In contrast to civil engineering and cultural heritage, academic object-oriented disciplines, like archaeology, art and architecture history, are acting as outside spectators. Since the 1990s, it has been argued that a 3D model is not likely to be considered a scientific reconstruction unless it is grounded on accurate documentation and visualisation. However, these standards are still missing and the validation of the outcomes is not fulfilled. Meanwhile, the digital research data remain ephemeral and continue to fill the growing digital cemeteries. This study focuses, therefore, on the evaluation of the source-based digital 3D reconstructions and, especially, on uncertainty assessment in the case of hypothetical reconstructions of destroyed or never built artefacts according to scientific principles, making the models shareable and reusable by a potentially wide audience. The work initially focuses on terminology and on the definition of a workflow especially related to the classification and visualisation of uncertainty. The workflow is then applied to specific cases of 3D models uploaded to the DFG repository of the AI Mainz. In this way, the available methods of documenting, visualising and communicating uncertainty are analysed. In the end, this process will lead to a validation or a correction of the workflow and the initial assumptions, but also (dealing with different hypotheses) to a better definition of the levels of uncertainty.

A Trans-dimensional inversion algorithm to model deformation sources with unconstrained shape in finite element domains

Ground deformation provides valuable insights on subsurface processes with pattens reflecting the characteristics of the source at depth. In active volcanic sites displacements can be observed in unrest phases; therefore, a correct interpretation is essential to assess the hazard potential. Inverse modeling is employed to obtain quantitative estimates of parameters describing the source. However, despite the robustness of the available approaches, a realistic imaging of these reservoirs is still challenging. While analytical models return quick but simplistic results, assuming an isotropic and elastic crust, more sophisticated numerical models, accounting for the effects of topographic loads, crust inelasticity and structural discontinuities, require much higher computational effort and information about the crust rheology may be challenging to infer. All these approaches are based on a-priori source shape constraints, influencing the solution reliability. In this thesis, we present a new approach aimed at overcoming the aforementioned limitations, modeling sources free of a-priori shape constraints with the advantages of FEM simulations, but with a cost-efficient procedure. The source is represented as an assembly of elementary units, consisting in cubic elements of a regular FE mesh loaded with a unitary stress tensors. The surface response due to each of the six stress tensor components is computed and linearly combined to obtain the total displacement field. In this way, the source can assume potentially any shape. Our tests prove the equivalence of the deformation fields due to our assembly and that of corresponding cavities with uniform boundary pressure. Our ability to simulate pressurized cavities in a continuum domain permits to pre-compute surface responses, avoiding remeshing. A Bayesian trans-dimensional inversion algorithm implementing this strategy is developed. 3D Voronoi cells are used to sample the model domain, selecting the elementary units contributing to the source solution and those remaining inactive as part of the crust.

Developing a radiomic based machine learning model to identify patients with resected non-small-cell lung cancer at high risk of relapse

Background There is a wide variation of recurrence risk of Non-small-cell lung cancer (NSCLC) within the same Tumor Node Metastasis (TNM) stage, suggesting that other parameters are involved in determining this probability. Radiomics allows extraction of quantitative information from images that can be used for clinical purposes. The primary objective of this study is to develop a radiomic prognostic model that predicts a 3 year disease free-survival (DFS) of resected Early Stage (ES) NSCLC patients. Material and Methods 56 pre-surgery non contrast Computed Tomography (CT) scans were retrieved from the PACS of our institution and anonymized. Then they were automatically segmented with an open access deep learning pipeline and reviewed by an experienced radiologist to obtain 3D masks of the NSCLC. Images and masks underwent to resampling normalization and discretization. From the masks hundreds Radiomic Features (RF) were extracted using Py-Radiomics. Hence, RF were reduced to select the most representative features. The remaining RF were used in combination with Clinical parameters to build a DFS prediction model using Leave-one-out cross-validation (LOOCV) with Random Forest. Results and Conclusion A poor agreement between the radiologist and the automatic segmentation algorithm (DICE score of 0.37) was found. Therefore, another experienced radiologist manually segmented the lesions and only stable and reproducible RF were kept. 50 RF demonstrated a high correlation with the DFS but only one was confirmed when clinicopathological covariates were added: Busyness a Neighbouring Gray Tone Difference Matrix (HR 9.610). 16 clinical variables (which comprised TNM) were used to build the LOOCV model demonstrating a higher Area Under the Curve (AUC) when RF were included in the analysis (0.67 vs 0.60) but the difference was not statistically significant (p=0,5147).

Design of compliant mechanisms and their application to morphing wing technology

This thesis describes a study conducted for the development of a new approach for the design of compliant mechanisms. Currently compliant mechanisms are based on a 2.5D design method. The applications for which compliant mechanisms can be used this way, is limited. The proposed research suggests to use a 3D approach for the design of CM’s, to better exploit its useful properties. To test the viability of this method, a practical application was chosen. The selected application is related to morphing wings. During this project a working prototype of a variable sweep and variable AoA system was designed and made for an SUAV. A compliant hinge allows the system to achieve two DOF. This hinge has been designed using the proposed 3D design approach. To validate the capabilities of the design, two methods were used. One of these methods was by simulation. By using analysis software, a basic idea could be provided of the stress and deformation of the designed mechanism. The second validation was done by means of AM. Using FDM and material jetting technologies, several prototypes were manufactured. The result of the first model showed that the DOF could be achieved. Models manufactured using material jetting technology, proved that the designed model could provide the desired motion and exploit the positive characteristics of CM. The system could be manufactured successfully in one part. Being able to produce the system in one part makes the need for an extensive assembly process redundant. This improves its structural quality. The materials chosen for the prototypes were PLA, VeroGray and Rigur. The material properties were suboptimal for its final purpose, but successful results were obtained. The prototypes proved tough and were able to provide the desired motion. This proves that the proposed design method can be a useful tool for the design of improved CM’s. Furthermore, the variable sweep & AoA system could be used to boost the flight performance of SUAV’s.

Optimized methods to digital survey and 3D modelling of cultural heritage assets

Currently making digital 3D models and replicas of the cultural heritage assets play an important role in the preservation and having a high detail source for future research and intervention. In this dissertation, it is tried to assess different methods for digital surveying and making 3D replicas of cultural heritage assets in different scales of size. The methodologies vary in devices, software, workflow, and the amount of skill that is required. The three phases of the 3D modelling process are data acquisition, modelling, and model presentation. Each of these sections is divided into sub-sections and there are several approaches, methods, devices, and software that may be employed, furthermore, the selection process should be based on the operation's goal, available facilities, the scale and properties of the object or structure to be modeled, as well as the operators' expertise and experience. The most key point to remember is that the 3D modelling operation should be properly accurate, precise, and reliable; therefore, there are so many instructions and pieces of advice on how to perform 3D modelling effectively. It is an attempt to compare and evaluate the various ways of each phase in order to explain and demonstrate their differences, benefits, and drawbacks in order to serve as a simple guide for new and/or inexperienced users.

Nonlinear modelling of non-structural masonry walls under a low-intensity earthquake motion: calibration through a parametric study

This thesis aims to understand the behavior of a low-rise unreinforced masonry building (URM), the typical residential house in the Netherlands, when subjected to low-intensity earthquakes. In fact, in the last decades, the Groningen region was hit by several shallow earthquakes caused by the extraction of natural gas. In particular, the focus is addressed to the internal non-structural walls and to their interaction with the structural parts of the building. A simple and cost-efficient 2D FEM model is developed, focused on the interfaces representing mortar layers that are present between the non-structural walls and the rest of the structure. As a reference for geometries and materials, it has been taken into consideration a prototype that was built in full-scale at the EUCENTRE laboratory of Pavia (Italy). Firstly, a quasi-static analysis is performed by gradually applying a prescribed displacement on the roof floor of the structure. Sensitivity analyses are conducted on some key parameters characterizing mortar. This analysis allows for the calibration of their values and the evaluation of the reliability of the model. Successively, a transient analysis is performed to effectively subject the model to a seismic action and hence also evaluate the mechanical response of the building over time. Moreover, it was possible to compare the results of this analysis with the displacements recorded in the experimental tests by creating a model representing the entire considered structure. As a result, some conditions for the model calibration are defined. The reliability of the model is then confirmed by both the reasonable results obtained from the sensitivity analysis and the compatibility of the values obtained for the top displacement of the roof floor of the experimental test, and the same value acquired from the structural model.

Development of a state-variable filter for a motion control application.

In collaboration with G.D. SpA I attended an internship with the purpose of developing a filter for the position control of industrial machines during testing and maintenance operations. The filter elaborates a signal in position provided by an electonic handwheel, in order to enable the application to be controlled with a signal in velocity with arbitrarily dynamics chosen during the design phase. Limiting the dynamics of the filter provide a more stable and less demanding reference trajectory which reduce the vibrations and tracking errors of the motor controlled by it. It also prevents misusages of the handwheel from the technician which could end up in harmful interferences between the mechanical parts moved by the handwheel.

Integrated Proteomics Identified Up-regulated Focal Adhesion-mediated Proteins In Human Squamous Cell Carcinoma In An Orthotopic Murine Model.

Understanding the molecular mechanisms of oral carcinogenesis will yield important advances in diagnostics, prognostics, effective treatment, and outcome of oral cancer. Hence, in this study we have investigated the proteomic and peptidomic profiles by combining an orthotopic murine model of oral squamous cell carcinoma (OSCC), mass spectrometry-based proteomics and biological network analysis. Our results indicated the up-regulation of proteins involved in actin cytoskeleton organization and cell-cell junction assembly events and their expression was validated in human OSCC tissues. In addition, the functional relevance of talin-1 in OSCC adhesion, migration and invasion was demonstrated. Taken together, this study identified specific processes deregulated in oral cancer and provided novel refined OSCC-targeting molecules.

Electronic And Structural Study Of Pt-modified Au Vicinal Surfaces: A Model System For Pt-au Catalysts.

Two single crystalline surfaces of Au vicinal to the (111) plane were modified with Pt and studied using scanning tunneling microscopy (STM) and X-ray photoemission spectroscopy (XPS) in ultra-high vacuum environment. The vicinal surfaces studied are Au(332) and Au(887) and different Pt coverage (θPt) were deposited on each surface. From STM images we determine that Pt deposits on both surfaces as nanoislands with heights ranging from 1 ML to 3 ML depending on θPt. On both surfaces the early growth of Pt ad-islands occurs at the lower part of the step edge, with Pt ad-atoms being incorporated into the steps in some cases. XPS results indicate that partial alloying of Pt occurs at the interface at room temperature and at all coverage, as suggested by the negative chemical shift of Pt 4f core line, indicating an upward shift of the d-band center of the alloyed Pt. Also, the existence of a segregated Pt phase especially at higher coverage is detected by XPS. Sample annealing indicates that the temperature rise promotes a further incorporation of Pt atoms into the Au substrate as supported by STM and XPS results. Additionally, the catalytic activity of different PtAu systems reported in the literature for some electrochemical reactions is discussed considering our findings.

The Soluble Guanylyl Cyclase Activator Bay 60-2770 Potently Relaxes The Pulmonary Artery On Congenital Diaphragmatic Hernia Rabbit Model.

Congenital diaphragmatic hernia (CDH) is associated with pulmonary hypertension which is often difficult to manage, and a significant cause of morbidity and mortality. In this study, we have used a rabbit model of CDH to evaluate the effects of BAY 60-2770 on the in vitro reactivity of left pulmonary artery. CDH was performed in New Zealand rabbit fetuses (n = 10 per group) and compared to controls. Measurements of body, total and left lung weights (BW, TLW, LLW) were done. Pulmonary artery rings were pre-contracted with phenylephrine (10 μM), after which cumulative concentration-response curves to glyceryl trinitrate (GTN; NO donor), tadalafil (PDE5 inhibitor) and BAY 60-2770 (sGC activator) were obtained as well as the levels of NO (NO3/NO2). LLW, TLW and LBR were decreased in CDH (p < 0.05). In left pulmonary artery, the potency (pEC50) for GTN was markedly lower in CDH (8.25 ± 0.02 versus 9.27 ± 0.03; p < 0.01). In contrast, the potency for BAY 60-2770 was markedly greater in CDH (11.7 ± 0.03 versus 10.5 ± 0.06; p < 0.01). The NO2/NO3 levels were 62 % higher in CDH (p < 0.05). BAY 60-2770 exhibits a greater potency to relax the pulmonary artery in CDH, indicating a potential use for pulmonary hypertension in this disease.

Bay 41-2272, A Soluble Guanylate Cyclase Stimulator, Relaxes Isolated Human Ureter In A Standardized In Vitro Model.

To characterize the relaxation induced by BAY 41-2272 in human ureteral segments. Ureter specimens (n = 17) from multiple organ human deceased donors (mean age 40 ± 3.2 years, male/female ratio 2:1) were used to characterize the relaxing response of BAY 41-2272. Immunohistochemical analysis for endothelial and neuronal nitric oxide synthase, guanylate cyclase stimulator (sGC) and type 5 phosphodiesterase was also performed. The potency values were determined as the negative log of the molar to produce 50% of the maximal relaxation in potassium chloride-precontracted specimens. The unpaired Student t test was used for the comparisons. Immunohistochemistry revealed the presence of endothelial nitric oxide synthase in vessel endothelia and neuronal nitric oxide synthase in urothelium and nerve structures. sGC was expressed in the smooth muscle and urothelium layer, and type 5 phosphodiesterase was present in the smooth muscle only. BAY 41-2272 (0.001-100 μM) relaxed the isolated ureter in a concentration dependent manner, with a potency and maximal relaxation value of 5.82 ± 0.14 and 84% ± 5%, respectively. The addition of nitric oxide synthase and sGC inhibitors reduced the maximal relaxation values by 21% and 45%, respectively. However, the presence of sildenafil (100 nM) significantly potentiated (6.47 ± 0.10, P <.05) this response. Neither glibenclamide or tetraethylammonium nor ureteral urothelium removal influenced the relaxation response by BAY 41-2272. BAY 41-2272 relaxes the human isolated ureter in a concentration-dependent manner, mainly by activating the sGC enzyme in smooth muscle cells rather than in the urothelium, although a cyclic guanosine monophosphate-independent mechanism might have a role. The potassium channels do not seem to be involved.

Mesenchymal Stromal Cells From Adipose Tissue Attached To Suture Material Enhance The Closure Of Enterocutaneous Fistulas In A Rat Model.

Surgical treatment for enterocutaneous fistulas (EF) frequently fails. Cell therapy may represent a new approach to treatment. Mesenchymal stromal cells (MSCs) have high proliferative and differentiation capacity. This study aimed to investigate whether MSCs could adhere to suture filament (SF), promoting better EF healing. MSCs, 1 × 10(6), from adipose tissue (ATMSCs) were adhered to a Polyvicryl SF by adding a specific fibrin glue formulation. Adhesion was confirmed by confocal and scanning electron microscopy (SEM). A cecal fistula was created in 22 Wistar rats by incising the cecum and suturing the opening to the surgical wound subcutaneously with four separate stitches. The animals were randomly allocated to three groups: control (CG)-five animals, EF performed; injection (IG)-eight animals 1 × 10(6) ATMSCs injected around EF borders; and suture filament (SG): nine animals, sutured with 1 × 10(6) ATMSCs attached to the filaments with fibrin glue. Fistulas were photographed on the operation day and every 3 days until the 21st day and analyzed by two observers using ImageJ Software. Confocal and SEM results demonstrated ATMSCs adhered to SF (ATMSCs-SF). The average reduction size of the fistula area at 21st day was greater for the SG group (90.34%, P < 0.05) than the IG (71.80%) and CG (46.54%) groups. ATMSCs adhered to SF maintain viability and proliferative capacity. EF submitted to ATMSCs-SF procedure showed greater recovery and healing. This approach might be a new and effective tool for EF treatment.

Changes In Motor Behavior During Pregnancy In Rats: The Basis For A Possible Animal Model Of Restless Legs Syndrome.

Pregnant women have a 2-3 fold higher probability of developing restless legs syndrome (RLS - sleep-related movement disorders) than general population. This study aims to evaluate the behavior and locomotion of rats during pregnancy in order to verify if part of these animals exhibit some RLS-like features. We used 14 female 80-day-old Wistar rats that weighed between 200 and 250 g. The rats were distributed into control (CTRL) and pregnant (PN) groups. After a baseline evaluation of their behavior and locomotor activity in an open-field environment, the PN group was inducted into pregnancy, and their behavior and locomotor activity were evaluated on days 3, 10 and 19 of pregnancy and in the post-lactation period in parallel with the CTRL group. The serum iron and transferrin levels in the CTRL and PN groups were analyzed in blood collected after euthanasia by decapitation. There were no significant differences in the total ambulation, grooming events, fecal boli or urine pools between the CTRL and PN groups. However, the PN group exhibited fewer rearing events, increased grooming time and reduced immobilization time than the CTRL group (ANOVA, p<0.05). These results suggest that pregnant rats show behavioral and locomotor alterations similar to those observed in animal models of RLS, demonstrating to be a possible animal model of this sleep disorder.