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Sample records for multimodal intraoperative neuromonitoring

  1. Utility of Intraoperative Neuromonitoring during Minimally Invasive Fusion of the Sacroiliac Joint

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    Woods, Michael; Birkholz, Denise; MacBarb, Regina; Capobianco, Robyn; Woods, Adam

    2014-01-01

    Study Design. Retrospective case series. Objective. To document the clinical utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion for patients diagnosed with sacroiliac joint dysfunction (as a direct result of sacroiliac joint disruptions or degenerative sacroiliitis) and determine stimulated electromyography thresholds reflective of favorable implant position. Summary of Background Data. Intraoperative neuromonitoring is a well-accepted adjunct...

  2. Unraveling the complexities of invasive multimodality neuromonitoring.

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    Sinha, Saurabh; Hudgins, Eric; Schuster, James; Balu, Ramani

    2017-11-01

    Acute brain injuries are a major cause of death and disability worldwide. Survivors of life-threatening brain injury often face a lifetime of dependent care, and novel approaches that improve outcome are sorely needed. A delayed cascade of brain damage, termed secondary injury, occurs hours to days and even weeks after the initial insult. This delayed phase of injury provides a crucial window for therapeutic interventions that could limit brain damage and improve outcome. A major barrier in the ability to prevent and treat secondary injury is that physicians are often unable to target therapies to patients' unique cerebral physiological disruptions. Invasive neuromonitoring with multiple complementary physiological monitors can provide useful information to enable this tailored, precision approach to care. However, integrating the multiple streams of time-varying data is challenging and often not possible during routine bedside assessment. The authors review and discuss the principles and evidence underlying several widely used invasive neuromonitors. They also provide a framework for integrating data for clinical decision making and discuss future developments in informatics that may allow new treatment paradigms to be developed.

  3. Postprocessing algorithm for automated analysis of pelvic intraoperative neuromonitoring signals

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    Wegner Celine

    2016-09-01

    Full Text Available Two dimensional pelvic intraoperative neuromonitoring (pIONM® is based on electric stimulation of autonomic nerves under observation of electromyography of internal anal sphincter (IAS and manometry of urinary bladder. The method provides nerve identification and verification of its’ functional integrity. Currently pIONM® is gaining increased attention in times where preservation of function is becoming more and more important. Ongoing technical and methodological developments in experimental and clinical settings require further analysis of the obtained signals. This work describes a postprocessing algorithm for pIONM® signals, developed for automated analysis of huge amount of recorded data. The analysis routine includes a graphical representation of the recorded signals in the time and frequency domain, as well as a quantitative evaluation by means of features calculated from the time and frequency domain. The produced plots are summarized automatically in a PowerPoint presentation. The calculated features are filled into a standardized Excel-sheet, ready for statistical analysis.

  4. Multimodal neuromonitoring in pediatric cardiac anesthesia

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    Alexander J. C. Mittnacht

    2014-01-01

    Full Text Available Despite significant improvements in overall outcome, neurological injury remains a feared complication following pediatric congenital heart surgery (CHS. Only if adverse events are detected early enough, can effective actions be initiated preventing potentially serious injury. The multifactorial etiology of neurological injury in CHS patients makes it unlikely that one single monitoring modality will be effective in capturing all possible threats. Improving current and developing new technologies and combining them according to the concept of multimodal monitoring may allow for early detection and possible intervention with the goal to further improve neurological outcome in children undergoing CHS.

  5. Utility of Intraoperative Neuromonitoring during Minimally Invasive Fusion of the Sacroiliac Joint.

    Science.gov (United States)

    Woods, Michael; Birkholz, Denise; MacBarb, Regina; Capobianco, Robyn; Woods, Adam

    2014-01-01

    Study Design. Retrospective case series. Objective. To document the clinical utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion for patients diagnosed with sacroiliac joint dysfunction (as a direct result of sacroiliac joint disruptions or degenerative sacroiliitis) and determine stimulated electromyography thresholds reflective of favorable implant position. Summary of Background Data. Intraoperative neuromonitoring is a well-accepted adjunct to minimally invasive pedicle screw placement. The utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion using a series of triangular, titanium porous plasma coated implants has not been evaluated. Methods. A medical chart review of consecutive patients treated with minimally invasive surgical sacroiliac joint fusion was undertaken at a single center. Baseline patient demographics and medical history, intraoperative electromyography thresholds, and perioperative adverse events were collected after obtaining IRB approval. Results. 111 implants were placed in 37 patients. Sensitivity of EMG was 80% and specificity was 97%. Intraoperative neuromonitoring potentially avoided neurologic sequelae as a result of improper positioning in 7% of implants. Conclusions. The results of this study suggest that intraoperative neuromonitoring may be a useful adjunct to minimally invasive surgical sacroiliac joint fusion in avoiding nerve injury during implant placement.

  6. Utility of Intraoperative Neuromonitoring during Minimally Invasive Fusion of the Sacroiliac Joint

    Directory of Open Access Journals (Sweden)

    Michael Woods

    2014-01-01

    Full Text Available Study Design. Retrospective case series. Objective. To document the clinical utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion for patients diagnosed with sacroiliac joint dysfunction (as a direct result of sacroiliac joint disruptions or degenerative sacroiliitis and determine stimulated electromyography thresholds reflective of favorable implant position. Summary of Background Data. Intraoperative neuromonitoring is a well-accepted adjunct to minimally invasive pedicle screw placement. The utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion using a series of triangular, titanium porous plasma coated implants has not been evaluated. Methods. A medical chart review of consecutive patients treated with minimally invasive surgical sacroiliac joint fusion was undertaken at a single center. Baseline patient demographics and medical history, intraoperative electromyography thresholds, and perioperative adverse events were collected after obtaining IRB approval. Results. 111 implants were placed in 37 patients. Sensitivity of EMG was 80% and specificity was 97%. Intraoperative neuromonitoring potentially avoided neurologic sequelae as a result of improper positioning in 7% of implants. Conclusions. The results of this study suggest that intraoperative neuromonitoring may be a useful adjunct to minimally invasive surgical sacroiliac joint fusion in avoiding nerve injury during implant placement.

  7. Rating of intra-operative neuro-monitoring results in operative correction of the spinal deformities

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    A. A. Skripnikov

    2015-01-01

    Full Text Available Purpose of the work was filing the electrophysiological phenomena observed in the process of intra-operative neuromonitoring followed by development of the results’ scale of intra-operative neuro-physiological testing of the pyramidal tract. Materials and мethods. The selection for evaluation included data of 147 protocols of intra-operative neuromonitoring in 135 patients (53 males, 82 females, aged from 1 y. 5 m. to 52 years (14,1±0,7 years with spinal deformities of different etiology who underwent instrumentation spinal correction followed by fixation of thoracic / thoracolumbar spine segments using various variants of internal systems of trans-pedicular fixation. Intra-operative neuro-monitoring was performed using system «ISIS IOM» (Inomed Medizintechnik GmbH, Germany. The changes of motor evoked potentials were evaluated according to this scale. Results. Five types of pyramidal system reaction to operative invasion were revealed. According to neurophysiological criteria three grades of the risk of neurological disorders development during operative spinal deformity correction and, correspondingly, three levels of anxiety for the surgeon were defined. Conclusion. Intra-operative neurophysiological monitoring is the effective highly technological instrument to prevent neurological disorders in the spinal deformity. Offered rating scale of the risk of neurological complications gives the possibility to highlight three levels of anxiety during operative invasion.

  8. Does intraoperative neuromonitoring of recurrent nerves have an impact on the postoperative palsy rate? Results of a prospective multicenter study.

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    Mirallié, Éric; Caillard, Cécile; Pattou, François; Brunaud, Laurent; Hamy, Antoine; Dahan, Marcel; Prades, Michel; Mathonnet, Muriel; Landecy, Gérard; Dernis, Henri-Pierre; Lifante, Jean-Christophe; Sebag, Frederic; Jegoux, Franck; Babin, Emmanuel; Bizon, Alain; Espitalier, Florent; Durand-Zaleski, Isabelle; Volteau, Christelle; Blanchard, Claire

    2018-01-01

    The impact of intraoperative neuromonitoring on recurrent laryngeal nerve palsy remains debated. Our aim was to evaluate the potential protective effect of intraoperative neuromonitoring on recurrent laryngeal nerve during total thyroidectomy. This was a prospective, multicenter French national study. The use of intraoperative neuromonitoring was left at the surgeons' choice. Postoperative laryngoscopy was performed systematically at day 1 to 2 after operation and at 6 months in case of postoperative recurrent laryngeal nerve palsy. Univariate and multivariate analyses and propensity score (sensitivity analysis) were performed to compare recurrent laryngeal nerve palsy rates between patients operated with or without intraoperative neuromonitoring. Among 1,328 patients included (females 79.9%, median age 51.2 years, median body mass index 25.6 kg/m 2 ), 807 (60.8%) underwent intraoperative neuromonitoring. Postoperative abnormal vocal cord mobility was diagnosed in 131 patients (9.92%), including 69 (8.6%) and 62 (12.1%) in the intraoperative neuromonitoring and nonintraoperative neuromonitoring groups, respectively. Intraoperative neuromonitoring was associated with a lesser rate of recurrent laryngeal nerve palsy in univariate analysis (odds ratio = 0.68, 95% confidence interval, 0.47; 0.98, P = .04) but not in multivariate analysis (oddsratio = 0.74, 95% confidence interval, 0.47; 1.17, P = .19), or when using a propensity score (odds ratio = 0.76, 95% confidence interval, 0.53; 1.07, P = .11). There was no difference in the rates of definitive recurrent laryngeal nerve palsy (0.8% and 1.3% in intraoperative neuromonitoring and non-intraoperative neuromonitoring groups respectively, P = .39). The sensitivity, specificity, and positive and negative predictive values of intraoperative neuromonitoring for detecting abnormal postoperative vocal cord mobility were 29%, 98%, 61%, and 94%, respectively. The use of intraoperative

  9. Transzygomatic approach with intraoperative neuromonitoring for resection of middle cranial fossa tumors.

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    Son, Byung Chul; Lee, Sang Won; Kim, Sup; Hong, Jae Taek; Sung, Jae Hoon; Yang, Seung-Ho

    2012-02-01

    The authors reviewed the surgical experience and operative technique in a series of 11 patients with middle fossa tumors who underwent surgery using the transzygomatic approach and intraoperative neuromonitoring (IOM) at a single institution. This approach was applied to trigeminal schwannomas (n = 3), cavernous angiomas (n = 3), sphenoid wing meningiomas (n = 3), a petroclival meningioma (n = 1), and a hemangiopericytoma (n = 1). An osteotomy of the zygoma, a low-positioned frontotemporal craniotomy, removal of the remaining squamous temporal bone, and extradural drilling of the sphenoid wing made a flat trajectory to the skull base. Total resection was achieved in 9 of 11 patients. Significant motor pathway damage can be avoided using a change in motor-evoked potentials as an early warning sign. Four patients experienced cranial nerve palsies postoperatively, even though free-running electromyography of cranial nerves showed normal responses during the surgical procedure. A simple transzygomatic approach provides a wide surgical corridor for accessing the cavernous sinus, petrous apex, and subtemporal regions. Knowledge of the middle fossa structures is essential for anatomic orientation and avoiding injuries to neurovascular structures, although a neuronavigation system and IOM helps orient neurosurgeons.

  10. Intraoperative neuromonitoring alerts that reverse with intervention: treatment paradox and what to do about it.

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    Skinner, Stanley A; Holdefer, Robert N

    2014-04-01

    Intervention-mediated recovery from adversely changed evoked potential recordings may provide evidence for improved outcomes during neurophysiological intraoperative monitoring. However, these reversible signal changes (RSCs) are ambiguous because the patient's neurologic status cannot be known either at signal decline or after intervention. This article describes methods to reduce this ambiguity. Randomized control trials are not always possible or ethical. Recent thought on grading evidence has acknowledged that guidelines first described by Sir Austin Bradford Hill may support evidence for causation. Causality guidelines identified RSCs most likely to be truly positive in three reported studies. Diagnostic statistics were revised accordingly. A range of revised positive predictive values and likelihood ratios was calculated in the three studies, using causality guidelines. The revised data were similar to those reported for other diagnostic tests used in medicine. The RSCs may be assessed using causality guidelines for more accurate reporting of diagnostic statistics while preserving information related to surgical intervention and recovery that is lost with end of surgery diagnostics or when RSCs are ignored. A method is described for including RSCs in diagnostic statistics. This approach will more readily permit assessment of the value of neurophysiological intraoperative monitoring in prediction and prevention of neurologic deficits.

  11. Dosage effect of rocuronium on intraoperative neuromonitoring in patients undergoing thyroid surgery.

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    Han, Yang-dong; Liang, Feng; Chen, Peng

    2015-01-01

    The effect of different concentrations of rocuronium bromide used for anesthesia induction during thyroid surgery on the intraoperative recurrent laryngeal nerve monitoring was evaluated. One hundred patients undergoing thyroid operation were randomized into five groups (20 patients per group). Patients in group I were operated and monitored without the use of rocuronium bromide. Patients in groups II-V were respectively injected with 0.5x, 1x, 1.5x, and 2x ED95 rocuronium bromide intravenously. The time from injecting the rocuronium bromide to the beginning of tube insertion was recorded, the conditions of tracheal intubation were evaluated, and the changes in blood pressure and pulse during the intubation process were monitored. Vagus nerve/recurrent laryngeal nerve evoked muscle potential was monitored using the NIM-Response3.0 nerve electromyography monitor. The amplitude of electromyography signal was recorded every 5 min during 30 min after successful tracheal intubation. The tracheal intubation success rate was 100% in all groups. Compared with group I, intubating condition scores (Cooper scores) in the patients of groups II-V were higher (P rocuronium bromide during the anesthesia induction can improve the tracheal tube conditions without affecting the intraoperative recurrent laryngeal nerve monitoring. The use of 1x ED95 rocuronium bromide induction was associated with the best results.

  12. Two-year Outcomes from a Single Surgeon's Learning Curve Experience of Oblique Lateral Interbody Fusion without Intraoperative Neuromonitoring.

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    Woods, Kamal; Fonseca, Ahtziri; Miller, Larry E

    2017-12-22

    Introduction Oblique lumbar interbody fusion (OLIF) is a newer procedure that avoids the psoas and lumbosacral plexus due to its oblique trajectory into the retroperitoneal space. While early experience with OLIF is reassuring, the longer-term clinical efficacy has not been well established. The purpose of this study was to describe two-year clinical outcomes with OLIF performed by a single surgeon during the learning curve without the aid of the neuromonitoring. Materials and methods Chart review was performed for the consecutive patients who underwent OLIF by a single surgeon. Back pain severity on a visual analog scale (VAS) and Oswestry Disability Index (ODI) were collected preoperatively and postoperatively at six weeks, three months, six months, one year and two years. Results A total of 21 patients (38 levels) were included in this study. The indications for surgery were degenerative disc disease (n=10, 47.6%), spondylolisthesis (n=9, 42.9%) and spinal stenosis (n=6, 28.6%). The median operating room time was 351 minutes (interquartile range (IQR): 279-406 minutes), blood loss was 40 ml (IQR: 30-150 ml), and hospital stay was 2.0 days (IQR: 1.0-3.5 days). The complication rate was 9.5%, both venous injuries. There were no other perioperative complications. Back pain severity decreased by 70%, on average, over two years (p safe and clinically efficacious for up to two years. The complication rate in this cohort is similar to other published OLIF series and appears acceptable when compared to the lateral lumbar interbody fusion (LLIF) and the anterior lumbar interbody fusion (ALIF). No motor or sensory deficits were observed in this study, supporting the premise that the neuromonitoring is unnecessary in OLIF.

  13. Bilateral recurrent laryngeal nerve injury in total thyroidectomy with or without intraoperative neuromonitoring. Systematic review and meta-analysis.

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    Pardal-Refoyo, José Luis; Ochoa-Sangrador, Carlos

    2016-01-01

    The risk of producing bilateral laryngeal paralysis (BLP) in total thyroidectomy (TT) is low, but it is a concern for the surgeon and a serious safety incident that may compromise the airway, require reintubation or tracheostomy and cause serious sequelae or death. Neuromonitoring (NM), as an early diagnostic tool for the existence of injury to the recurrent laryngeal nerve (RLN), has not been shown to have reduced the risk, even though published series show lower incidences. Our objective was to estimate the risk of bilateral RLN paralysis with and without NM TT by systematic review and meta-analysis. We performed a systematic review of clinical trials, cohort studies and case series with total thyroidectomy without NM published in the period 2000-2014. A database search was performed using PubMed, Scopus (EMBASE) and the Cochrane Library. Heterogeneity between studies was explored and weighted risks grouped according to random effects models were estimated. We selected 40 articles and estimates of risk were identified in 54 case series (without NM, 25; with NM, 29) with 30,922 patients. The prevalence of BLP in the series with NM was lower compared to that without NM (2.43‰, [1.55 to 3.5‰] versus 5.18‰ [2.53 to 8.7‰]). This difference is equivalent to an absolute risk reduction of 2.75‰ with a number needed to treat of 364.13. The NM group was more homogeneous (I2=7.52%) than those without NM (I2=79.32%). The observed differences in the subgroup analysis were very imprecise because the number of observed paralysis was very low. The risk of bilateral paralysis is lower in studies with neuromonitoring. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  14. Intraoperative high-field magnetic resonance imaging, multimodal neuronavigation, and intraoperative electrophysiological monitoring-guided surgery for treating supratentorial cavernomas.

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    Li, Fang-Ye; Chen, Xiao-Lei; Xu, Bai-Nan

    2016-09-01

    To determine the beneficial effects of intraoperative high-field magnetic resonance imaging (MRI), multimodal neuronavigation, and intraoperative electrophysiological monitoring-guided surgery for treating supratentorial cavernomas. Twelve patients with 13 supratentorial cavernomas were prospectively enrolled and operated while using a 1.5 T intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. All cavernomas were deeply located in subcortical areas or involved critical areas. Intraoperative high-field MRIs were obtained for the intraoperative "visualization" of surrounding eloquent structures, "brain shift" corrections, and navigational plan updates. All cavernomas were successfully resected with guidance from intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. In 5 cases with supratentorial cavernomas, intraoperative "brain shift" severely deterred locating of the lesions; however, intraoperative MRI facilitated precise locating of these lesions. During long-term (>3 months) follow-up, some or all presenting signs and symptoms improved or resolved in 4 cases, but were unchanged in 7 patients. Intraoperative high-field MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring are helpful in surgeries for the treatment of small deeply seated subcortical cavernomas.

  15. Intraoperative Vascular Neuromonitoring in Patients with Subarachnoid Hemorrhage: A Pilot Study Using Combined Laser-Doppler Spectrophotometry.

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    Schmitz, Emilija; Bischoff, Barbara; Wolf, Dennis; Schmitt, Hubert J; Eyupoglu, Ilker Y; Roessler, Karl; Buchfelder, Michael; Sommer, Björn

    2017-11-01

    Intraoperative monitoring of cerebral microcirculation in patients with subarachnoid hemorrhage (SAH) may predict the postoperative neurologic outcome. In this pilot study, we examined the value of a novel noninvasive real-time measurement technique for detecting changes in local microcirculation. We used the O2C (Oxygen to see) laser-Doppler spectrophotometry system in 14 patients with Hunt & Hess grade 2-5 SAH who underwent microsurgical cerebral aneurysm clipping. A subdural probe recorded capillary venous oxygenation (SO 2 ), relative hemoglobin concentration, blood cell velocity, and blood flow at a tissue depth of 7 mm. Data were recorded immediately before dural closure. We also recorded somatosensory evoked potentials (SEPs) with median and tibial nerve stimulation. Results were compared with neurologic performance, as measured on the modified Rankin Scale, at the day of discharge from the hospital and 12 months thereafter. Patient functional outcomes after discharge and 12 months were correlated with pathological decreased flow and increased SO 2 values. In 6 of 8 patients, microcirculatory monitoring parameters indicated ischemia during surgery, as shown by electrophysiological SEP changes and infarction detected on the postoperative computed tomography (CT) scan. Pathological SEP results correlated closely with infarct demarcation as seen on CT. Our results indicate the potential benefit of intraoperative combined laser-Doppler flowmetry and spectrophotometry for predicting postoperative clinical outcomes in this small patient sample. Larger-cohort testing is needed to verify our findings and show the possible merits of this novel method. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Integrating multimodal information for intraoperative assistance in neurosurgery

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    Eisenmann U.

    2015-09-01

    Full Text Available Computer-assisted planning of complex neurosurgical interventions benefits from a variety of specific functions and tools. However, commercial planning- and neuronavigation systems are rather restrictive concerning the availability of innovative methods such as novel imaging modalities, fiber tracking algorithms or electrical dipole mapping. In this respect there is a demand for modular neurosurgical planning systems offering flexible interfaces for easy enhancement. Furthermore all relevant planning information should be available within neuron-avigation. In this work we present a planning system providing these capabilities and its suitability and application in a clinical setting. Our Multimodal Planning System (MOPS 3D offers a variety of tools such as definition of trajectories for minimally invasive surgery, segmentation of ROIs, integration of functional information from atlas maps or magnetoencephalography. It also supplies plugin interfaces for future extensions. For intraoperative application MOPS is coupled with the neuronavigation system Brainlab Vector Vision Cranial/ENT (VVC. We evaluated MOPS in the Department of Neurosurgery at the University Hospital Heidelberg. Surgical planning and navigation was performed in 5 frequently occurring clinical cases. The time necessary for planning was between 5 and 15 minutes including data import, segmentation and planning tasks. The additional information intraoperatively provided by MOPS 3D was highly appreciated by the neurosurgeons and the performance was satisfactory.

  17. Stereoscopic Integrated Imaging Goggles for Multimodal Intraoperative Image Guidance.

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    Christopher A Mela

    Full Text Available We have developed novel stereoscopic wearable multimodal intraoperative imaging and display systems entitled Integrated Imaging Goggles for guiding surgeries. The prototype systems offer real time stereoscopic fluorescence imaging and color reflectance imaging capacity, along with in vivo handheld microscopy and ultrasound imaging. With the Integrated Imaging Goggle, both wide-field fluorescence imaging and in vivo microscopy are provided. The real time ultrasound images can also be presented in the goggle display. Furthermore, real time goggle-to-goggle stereoscopic video sharing is demonstrated, which can greatly facilitate telemedicine. In this paper, the prototype systems are described, characterized and tested in surgeries in biological tissues ex vivo. We have found that the system can detect fluorescent targets with as low as 60 nM indocyanine green and can resolve structures down to 0.25 mm with large FOV stereoscopic imaging. The system has successfully guided simulated cancer surgeries in chicken. The Integrated Imaging Goggle is novel in 4 aspects: it is (a the first wearable stereoscopic wide-field intraoperative fluorescence imaging and display system, (b the first wearable system offering both large FOV and microscopic imaging simultaneously,

  18. Multimodal correlation and intraoperative matching of virtual models in neurosurgery

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    Ceresole, Enrico; Dalsasso, Michele; Rossi, Aldo

    1994-01-01

    The multimodal correlation between different diagnostic exams, the intraoperative calibration of pointing tools and the correlation of the patient's virtual models with the patient himself, are some examples, taken from the biomedical field, of a unique problem: determine the relationship linking representation of the same object in different reference frames. Several methods have been developed in order to determine this relationship, among them, the surface matching method is one that gives the patient minimum discomfort and the errors occurring are compatible with the required precision. The surface matching method has been successfully applied to the multimodal correlation of diagnostic exams such as CT, MR, PET and SPECT. Algorithms for automatic segmentation of diagnostic images have been developed to extract the reference surfaces from the diagnostic exams, whereas the surface of the patient's skull has been monitored, in our approach, by means of a laser sensor mounted on the end effector of an industrial robot. An integrated system for virtual planning and real time execution of surgical procedures has been realized.

  19. A comparison between succinylcholine and rocuronium on the recovery profile of the laryngeal muscles during intraoperative neuromonitoring of the recurrent laryngeal nerve: A prospective porcine model

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    I-Cheng Lu

    2013-09-01

    Full Text Available The use of succinylcholine and rocuronium are reportedly feasible during intraoperative neuromonitoring (IONM of the recurrent laryngeal nerve (RLN in thyroid surgery. This study aimed to investigate and compare the recovery profiles of succinylcholine and rocuronium on the laryngeal muscle during IONM of the RLN in a porcine model. Nine male Duroc-Landrace piglets were anesthetized with thiamylal and underwent tracheal intubation without neuromuscular blocking agents (NMBAs. Needle electrodes were inserted into the vocalis muscles through the cricothyroid ligament. The RLN was exposed and stimulated. Electromyographic (EMG signals were obtained before and after the intravenous administration of a NMBA. The EMG amplitudes were measured before and after (at 1-minute intervals the administration of the study drug until complete recovery. The study NMBA regimen included succinylcholine (1 mg/kg, low-dose rocuronium (0.3 mg/kg, and standard dose rocuronium (0.6 mg/kg. The maximal neuromuscular blockade and 80% recovery (i.e., duration of the control responses were recorded and analyzed. The 80% recovery of the control response for succinylcholine (1 mg/kg was 19.7 ± 1.5 minutes; low-dose rocuronium (0.3 mg/kg, 16.3 ± 2.5 minutes; and standard dose rocuronium (0.6 mg/kg, 29.3 ± 5.7 minutes. Succinylcholine (1 mg/kg and low-dose rocuronium (0.3 mg/kg had significantly shorter durations than standard dose rocuronium (0.6 mg/kg. The EMG signal recovery returned to baseline within 30 minutes in the succinylcholine and low-dose rocuronium groups, but it did not return to baseline until 1 hour after surgery in the rocuronium (0.6 mg/kg group. In this study, succinylcholine (1 mg/kg and low-dose rocuronium (0.3 mg/kg had favorable recovery profiles on the laryngeal muscle. It is recommended that low-dose rocuronium may replace succinylcholine for the induction of general anesthesia during IONM of the RLN in thyroid surgery.

  20. A comparison between succinylcholine and rocuronium on the recovery profile of the laryngeal muscles during intraoperative neuromonitoring of the recurrent laryngeal nerve: a prospective porcine model.

    Science.gov (United States)

    Lu, I-Cheng; Chang, Pi-Ying; Hsu, Hung-Te; Tseng, Kuang-Yi; Wu, Che-Wei; Lee, Ka-Wo; Ho, Kuen-Yao; Chiang, Feng-Yu

    2013-09-01

    The use of succinylcholine and rocuronium are reportedly feasible during intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) in thyroid surgery. This study aimed to investigate and compare the recovery profiles of succinylcholine and rocuronium on the laryngeal muscle during IONM of the RLN in a porcine model. Nine male Duroc-Landrace piglets were anesthetized with thiamylal and underwent tracheal intubation without neuromuscular blocking agents (NMBAs). Needle electrodes were inserted into the vocalis muscles through the cricothyroid ligament. The RLN was exposed and stimulated. Electromyographic (EMG) signals were obtained before and after the intravenous administration of a NMBA. The EMG amplitudes were measured before and after (at 1-minute intervals) the administration of the study drug until complete recovery. The study NMBA regimen included succinylcholine (1 mg/kg), low-dose rocuronium (0.3 mg/kg), and standard dose rocuronium (0.6 mg/kg). The maximal neuromuscular blockade and 80% recovery (i.e., duration) of the control responses were recorded and analyzed. The 80% recovery of the control response for succinylcholine (1 mg/kg) was 19.7 ± 1.5 minutes; low-dose rocuronium (0.3 mg/kg), 16.3 ± 2.5 minutes; and standard dose rocuronium (0.6 mg/kg), 29.3 ± 5.7 minutes. Succinylcholine (1 mg/kg) and low-dose rocuronium (0.3 mg/kg) had significantly shorter durations than standard dose rocuronium (0.6 mg/kg). The EMG signal recovery returned to baseline within 30 minutes in the succinylcholine and low-dose rocuronium groups, but it did not return to baseline until 1 hour after surgery in the rocuronium (0.6 mg/kg) group. In this study, succinylcholine (1 mg/kg) and low-dose rocuronium (0.3 mg/kg) had favorable recovery profiles on the laryngeal muscle. It is recommended that low-dose rocuronium may replace succinylcholine for the induction of general anesthesia during IONM of the RLN in thyroid surgery. Copyright © 2013. Published by

  1. Intraoperative Neurophysiological Monitoring for Endoscopic Endonasal Approaches to the Skull Base: A Technical Guide

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    Harminder Singh

    2016-01-01

    Full Text Available Intraoperative neurophysiological monitoring during endoscopic, endonasal approaches to the skull base is both feasible and safe. Numerous reports have recently emerged from the literature evaluating the efficacy of different neuromonitoring tests during endonasal procedures, making them relatively well-studied. The authors report on a comprehensive, multimodality approach to monitoring the functional integrity of at risk nervous system structures, including the cerebral cortex, brainstem, cranial nerves, corticospinal tract, corticobulbar tract, and the thalamocortical somatosensory system during endonasal surgery of the skull base. The modalities employed include electroencephalography, somatosensory evoked potentials, free-running and electrically triggered electromyography, transcranial electric motor evoked potentials, and auditory evoked potentials. Methodological considerations as well as benefits and limitations are discussed. The authors argue that, while individual modalities have their limitations, multimodality neuromonitoring provides a real-time, comprehensive assessment of nervous system function and allows for safer, more aggressive management of skull base tumors via the endonasal route.

  2. Multimodal Imaging Nanoparticles Derived from Hyaluronic Acid for Integrated Preoperative and Intraoperative Cancer Imaging

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    William M. Payne

    2017-01-01

    Full Text Available Surgical resection remains the most promising treatment strategy for many types of cancer. Residual malignant tissue after surgery, a consequence in part due to positive margins, contributes to high mortality and disease recurrence. In this study, multimodal contrast agents for integrated preoperative magnetic resonance imaging (MRI and intraoperative fluorescence image-guided surgery (FIGS are developed. Self-assembled multimodal imaging nanoparticles (SAMINs were developed as a mixed micelle formulation using amphiphilic HA polymers functionalized with either GdDTPA for T1 contrast-enhanced MRI or Cy7.5, a near infrared fluorophore. To evaluate the relationship between MR and fluorescence signal from SAMINs, we employed simulated surgical phantoms that are routinely used to evaluate the depth at which near infrared (NIR imaging agents can be detected by FIGS. Finally, imaging agent efficacy was evaluated in a human breast tumor xenograft model in nude mice, which demonstrated contrast in both fluorescence and magnetic resonance imaging.

  3. Multimodal treatment utilizing intraoperative radiotherapy for advanced cancer of the pancreas

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    Onodera, Tokio

    1982-01-01

    A multimodal treatment was consisted of intraoperative radiation, external radiation, by-pass operation, chemotherapy and total parenteral nutrition if necessary to cover decreased oral-intake. Thirty-three cases were subjected to this therapy for 6 years. The stage of the tumors varied from a localized tumor in the pancreas to a huge tumor with multiple metastases, though the latter abandoned recently to be contraindication to this therapy. At laparotomy, a high energy electron beam was irradiated to the tumor with a dosage of 3,000 rad using a 20 MeV Betatron. The tumor was carefully prepared in order to avoid irradiating the duodenum and stomach. Choledochojejunostomy and gastrojejunostomy were performed in almost all of patients with cancer of head of pancreas. In some patients, external radiation was added with a dosage of 3,000 rad by linear X-ray. After radiotherapy, chemotherapy employing 5-FU or FT-207 was continued including. The survival time after this therapy was varied mainly according to the stages of the tumor. In patients with multiple metastasis to the liver or peritoneal dissemination, no remarkable effects were obtained by this therapy. On the otherhand, among 14 patients with localized tumor in the pancreas, 7 survived more than one year and the mean survival time of treated patients was nevershorter than that of patients who received resection of the tumor. Most of the treated patients could spend at home until their condition became critical, because by-pass operation could overcome jaundice or the duodenal stenosis and intraoperative radiation could palliate the pain of cancer of pancreas. Tumor effect of intraoperative radiation was confirmed by both of the second laporatomy for twice intraoperative radiation and laparatomy. (author)

  4. Repeated sugammadex reversal of muscle relaxation during lumbar spine surgery with intraoperative neurophysiological multimodal monitoring.

    Science.gov (United States)

    Errando, C L; Blanco, T; Díaz-Cambronero, Ó

    2016-11-01

    Intraoperative neurophysiological monitoring during spine surgery is usually acomplished avoiding muscle relaxants. A case of intraoperative sugammadex partial reversal of the neuromuscular blockade allowing adequate monitoring during spine surgery is presented. A 38 year-old man was scheduled for discectomy and vertebral arthrodesis throughout anterior and posterior approaches. Anesthesia consisted of total intravenous anesthesia plus rocuronium. Intraoperatively monitoring was needed, and the muscle relaxant reverted twice with low dose sugammadex in order to obtain adequate responses. The doses of sugammadex used were conservatively selected (0.1mg/kg boluses increases, total dose needed 0.4mg/kg). Both motor evoqued potentials, and electromyographic responses were deemed adequate by the neurophysiologist. If muscle relaxation was needed in the context described, this approach could be useful to prevent neurological sequelae. This is the first study using very low dose sugammadex to reverse rocuronium intraoperatively and to re-establish the neuromuscular blockade. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Multimodal analgesic treatment in video-assisted thoracic surgery lobectomy using an intraoperative intercostal catheter

    DEFF Research Database (Denmark)

    Wildgaard, Kim; Petersen, Rene H; Hansen, Henrik J

    2012-01-01

    OBJECTIVES: No golden standard for analgesia in video-assisted thoracic surgery (VATS) lobectomy exists. A simple multimodal approach using an intercostal catheter (ICC) may be of benefit since acute post-operative pain following VATS lobectomy primarily originates from the chest drain area......) and inserted an ICC at the drain site level for continuous delivery of 6 ml of 0.25% bupivacaine h(-1). Pain scores at rest, mobilization and with the extended arms were followed until discharge or for 4 days. RESULTS: Forty-eight patients, mean age 64 years (CI: 61-68), were included. The mean time...... for the PVB and ICC placement was 5 min (CI: 4.7-5.9). The mean pain score at rest using a numerical rating scale (NRS, 0-10) was 85% of patients reporting satisfactory or very satisfactory pain treatment all days. CONCLUSIONS: Acute pain after VATS lobectomy may be adequately controlled using a multimodal...

  6. Evaluation of multimodality treatment for advanced pancreatic cancer. Special reference to intraoperative vs. external radiation therapy

    International Nuclear Information System (INIS)

    Wakasugi, Hideyuki; Funakoshi, Akihiro; Seo, Yousuke; Iguchi, Haruo; Wada, Susumu

    1999-01-01

    Intraoperative radiation therapy (IORT)+postoperative external beam radiation therapy (ERT) with chemotherapy and ERT alone with chemotherapy have been performed in our hospital for unresectable, especially locally advanced, pancreatic cancer. We compared the former method with the latter. Chemotherapy was performed together with radiation, using 5-FU, CDDP, and MMC. IORT+ERT was successful in only half of the treated patients, while ERT alone was successful in almost all of the patients. As a result, the doses of radiation were often shorter in patients treated by the former method compared to the latter method. Both methods, when completed for locally advanced pancreatic cancer (stage IVa), produced good effects on tumor markers, tumor size and pain. Furthermore, the latter method was better than the former in improving the survival time and quality of life (QOL). Therefore, ERT is a practical and useful method for patients with locally advanced pancreatic cancer. (author)

  7. Multimodality

    DEFF Research Database (Denmark)

    Buhl, Mie

    2010-01-01

    In this paper, I address an ongoing discussion in Danish E-learning research about how to take advantage of the fact that digital media facilitate other communication forms than text, so-called ‘multimodal' communication, which should not be confused with the term ‘multimedia'. While multimedia...... on their teaching and learning situations. The choices they make involve e-learning resources like videos, social platforms and mobile devices, not just as digital artefacts we interact with, but the entire practice of using digital media. In a life-long learning perspective, multimodality is potentially very...

  8. Multimodality

    DEFF Research Database (Denmark)

    Buhl, Mie

    In this paper, I address an ongoing discussion in Danish E-learning research about how to take advantage of the fact that digital media facilitate other communication forms than text, so-called ‘multimodal’ communication, which should not be confused with the term ‘multimedia’. While multimedia...... and learning situations. The choices they make involve E-learning resources like videos, social platforms and mobile devices, not just as digital artefacts we interact with, but the entire practice of using digital media. In a life-long learning perspective, multimodality is potentially very useful...

  9. The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas: early experience in the Advanced Multimodality Image Guided Operating suite

    Science.gov (United States)

    Zaidi, Hasan A.; De Los Reyes, Kenneth; Barkhoudarian, Garni; Litvack, Zachary N.; Bi, Wenya Linda; Rincon-Torroella, Jordina; Mukundan, Srinivasan; Dunn, Ian F.; Laws, Edward R.

    2016-01-01

    Objective Endoscopic skull base surgery has become increasingly popular among the skull base surgery community, with improved illumination and angled visualization potentially improving tumor resection rates. Intraoperative MRI (iMRI) is used to detect residual disease during the course of the resection. This study is an investigation of the utility of 3-T iMRI in combination with transnasal endoscopy with regard to gross-total resection (GTR) of pituitary macroadenomas. Methods The authors retrospectively reviewed all endoscopic transsphenoidal operations performed in the Advanced Multimodality Image Guided Operating (AMIGO) suite from November 2011 to December 2014. Inclusion criteria were patients harboring presumed pituitary macroadenomas with optic nerve or chiasmal compression and visual loss, operated on by a single surgeon. Results Of the 27 patients who underwent transsphenoidal resection in the AMIGO suite, 20 patients met the inclusion criteria. The endoscope alone, without the use of iMRI, would have correctly predicted 13 (65%) of 20 cases. Gross-total resection was achieved in 12 patients (60%) prior to MRI. Intraoperative MRI helped convert 1 STR and 4 NTRs to GTRs, increasing the number of GTRs from 12 (60%) to 16 (80%). Conclusions Despite advances in visualization provided by the endoscope, the incidence of residual disease can potentially place the patient at risk for additional surgery. The authors found that iMRI can be useful in detecting unexpected residual tumor. The cost-effectiveness of this tool is yet to be determined. PMID:26926058

  10. Medical Error Avoidance in Intraoperative Neurophysiological Monitoring: The Communication Imperative.

    Science.gov (United States)

    Skinner, Stan; Holdefer, Robert; McAuliffe, John J; Sala, Francesco

    2017-11-01

    Error avoidance in medicine follows similar rules that apply within the design and operation of other complex systems. The error-reduction concepts that best fit the conduct of testing during intraoperative neuromonitoring are forgiving design (reversibility of signal loss to avoid/prevent injury) and system redundancy (reduction of false reports by the multiplication of the error rate of tests independently assessing the same structure). However, error reduction in intraoperative neuromonitoring is complicated by the dichotomous roles (and biases) of the neurophysiologist (test recording and interpretation) and surgeon (intervention). This "interventional cascade" can be given as follows: test → interpretation → communication → intervention → outcome. Observational and controlled trials within operating rooms demonstrate that optimized communication, collaboration, and situational awareness result in fewer errors. Well-functioning operating room collaboration depends on familiarity and trust among colleagues. Checklists represent one method to initially enhance communication and avoid obvious errors. All intraoperative neuromonitoring supervisors should strive to use sufficient means to secure situational awareness and trusted communication/collaboration. Face-to-face audiovisual teleconnections may help repair deficiencies when a particular practice model disallows personal operating room availability. All supervising intraoperative neurophysiologists need to reject an insular or deferential or distant mindset.

  11. Selective pelvic autonomic nerve stimulation with simultaneous intraoperative monitoring of internal anal sphincter and bladder innervation.

    Science.gov (United States)

    Kneist, W; Kauff, D W; Koch, K P; Schmidtmann, I; Heimann, A; Hoffmann, K P; Lang, H

    2011-01-01

    Pelvic autonomic nerve preservation avoids postoperative functional disturbances. The aim of this feasibility study was to develop a neuromonitoring system with simultaneous intraoperative verification of internal anal sphincter (IAS) activity and intravesical pressure. 14 pigs underwent low anterior rectal resection. During intermittent bipolar electric stimulation of the inferior hypogastric plexus (IHP) and the pelvic splanchnic nerves (PSN), electromyographic signals of the IAS and manometry of the urinary bladder were observed simultaneously. Stimulation of IHP and PSN as well as simultaneous intraoperative monitoring could be realized with an adapted neuromonitoring device. Neurostimulation resulted in either bladder or IAS activation or concerted activation of both. Intravesical pressure increase as well as amplitude increase of the IAS neuromonitoring signal did not differ significantly between stimulation of IHP and PSN [6.0 cm H(2)O (interquartile range [IQR] 3.5-9.0) vs. 6.0 cm H(2)O (IQR 3.0-10.0) and 12.1 μV (IQR 3.0-36.7) vs. 40.1 μV (IQR 9.0-64.3)] (p > 0.05). Pelvic autonomic nerve stimulation with simultaneous intraoperative monitoring of IAS and bladder innervation is feasible. The method may enable neuromonitoring with increasing selectivity for pelvic autonomic nerve preservation. Copyright © 2011 S. Karger AG, Basel.

  12. [Does intraoperative nerve monitoring reduce the rate of recurrent nerve palsies during thyroid surgery?].

    Science.gov (United States)

    Timmermann, W; Dralle, H; Hamelmann, W; Thomusch, O; Sekulla, C; Meyer, Th; Timm, S; Thiede, A

    2002-05-01

    Two different aspects of the influence of neuromonitoring on the possible reduction of post-operative recurrent laryngeal nerve palsies require critical examination: the nerve identification and the monitoring of it's functions. Due to the additional information from the EMG signals, neuromonitoring is the best method for identifying the nerves as compared to visual identification alone. There are still no randomized studies available that compare the visual and electrophysiological recurrent laryngeal nerve detection in thyroid operations with respect to the postoperative nerve palsies. Nevertheless, comparisons with historical collectives show that a constant low nerve-palsy-rate was achieved with electrophysiological detection in comparison to visual detection. The rate of nerve identification is normally very high and amounts to 99 % in our own patients. The data obtained during the "Quality assurance of benign and malignant Goiter" study show that in hemithyreoidectomy and subtotal resection, lower nerve-palsy-rates are achieved with neuromonitoring as compared to solely visual detection. Following subtotal resection, this discrepancy becomes even statistically significant. While monitoring the nerve functions with the presently used neuromonitoring technique, it is possible to observe the EMG-signal remaining constant or decreasing in volume. Assuming that a constant neuromonitoring signal represents a normal vocal cord, our evaluation shows that there is a small percentage of false negative and positive results. Looking at the permanent recurrent nerve palsy rates, this method has a specificity of 98 %, a sensitivity of 100 %, a positive prognostic value of 10 %, and a negative prognostic value of 100 %. Although an altered neuromonitoring signal can be taken as a clear indication of eventual nerve damage, an absolutely reliable statement about the postoperative vocal cord function is presently not possible with intraoperative neuromonitoring.

  13. Recommendations on the use of neuromonitoring in thyroid and parathyroid surgery.

    Science.gov (United States)

    Pardal-Refoyo, José Luis; Parente-Arias, Pablo; Arroyo-Domingo, Marta María; Maza-Solano, Juan Manuel; Granell-Navarro, José; Martínez-Salazar, Jesús María; Moreno-Luna, Ramón; Vargas-Yglesias, Elvylins

    2017-09-14

    Thyroid and parathyroid surgery (TPTS) is associated with risk of injury to the recurrent laryngeal nerve, superior laryngeal nerve and voice changes. Intraoperative neuromonitoring (IONM), intermittent or continuous, evaluates the functional state of the laryngeal nerves and is being increasingly used. This means that points of consensus on the most controversial aspects are necessary. To develop a support document for guidance on the use of IONM in TPTS. Work group consensus through systematic review and the Delphi method. Seven sections were identified on which points of consensus were identified: indications, equipment, technique (programming and registration parameters), behaviour on loss of signal, laryngoscopy, voice and legal implications. IONM helps in the location and identification of the recurrent laryngeal nerve, helps during its dissection, reports on its functional status at the end of surgery and enables decision-making in the event of loss of signal in the first operated side in a scheduled bilateral thyroidectomy or previous contralateral paralysis. The accuracy of IONM depends on variables such as accomplished technique, technology and training in the correct execution of the technique and interpretation of the signal. This document is a starting point for future agreements on TPTS in each of the sections of consensus. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  14. Hemodynamic and neuro-monitoring for neurocritically ill patients: An international survey of intensivists.

    Science.gov (United States)

    Sivakumar, Sanjeev; Taccone, Fabio S; Rehman, Mohammed; Hinson, Holly; Naval, Neeraj; Lazaridis, Christos

    2017-06-01

    To investigate multimodality systemic and neuro-monitoring practices in acute brain injury (ABI) and to analyze differences among "neurointensivists" (NI; clinical practice comprised >1/3 by neurocritical care), and other intensivists (OI). Anonymous 22-question Web-based survey among physician members of SCCM and ESICM. Six hundred fifty-five responded (66% completion rate); 422 (65%) were OI, and 226 (35%) were NI. More NI follow hemodynamic protocols for TBI (44.5% vs 33%, P=.007) and SAH (38% vs 21%, P<.001). For CPP optimization, NI use more arterial-waveform-analysis (AWA) (45% vs 35%, P=.019), and ultrasound (37.5% vs 28%, P=.023); NI use more PbtO 2 (28% vs 10%, P<.001). In the case scenario of raised ICP/low PbtO 2 , most employ analgesia and/or sedation (47%) and osmotherapy (38%). More NI use pressure reactivity (vasopressor use OI 23% vs NI 34.5%, P=.014). For DCI, more NI target cardiac index (CI) (35% vs 21%, P<.001), and fluid responsiveness (62.5% vs 53%, P=.03). Also, NI use more angiography (57% vs 43.5%, P=.004), TCD (56.5% vs 38%, P<.001), CTP (32% vs16%, P<.001), and PbtO 2 (18% vs 7.5%, P=.001). Intensivists with exposure to ABI patients employ more neuro- and hemodynamic monitoring. We found large heterogeneity and low overall use of advanced brain-physiology parameters. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Intraoperative nerve monitoring in laryngotracheal surgery.

    Science.gov (United States)

    Bolufer, Sergio; Coves, María Dolores; Gálvez, Carlos; Villalona, Gustavo Adolfo

    Laryngotracheal surgery has an inherent risk of injury to the recurrent laryngeal nerves (RLN). These complications go from minor dysphonia to even bilateral vocal cord paralysis. The intraoperative neuromonitoring of the RLN was developed in the field of thyroid surgery, in order to preserve nerve and vocal cord function. However, tracheal surgery requires in-field intubation of the distal trachea, which limits the use of nerve monitoring using conventional endotracheal tube with surface electrodes. Given these challenges, we present an alternative method for nerve monitoring during laryngotracheal surgery through the insertion of electrodes within the endolaryngeal musculature by bilateral puncture. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Value of intraoperative radiotherapy in locally advanced rectal cancer

    NARCIS (Netherlands)

    Ferenschild, Floris T. J.; Vermaas, Maarten; Nuyttens, Joost J. M. E.; Graveland, Wilfried J.; Marinelli, Andreas W. K. S.; van der Sijp, Joost R.; Wiggers, Theo; Verhoef, Cornelis; Eggermont, Alexander M. M.; de Wilt, Johannes H. W.

    PURPOSE: This study was designed to analyze the results of a multimodality treatment using preoperative radiotherapy, followed by surgery and intraoperative radiotherapy in patients with primary locally advanced rectal cancer. METHODS: Between 1987 and 2002, 123 patients with initial unresectable

  17. Evidence and recommendation. Intermitent neuromonitoring in thyroid surgery is usefulness for reduction of recurrent nerve palsy?

    Directory of Open Access Journals (Sweden)

    José Luis PARDAL-REFOYO

    2017-03-01

    Full Text Available Introduction and objective: Clinical Question. In a patient with thyroid disease [patient], submitted to thyroidectomy [intervention], the use of neuromonitoring against the single visual identification of recurrent laryngeal nerve (RLN [comparison], offers advantages? [result]. Material and Methods: Literature review in PubMed, Scopus and Cochrane Library data descriptors and search strategy: (((((((laryngeal OR larynx AND nerve AND monitoring AND thyroidectomy AND meta-analysis. 10 items in English or Spanish of which 7 were selected for the qualitative study were obtained. Results: Level of evidence. Evidence for the lower incidence of transient unilateral paralysis in patients with neuromonitoring is moderate-high. Evidence on the lower incidence of permanent unilateral paralysis of RLN with NM is low. Evidence on the lower incidence of bilateral paralysis of RLN with neuromonitoring is low. Conclusions: Recommendation. Concerning the reduction of transient paralysis of the RLN the recommendation of the use of neuromonitoring in thyroid surgery is strongly in favor. Regarding permanent paralysis recommendation is weak in favor (no recommendation against. Regarding prevention of bilateral laryngeal paralysis recommendation for weak. The decision to use NM cannot be based on the incidence of RLN paralysis.

  18. Intraoperative electrocorticography

    Directory of Open Access Journals (Sweden)

    Gabriela Alcaraz

    2017-01-01

    Full Text Available Intraoperative electrocorticography (ECoG is the recording of electrophysiological activity from electrodes placed directly on the exposed surface of brain, during surgery for epilepsy and tumor resection. The ECoG is helpful in defining the seizure onset and spread within the cortical surface and delineation of the interface between epileptogenic zones and functional cortex substance of the brain. Intraoperative ECoG is an invasive procedure, it is performed during surgery mostly commonly during awake craniotomy but at times during general anaesthesia. As most anesthetic agents will affect ECoG, they should be minimized or stopped prior to any recording. Activation of intraoperative epileptiform activity may also be required if there are no spontaneous discharges. The appropriate management of the anesthetic during the time of ECoG is critical for its success. There are limitations and some controversies to all the uses of intraoperative ECoG, thus each center will set their own indications, criteria, and protocols.

  19. Intraoperative neurophysiological monitoring for the anaesthetist ...

    African Journals Online (AJOL)

    Intraoperative neurophysiological monitoring (IONM) has become the gold standard for the monitoring of functional nervous tissue and mapping of eloquent brain tissue during neurosurgical procedures. The multimodal use of somatosensory-evoked potentials and motor-evoked potentials ensures adequate monitoring of ...

  20. Continuous intraoperative monitoring of pelvic autonomic nerves during TME to prevent urogenital and anorectal dysfunction in rectal cancer patients (NEUROS): a randomized controlled trial

    International Nuclear Information System (INIS)

    Kauff, D. W.; Kronfeld, K; Gorbulev, S; Wachtlin, D; Lang, H; Kneist, W

    2016-01-01

    Urinary, sexual and anorectal sequelae are frequent after rectal cancer surgery and were found to be related to intraoperative neurogenic impairment. Neuromonitoring methods have been developed to identify and preserve the complex pelvic autonomic nervous system in order to maintain patients’ quality of life. So far no randomized study has been published dealing with the role of neuromonitoring in rectal cancer surgery. NEUROS is a prospective two-arm randomized controlled multicenter clinical trial comparing the functional outcome in rectal cancer patients undergoing total mesorectal excision (TME) with and without pelvic intraoperative neuromonitoring (pIONM). A total of 188 patients will be included. Primary endpoint is the urinary function measured by the International Prostate Symptom Score. Secondary endpoints consist of sexual, anorectal functional outcome and safety, especially oncologic safety and quality of TME. Sexual function is assessed in females with the Female Sexual Function Index and in males with the International Index of Erectile Function. For evaluation of anorectal function the Wexner-Vaizey score is used. Functional evaluation is scheduled before radiochemotherapy (if applicable), preoperatively (baseline), before hospital discharge, 3 and 6 months after stoma closure and 12 months after surgery. For assessment of safety adverse events, the rates of positive resection margins and quality of mesorectum are documented. This study will provide high quality evidence on the efficacy of pIONM aiming for improvement of functional outcome in rectal cancer patients undergoing TME. Clinicaltrials.gov: NCT01585727. Registration date is 04/25/2012

  1. Effect of intraoperative neuromonitoring on recurrent laryngeal nerve palsy rates after thyroid surgery—A meta-analysis

    Directory of Open Access Journals (Sweden)

    Shixing Zheng

    2013-08-01

    Conclusion: Based on this meta-analysis, statistically significant differences were determined in terms of the incidences of total and transient recurrent laryngeal nerve palsy after using IONM versus recurrent laryngeal nerve identification alone during thyroidectomy. However, no statistically significant differences were identified regarding the incidence of persistent recurrent laryngeal nerve palsy between groups.

  2. Multimodal brain monitoring in fulminant hepatic failure

    Science.gov (United States)

    Paschoal Jr, Fernando Mendes; Nogueira, Ricardo Carvalho; Ronconi, Karla De Almeida Lins; de Lima Oliveira, Marcelo; Teixeira, Manoel Jacobsen; Bor-Seng-Shu, Edson

    2016-01-01

    Acute liver failure, also known as fulminant hepatic failure (FHF), embraces a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction, and hepatic encephalopathy. Cerebral edema and intracranial hypertension are common causes of mortality in patients with FHF. The management of patients who present acute liver failure starts with determining the cause and an initial evaluation of prognosis. Regardless of whether or not patients are listed for liver transplantation, they should still be monitored for recovery, death, or transplantation. In the past, neuromonitoring was restricted to serial clinical neurologic examination and, in some cases, intracranial pressure monitoring. Over the years, this monitoring has proven insufficient, as brain abnormalities were detected at late and irreversible stages. The need for real-time monitoring of brain functions to favor prompt treatment and avert irreversible brain injuries led to the concepts of multimodal monitoring and neurophysiological decision support. New monitoring techniques, such as brain tissue oxygen tension, continuous electroencephalogram, transcranial Doppler, and cerebral microdialysis, have been developed. These techniques enable early diagnosis of brain hemodynamic, electrical, and biochemical changes, allow brain anatomical and physiological monitoring-guided therapy, and have improved patient survival rates. The purpose of this review is to discuss the multimodality methods available for monitoring patients with FHF in the neurocritical care setting. PMID:27574545

  3. Intraoperative radiation therapy

    International Nuclear Information System (INIS)

    Dobelbower Junior, R.R.

    1987-01-01

    A briefly history of intraoperative radiotherapy is presented. The equipment used is described and the treatment with superficial X-ray beams, orthovoltage X-ray beams and megavoltage electron beams are discussed. The effect on normal tissues and the clinical use of intraoperative radiotherapy in several Kind of cancer is studied. (M.A.C.) [pt

  4. Wave Change of Intraoperative Transcranial Motor-Evoked Potentials During Corrective Fusion for Syndromic and Neuromuscular Scoliosis.

    Science.gov (United States)

    Ando, Kei; Kobayashi, Kazuyoshi; Ito, Kenyu; Tsushima, Mikito; Morozumi, Masayoshi; Tanaka, Satoshi; Machino, Masaaki; Ota, Kyotaro; Nishida, Yoshihiro; Ishiguro, Naoki; Imagama, Shiro

    2018-03-29

    There is little information on intraoperative neuromonitoring during correction fusion surgery for syndromic scoliosis. To investigate intraoperative TcMEPs and conditions (body temperature and blood pressure) for syndromic scoliosis. The subjects were 23 patients who underwent 25 surgeries for corrective fusion using TcMEP. Patients were divided into groups based on a decrease (DA+) or no decrease (DA-) of the amplitude of the TcMEP waveform of ≥70%. The groups were compared for age, sex, disease, type of surgery, fusion area, operation time, estimated blood loss, body temperature, blood pressure, Cobb angle, angular curve (Cobb angle/number of vertebra), bending flexibility, correction rate, and recovery. The mean Cobb angles before and after surgery were 85.2° and 29.1°, giving a correction rate of 68.2%. There were 16 surgeries (64.0%) with intraoperative TcMEP wave changes. The DA+ and DA- groups had similar intraoperative conditions, but the short angular curve differed significantly between these groups. Amplitude deterioration occurred in 4 cases during first rod placement, in 8 during rotation, and in 3 during second rod placement after rotation. Seven patients had complete loss of TcMEP. However, most TcMEP changes recovered after pediclectomy or decreased correction. The preoperative angular curve differed significantly between patients with and without TcMEP changes (P corrective fusion, and all but one of these changes occurred during the correction procedure. The angular curve was a risk factor for intraoperative motor deficit.

  5. Neurodevelopmental Outcomes Following Regional Cerebral Perfusion with Neuromonitoring for Neonatal Aortic Arch Reconstruction

    Science.gov (United States)

    Andropoulos, Dean B.; Easley, R. Blaine; Brady, Ken; McKenzie, E. Dean; Heinle, Jeffrey S.; Dickerson, Heather A.; Shekerdemian, Lara S.; Meador, Marcie; Eisenman, Carol; Hunter, Jill V.; Turcich, Marie; Voigt, Robert G.; Fraser, Charles D.

    2013-01-01

    Background In this study we report magnetic resonance imaging (MRI) brain injury, and 12 month neurodevelopmental outcomes, when regional cerebral perfusion (RCP) is utilized for neonatal aortic arch reconstruction. Methods Fifty seven neonates receiving RCP during aortic arch reconstruction were enrolled in a prospective outcome study. RCP flows were determined by near-infrared spectroscopy and transcranial Doppler monitoring. Brain MRI were performed preoperatively and 7 days postoperatively. Bayley Scales of Infant Development III was performed at 12 months. Results Mean RCP time was 71 ± 28 minutes (range 5–121), mean flow 56.6 ± 10.6 ml/kg/min. New postoperative MRI brain injury was seen in 40% of patients. For 35 RCP patients at age 12 months, mean Bayley III composite standard scores were: Cognitive = 100.1 ± 14.6,(range 75–125); Language = 87.2 ± 15.0, (range 62–132); Motor = 87.9 ± 16.8, (range 58–121).Increasing duration of RCP was not associated with adverse neurodevelopmental outcomes. Conclusions Neonatal aortic arch repair with RCP utilizing a neuromonitoring strategy results in 12-month cognitive outcomes that are at reference population norms; language and motor outcomes are lower than the reference population norms by 0.8–0.9 standard deviation. This largest RCP group with neurodevelopmental outcomes published to date demonstrates that this technique is effective and safe in supporting the brain during neonatal aortic arch reconstruction. PMID:22766302

  6. [Intraoperative multidimensional visualization].

    Science.gov (United States)

    Sperling, J; Kauffels, A; Grade, M; Alves, F; Kühn, P; Ghadimi, B M

    2016-12-01

    Modern intraoperative techniques of visualization are increasingly being applied in general and visceral surgery. The combination of diverse techniques provides the possibility of multidimensional intraoperative visualization of specific anatomical structures. Thus, it is possible to differentiate between normal tissue and tumor tissue and therefore exactly define tumor margins. The aim of intraoperative visualization of tissue that is to be resected and tissue that should be spared is to lead to a rational balance between oncological and functional results. Moreover, these techniques help to analyze the physiology and integrity of tissues. Using these methods surgeons are able to analyze tissue perfusion and oxygenation. However, to date it is not clear to what extent these imaging techniques are relevant in the clinical routine. The present manuscript reviews the relevant modern visualization techniques focusing on intraoperative computed tomography and magnetic resonance imaging as well as augmented reality, fluorescence imaging and optoacoustic imaging.

  7. Multimodality and Ambient Intelligence

    NARCIS (Netherlands)

    Nijholt, Antinus; Verhaegh, W.; Aarts, E.; Korst, J.

    2004-01-01

    In this chapter we discuss multimodal interface technology. We present eexamples of multimodal interfaces and show problems and opportunities. Fusion of modalities is discussed and some roadmap discussions on research in multimodality are summarized. This chapter also discusses future developments

  8. Markerless registration for image guided surgery. Preoperative image, intraoperative video image, and patient

    International Nuclear Information System (INIS)

    Kihara, Tomohiko; Tanaka, Yuko

    1998-01-01

    Real-time and volumetric acquisition of X-ray CT, MR, and SPECT is the latest trend of the medical imaging devices. A clinical challenge is to use these multi-modality volumetric information complementary on patient in the entire diagnostic and surgical processes. The intraoperative image and patient integration intents to establish a common reference frame by image in diagnostic and surgical processes. This provides a quantitative measure during surgery, for which we have been relied mostly on doctors' skills and experiences. The intraoperative image and patient integration involves various technologies, however, we think one of the most important elements is the development of markerless registration, which should be efficient and applicable to the preoperative multi-modality data sets, intraoperative image, and patient. We developed a registration system which integrates preoperative multi-modality images, intraoperative video image, and patient. It consists of a real-time registration of video camera for intraoperative use, a markerless surface sampling matching of patient and image, our previous works of markerless multi-modality image registration of X-ray CT, MR, and SPECT, and an image synthesis on video image. We think these techniques can be used in many applications which involve video camera like devices such as video camera, microscope, and image Intensifier. (author)

  9. Neurodevelopmental outcomes after regional cerebral perfusion with neuromonitoring for neonatal aortic arch reconstruction.

    Science.gov (United States)

    Andropoulos, Dean B; Easley, R Blaine; Brady, Ken; McKenzie, E Dean; Heinle, Jeffrey S; Dickerson, Heather A; Shekerdemian, Lara S; Meador, Marcie; Eisenman, Carol; Hunter, Jill V; Turcich, Marie; Voigt, Robert G; Fraser, Charles D

    2013-02-01

    In this study we report magnetic resonance imaging (MRI) brain injury and 12-month neurodevelopmental outcomes when regional cerebral perfusion (RCP) is used for neonatal aortic arch reconstruction. Fifty-seven neonates receiving RCP during aortic arch reconstruction were enrolled in a prospective outcome study. RCP flows were determined by near-infrared spectroscopy and transcranial Doppler monitoring. Brain MRI was performed preoperatively and 7 days postoperatively. Bayley Scales of Infant Development III was performed at 12 months. Mean RCP time was 71 ± 28 minutes (range, 5 to 121 minutes) and mean flow was 56.6 ± 10.6 mL/kg/min. New postoperative MRI brain injury was seen in 40% of patients. For 35 RCP patients at age 12 months, mean Bayley Scales III Composite standard scores were: Cognitive, 100.1 ± 14.6 (range, 75 to 125); Language, 87.2 ± 15.0 (range, 62 to 132); and Motor, 87.9 ± 16.8 (range, 58 to 121). Increasing duration of RCP was not associated with adverse neurodevelopmental outcomes. Neonatal aortic arch repair with RCP using a neuromonitoring strategy results in 12-month cognitive outcomes that are at reference population norms. Language and motor outcomes are lower than the reference population norms by 0.8 to 0.9 standard deviations. The neurodevelopmental outcomes in this RCP cohort demonstrate that this technique is effective and safe in supporting the brain during neonatal aortic arch reconstruction. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Ambulatory EEG NeuroMonitor platform for engagement studies of children with development delays

    Science.gov (United States)

    Mahajan, Ruhi; Consul-Pacareu, Sergi; Abusaud, Mohammed; Sahadat, Md N.; Morshed, Bashir I.

    2013-05-01

    Engagement monitoring is crucial in many clinical and therapy applications such as early learning preschool classes for children with developmental delays including autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), or cerebral palsy; as it is challenging for the instructors to evaluate the individual responses of these children to determine the effectiveness of the teaching strategies due to the diverse and unique need of each child who might have difficulty in verbal or behavioral communication. This paper presents an ambulatory scalp electroencephalogram (EEG) NeuroMonitor platform to study brain engagement activities in natural settings. The developed platform is miniature (size: 2.2" x 0.8" x 0.36", weight: 41.8 gm with 800 mAh Li-ion battery and 3 snap leads) and low-power (active mode: 32 mA low power mode: under 5mA) with 2 channels (Fp1, Fp2) to record prefrontal cortex activities of the subject in natural settings while concealed within a headband. The signals from the electrodes are amplified with a low-power instrumentation amplifier; notch filtered (fc = 60Hz), then band-passed by a 2nd-order Chebyshev-I low-pass filter cascaded with a 2nd-order low-pass (fc = 125Hz). A PSoC ADC (16-bit, 256 sps) samples this filtered signal, and can either transmit it through a Class-2 Bluetooth transceiver to a remote station for real-time analysis or store it in a microSD card for offline processing. This platform is currently being evaluated to capture data in the classroom settings for engagement monitoring of children, aimed to study the effectiveness of various teaching strategies that will allow the development of personalized classroom curriculum for children with developmental delays.

  11. Intraoperative cranial nerve monitoring.

    Science.gov (United States)

    Harper, C Michel

    2004-03-01

    The purpose of intraoperative monitoring is to preserve function and prevent injury to the nervous system at a time when clinical examination is not possible. Cranial nerves are delicate structures and are susceptible to damage by mechanical trauma or ischemia during intracranial and extracranial surgery. A number of reliable electrodiagnostic techniques, including nerve conduction studies, electromyography, and the recording of evoked potentials have been adapted to the study of cranial nerve function during surgery. A growing body of evidence supports the utility of intraoperative monitoring of cranial nerve nerves during selected surgical procedures.

  12. Intraoperative ultrasound in neurosurgery

    International Nuclear Information System (INIS)

    Velasco, J.; Manzanares, R.; Fernandez, L.; Hernando, A.; Ramos, M. del Mar; Garcia, R.

    1996-01-01

    The present work is a review of the major indications for intraoperative ultrasound in the field of neurosurgery, stressing the exploratory method and describing what we consider to be the most illustrative cases. We attempt to provide a thorough view of this constantly developing technique which, despite its great practical usefulness, may be being underemployed. (Author) 47 refs

  13. Dorsal rhizotomy for children with spastic diplegia of cerebral palsy origin: usefulness of intraoperative monitoring.

    Science.gov (United States)

    Georgoulis, George; Brînzeu, Andrei; Sindou, Marc

    2018-04-13

    OBJECTIVE The utility of intraoperative neuromonitoring (ION), namely the study of muscle responses to radicular stimulation, remains controversial. The authors performed a prospective study combining ventral root (VR) stimulation for mapping anatomical levels and dorsal root (DR) stimulation as physiological testing of metameric excitability. The purpose was to evaluate to what extent the intraoperative data led to modifications in the initial decisions for surgical sectioning established by the pediatric multidisciplinary team (i.e., preoperative chart), and thus estimate its practical usefulness. METHODS Thirteen children with spastic diplegia underwent the following surgical protocol. First, a bilateral intradural approach was made to the L2-S2 VRs and DRs at the exit from or entry to their respective dural sheaths, through multilevel interlaminar enlarged openings. Second, stimulation-just above the threshold-of the VR at 2 Hz to establish topography of radicular myotome distribution, and then of the DR at 50 Hz as an excitability test of root circuitry, with independent identification of muscle responses by the physiotherapist and by electromyographic recordings. The study aimed to compare the final amounts of root sectioning-per radicular level, established after intraoperative neuromonitoring guidance-with those determined by the multidisciplinary team in the presurgical chart. RESULTS The use of ION resulted in differences in the final percentage of root sectioning for all root levels. The root levels corresponding to the upper lumbar segments were modestly excitable under DR stimulation, whereas progressively lower root levels displayed higher excitability. The difference between root levels was highly significant, as evaluated by electromyography (p = 0.00004) as well as by the physiotherapist (p = 0.00001). Modifications were decided in 11 of the 13 patients (84%), and the mean absolute difference in the percentage of sectioning quantity per radicular

  14. Intraoperative radiotherapy in primary rectal cancer; Intraoperative Radiotherapie des primaeren Rektumkarzinoms

    Energy Technology Data Exchange (ETDEWEB)

    Mund, Christian

    2013-06-17

    According to the results of several studies intraoperative radiotherapy seems to influence local control for primary rectal cancer in UICC-Stage II / III positively, though recommendations in therapy cannot be given as studies of high evidence level do not exist. As IORT is rarely available and makes patient recruitment difficult, prospective randomised trials have not been carried out yet. This emphasizes the importance of non-randomised trials for an evaluation of IORT. A comparison of 21 patients with locally advanced rectal cancer who had been treated with intraoperative radiation therapy and 21 similar cases without an application of IORT could not show any significant improvements in prognosis (recurrences, metastases and disease-specific survival). Nevertheless the employment of intraoperative radiation showed a trend in improvement of local control. This hast been shown by several other studies before. Thus the application of IORT in patients with locally advanced rectal cancer is considered a useful part in multimodal treatment and should further be evaluated in specialized centres. In case-control studies 1:1-matching leads to a good comparability of groups and renders conclusions of high internal validity possible. To gain a sufficient power, this type of trials should however primarily be carried out by centres with a high number of cases.

  15. Intraoperative definition of bottom-of-sulcus dysplasia using intraoperative ultrasound and single depth electrode recording - A technical note.

    Science.gov (United States)

    Miller, Dorothea; Carney, Patrick; Archer, John S; Fitt, Gregory J; Jackson, Graeme D; Bulluss, Kristian J

    2018-02-01

    Bottom of sulcus dysplasias (BOSDs) are localized focal cortical dysplasias (FCDs) centred on the bottom of a sulcus that can be highly epileptogenic, but difficult to delineate intraoperatively. We report on a patient with refractory epilepsy due to a BOSD, successfully resected with the aid of a multimodal surgical approach using neuronavigation based on MRI and PET, intraoperative ultrasound (iUS) and electrocorticography (ECoG) using depth electrodes. The lesion could be visualized on iUS showing an increase in echogenicity at the grey-white matter junction. IUS demonstrated the position of the depth electrode in relation to the lesion. Depth electrode recording showed almost continuous spiking. Thus, intraoperative imaging and electrophysiology helped confirm the exact location of the lesion. Post-resection ultrasound demonstrated the extent of the resection and depth electrode recording did not show any epileptiform activity. Thus, both techniques helped assess completeness of resection. The patient has been seizure free since surgery. Using a multimodal approach including iUS and ECoG is a helpful adjunct in surgery for BOSD and may improve seizure outcome. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Intraoperative local infiltration analgesia for early analgesia after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial

    DEFF Research Database (Denmark)

    Lunn, Troels H; Husted, Henrik; Solgaard, Søren

    2011-01-01

    : High-volume local infiltration analgesia (LIA) is widely applied as part of a multimodal pain management strategy in total hip arthroplasty (THA). However, methodological problems hinder the exact interpretation of previous trials, and the evidence for LIA in THA remains to be clarified....... Therefore, we evaluated whether intraoperative high-volume LIA, in addition to a multimodal oral analgesic regimen, would further reduce acute postoperative pain after THA....

  17. Visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy: what about the costs?

    Science.gov (United States)

    Dionigi, Gianlorenzo; Bacuzzi, Alessandro; Boni, Luigi; Rausei, Stefano; Rovera, Francesca; Dionigi, Renzo

    2012-04-01

    The objective of the present study was to evaluate costs for thyroidectomy performed with the aid of intraoperative neural monitoring (IONM), which has gained widespread acceptance during thyroid surgery as an adjunct to the gold standard of visual nerve identification. Through a micro-costing approach, the thyroidectomy patient-care process (with and without IONM) was analyzed by considering direct costs (staff time, consumables, equipment, drugs, operating room, and general expenses). Unit costs were collected from hospital accounting and standard tariff lists. To assess the impact of the IONM technology on hospital management, three macro-scenarios were considered: (1) traditional thyroidectomy; (2) thyroidectomy with IONM in a high-volume setting (5 procedures per week); and (3) thyroidectomy with IONM in a low-volume setting (1 procedure per week). Energy-based devices (EBD) for hemostasis and dissection in thyroidectomy were also evaluated, as well as the reimbursement made by the Italian Healthcare System on the basis of diagnosis related groups (DRGs), about €2,600. Comparison between costs and the DRG fee shows an underfunding of total hospitalization costs for all thyroidectomies, regardless of IONM use (scenario 1: €3,471). The main cost drivers are consumables and technologies (25%), operating room (16%), and staff (14%). Hospitalization costs for a thyroidectomy with IONM range from €3,713 to €3,770 (scenarios 2 and 3), 5–7% higher than those for traditional thyroidectomy. Major economic differences emerge when an EBD is used (€3,969). The regional DRG tariff for thyroid surgery is barely sufficient to cover conventional surgery costs. Intraoperative neural monitoring accounts for 5–7% of the hospitalization costs for a thyroidectomy.

  18. [Intraoperative floppy iris syndrome].

    Science.gov (United States)

    Mazal, Z

    2007-04-01

    In the year 2005, Chang and Cambell described unusual reaction of the iris during the cataract surgery in patients treated with tamsulosine. This was named as IFIS, an acronym for the Intraoperative Floppy Iris Syndrome. In its advanced stage, the syndrome is characterized by insufficient mydfiasis before the surgery, narrowing of the pupil during the surgery, its impossible dilatation during the surgery by means of stretching, unusual elasticity of the pupilar margin, surging and fluttering iris with tendency to prolapse. The same manifestations we observed in our patients and we confirm the direct connection with tamsulosine hydrochloride treatment. Tamsulosine is the antagonist of alpha 1A adrenergic receptors whose are present, except in the smooth musculature of the prostate gland and the urinary bladder, in the iris dilator as well. At the same time we observed this syndrome rarely in some patients not using tamsulosine. In most cases, these patients were treated with antipsychotic drugs.

  19. Multimodal treatment for unresectable pancreatic cancer

    International Nuclear Information System (INIS)

    Katayama, Kanji; Iida, Atsushi; Fujita, Takashi; Kobayashi, Taizo; Shinmoto, Syuichi; Hirose, Kazuo; Yamaguchi, Akio; Yoshida, Masanori

    1998-01-01

    In order to improve in prognosis and quality of life (QOL), the multimodal treatment for unresectable pancreatic cancers were performed. Bypass surgery was carried out for unresectable pancreatic cancer with intraoperative irradiation (IOR). After surgery, patients were treated with the combination of CDDP (25 mg) and MMC (4 mg) administration, intravenously continuous injection of 5-FU (250 mg for 24 hours), external radiation by the high voltage X-ray (1.5 Gy per irradiation, 4 times a week, and during hyperthermia 3 Gy per irradiation) and hyperthermia using the Thermotron RF-8 warmer. Six out of 13 patients received hyperthermia at over 40degC, were obtained PR, and their survival periods were 22, 21, 19, 18, 11 and 8 months and they could return to work. For all patients with pain, the symptom was abolished or reduced. The survival periods in cases of the multimodal treatment were longer than those of only bypass-surgery or of the resective cases with the curability C. The multimodal treatment combined with radiation, hyperthermia and surgery is more useful for the removal of pain and the improvement of QOL, and also expected the improvement of the prognosis than pancreatectomy. And hyperthermia has an important role on the effect of this treatment. (K.H.)

  20. Multimodal treatment for unresectable pancreatic cancer

    Energy Technology Data Exchange (ETDEWEB)

    Katayama, Kanji; Iida, Atsushi; Fujita, Takashi; Kobayashi, Taizo; Shinmoto, Syuichi; Hirose, Kazuo; Yamaguchi, Akio; Yoshida, Masanori [Fukui Medical School, Matsuoka (Japan)

    1998-07-01

    In order to improve in prognosis and quality of life (QOL), the multimodal treatment for unresectable pancreatic cancers were performed. Bypass surgery was carried out for unresectable pancreatic cancer with intraoperative irradiation (IOR). After surgery, patients were treated with the combination of CDDP (25 mg) and MMC (4 mg) administration, intravenously continuous injection of 5-FU (250 mg for 24 hours), external radiation by the high voltage X-ray (1.5 Gy per irradiation, 4 times a week, and during hyperthermia 3 Gy per irradiation) and hyperthermia using the Thermotron RF-8 warmer. Six out of 13 patients received hyperthermia at over 40degC, were obtained PR, and their survival periods were 22, 21, 19, 18, 11 and 8 months and they could return to work. For all patients with pain, the symptom was abolished or reduced. The survival periods in cases of the multimodal treatment were longer than those of only bypass-surgery or of the resective cases with the curability C. The multimodal treatment combined with radiation, hyperthermia and surgery is more useful for the removal of pain and the improvement of QOL, and also expected the improvement of the prognosis than pancreatectomy. And hyperthermia has an important role on the effect of this treatment. (K.H.)

  1. Targeted intraoperative radiotherapy in oncology

    CERN Document Server

    Keshtgar, Mohammed; Wenz, Frederik

    2014-01-01

    Targeted intraoperative radiotherapy is a major advance in the management of cancer patients. With an emphasis on practical aspects, this book offers an ideal introduction to this innovative  technology for clinicians.

  2. Multimodal fluorescence imaging spectroscopy

    NARCIS (Netherlands)

    Stopel, Martijn H W; Blum, Christian; Subramaniam, Vinod; Engelborghs, Yves; Visser, Anthonie J.W.G.

    2014-01-01

    Multimodal fluorescence imaging is a versatile method that has a wide application range from biological studies to materials science. Typical observables in multimodal fluorescence imaging are intensity, lifetime, excitation, and emission spectra which are recorded at chosen locations at the sample.

  3. Multimodality in organization studies

    DEFF Research Database (Denmark)

    Van Leeuwen, Theo

    2017-01-01

    This afterword reviews the chapters in this volume and reflects on the synergies between organization and management studies and multimodality studies that emerge from the volume. These include the combination of strong sociological theorizing and detailed multimodal analysis, a focus on material...

  4. Intraoperative transfusion practices in Europe

    DEFF Research Database (Denmark)

    Meier, J; Filipescu, D; Kozek-Langenecker, S

    2016-01-01

    BACKGROUND: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (p......RBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. METHODS: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month...... period in 2013. RESULTS: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone...

  5. Multimodal freight investment criteria.

    Science.gov (United States)

    2010-07-01

    Literature was reviewed on multi-modal investment criteria for freight projects, examining measures and techniques for quantifying project benefits and costs, as well as ways to describe the economic importance of freight transportation. : A limited ...

  6. Intraoperative radiotherapy - Current status

    International Nuclear Information System (INIS)

    Gunderson, Leonard L.; Willett, Christopher G.; Harrison, Louis B.

    1997-01-01

    Purpose/Objective: Intraoperative irradiation (IORT) in its broadest sense refers to the delivery of irradiation at the time of an operation. This refresher course will discuss the use of both electrons (IOERT) and high dose rate brachytherapy (IOHDR) in conjunction with surgical exploration and resection ± external irradiation/chemotherapy. Both IORT methods have evolved with similar philosophies as an attempt to achieve higher effective doses of irradiation while dose limiting structures are surgically displaced. The rationale for each is supported by excellent local control ± survival results achieved with brachytherapy alone or as a boost to external irradiation in organ preservation efforts in traditional sites (head and neck, breast, gynecologic) wherein a boost dose could be delivered to smaller volumes than could usually be accomplished with external irradiation alone. IOERT has been a tool in modern radiotherapy in Japan since the 1960's and in the U.S. since the mid 1970's. Results from randomized and nonrandomized trials will be presented in the refresher course with major emphasis on GI sites (gastric, pancreas, colorectal) since the data is more mature. While the largest clinical experience with IOERT (± external irradiation/chemotherapy, maximal resection) has been with gastrointestinal cancers in adults, moderate experience has also been obtained with locally advanced retroperitoneal sarcomas and recurrent genitourinary and gynecologic cancers. With primary colorectal cancers that are unresectable for cure or for locally recurrent colorectal cancers, both local control and long-term survival appear to be improved with the aggressive combinations including IOERT when compared to results achieved with conventional treatment. When residual disease exists after resection of gastric cancers, IOERT ± external radiation has achieved optimistic survival results in trials in Japan, the U.S., Spain and China. With locally unresectable pancreatic cancer, an

  7. Learning multimodal dictionaries.

    Science.gov (United States)

    Monaci, Gianluca; Jost, Philippe; Vandergheynst, Pierre; Mailhé, Boris; Lesage, Sylvain; Gribonval, Rémi

    2007-09-01

    Real-world phenomena involve complex interactions between multiple signal modalities. As a consequence, humans are used to integrate at each instant perceptions from all their senses in order to enrich their understanding of the surrounding world. This paradigm can be also extremely useful in many signal processing and computer vision problems involving mutually related signals. The simultaneous processing of multimodal data can, in fact, reveal information that is otherwise hidden when considering the signals independently. However, in natural multimodal signals, the statistical dependencies between modalities are in general not obvious. Learning fundamental multimodal patterns could offer deep insight into the structure of such signals. In this paper, we present a novel model of multimodal signals based on their sparse decomposition over a dictionary of multimodal structures. An algorithm for iteratively learning multimodal generating functions that can be shifted at all positions in the signal is proposed, as well. The learning is defined in such a way that it can be accomplished by iteratively solving a generalized eigenvector problem, which makes the algorithm fast, flexible, and free of user-defined parameters. The proposed algorithm is applied to audiovisual sequences and it is able to discover underlying structures in the data. The detection of such audio-video patterns in audiovisual clips allows to effectively localize the sound source on the video in presence of substantial acoustic and visual distractors, outperforming state-of-the-art audiovisual localization algorithms.

  8. Multimodality Registration without a Dedicated Multimodality Scanner

    Directory of Open Access Journals (Sweden)

    Bradley J. Beattie

    2007-03-01

    Full Text Available Multimodality scanners that allow the acquisition of both functional and structural image sets on a single system have recently become available for animal research use. Although the resultant registered functional/structural image sets can greatly enhance the interpretability of the functional data, the cost of multimodality systems can be prohibitive, and they are often limited to two modalities, which generally do not include magnetic resonance imaging. Using a thin plastic wrap to immobilize and fix a mouse or other small animal atop a removable bed, we are able to calculate registrations between all combinations of four different small animal imaging scanners (positron emission tomography, single-photon emission computed tomography, magnetic resonance, and computed tomography [CT] at our disposal, effectively equivalent to a quadruple-modality scanner. A comparison of serially acquired CT images, with intervening acquisitions on other scanners, demonstrates the ability of the proposed procedures to maintain the rigidity of an anesthetized mouse during transport between scanners. Movement of the bony structures of the mouse was estimated to be 0.62 mm. Soft tissue movement was predominantly the result of the filling (or emptying of the urinary bladder and thus largely constrained to this region. Phantom studies estimate the registration errors for all registration types to be less than 0.5 mm. Functional images using tracers targeted to known structures verify the accuracy of the functional to structural registrations. The procedures are easy to perform and produce robust and accurate results that rival those of dedicated multimodality scanners, but with more flexible registration combinations and while avoiding the expense and redundancy of multimodality systems.

  9. Intraoperative ultrasound in colorectal surgery.

    Science.gov (United States)

    Greif, Franklin; Aranovich, David; Hananel, Nissim; Knizhnik, Mikhail; Belenky, Alexander

    2009-09-01

    To assess the accuracy of intraoperative ultrasound (IOUS) as a localizing technique for colorectal resections, and its impact on surgical management. Twenty-five patients (15 men and 10 women; mean age, 74.4 years) with early cancers (p T1), or polyps, not amenable to endoscopic removal were selected. IOUS was used as a sole method of intraoperative localization. Its performance was evaluated through review of preoperative colonoscopy reports, intraoperative findings, histopathology reports, and clinical follow-up. The lesions were situated in the cecum (n = 5), ascending colon (n = 3), transverse colon (n = 4), descending colon (n = 7), and rectum (n = 6). IOUS technique allowed correct localization in 24 of 25 patients, visualization of the bowel wall, and its penetration by malignant tumors. In rectal lesions, IOUS showed clearly the tumor and its margin, which facilitated performance sphincter-sparing procedure. In patients with small polyps and early cancers of colon and rectum, IOUS may be effectively used as a sole method of intraoperative localization and provide additional information that may alter decision making with regard to surgical technique. (c) 2009 Wiley Periodicals, Inc.

  10. Multimodal Resources in Transnational Adoption

    DEFF Research Database (Denmark)

    Raudaskoski, Pirkko Liisa

    The paper discusses an empirical analysis which highlights the multimodal nature of identity construction. A documentary on transnational adoption provides real life incidents as research material. The incidents involve (or from them emerge) various kinds of multimodal resources and participants...

  11. Multimodal sequence learning.

    Science.gov (United States)

    Kemény, Ferenc; Meier, Beat

    2016-02-01

    While sequence learning research models complex phenomena, previous studies have mostly focused on unimodal sequences. The goal of the current experiment is to put implicit sequence learning into a multimodal context: to test whether it can operate across different modalities. We used the Task Sequence Learning paradigm to test whether sequence learning varies across modalities, and whether participants are able to learn multimodal sequences. Our results show that implicit sequence learning is very similar regardless of the source modality. However, the presence of correlated task and response sequences was required for learning to take place. The experiment provides new evidence for implicit sequence learning of abstract conceptual representations. In general, the results suggest that correlated sequences are necessary for implicit sequence learning to occur. Moreover, they show that elements from different modalities can be automatically integrated into one unitary multimodal sequence. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. Robust Multimodal Dictionary Learning

    Science.gov (United States)

    Cao, Tian; Jojic, Vladimir; Modla, Shannon; Powell, Debbie; Czymmek, Kirk; Niethammer, Marc

    2014-01-01

    We propose a robust multimodal dictionary learning method for multimodal images. Joint dictionary learning for both modalities may be impaired by lack of correspondence between image modalities in training data, for example due to areas of low quality in one of the modalities. Dictionaries learned with such non-corresponding data will induce uncertainty about image representation. In this paper, we propose a probabilistic model that accounts for image areas that are poorly corresponding between the image modalities. We cast the problem of learning a dictionary in presence of problematic image patches as a likelihood maximization problem and solve it with a variant of the EM algorithm. Our algorithm iterates identification of poorly corresponding patches and re-finements of the dictionary. We tested our method on synthetic and real data. We show improvements in image prediction quality and alignment accuracy when using the method for multimodal image registration. PMID:24505674

  13. Critical Analysis of Multimodal Discourse

    DEFF Research Database (Denmark)

    van Leeuwen, Theo

    2013-01-01

    This is an encyclopaedia article which defines the fields of critical discourse analysis and multimodality studies, argues that within critical discourse analysis more attention should be paid to multimodality, and within multimodality to critical analysis, and ends reviewing a few examples of re...

  14. Multimodality imaging techniques.

    Science.gov (United States)

    Martí-Bonmatí, Luis; Sopena, Ramón; Bartumeus, Paula; Sopena, Pablo

    2010-01-01

    In multimodality imaging, the need to combine morphofunctional information can be approached by either acquiring images at different times (asynchronous), and fused them through digital image manipulation techniques or simultaneously acquiring images (synchronous) and merging them automatically. The asynchronous post-processing solution presents various constraints, mainly conditioned by the different positioning of the patient in the two scans acquired at different times in separated machines. The best solution to achieve consistency in time and space is obtained by the synchronous image acquisition. There are many multimodal technologies in molecular imaging. In this review we will focus on those multimodality image techniques more commonly used in the field of diagnostic imaging (SPECT-CT, PET-CT) and new developments (as PET-MR). The technological innovations and development of new tracers and smart probes are the main key points that will condition multimodality image and diagnostic imaging professionals' future. Although SPECT-CT and PET-CT are standard in most clinical scenarios, MR imaging has some advantages, providing excellent soft-tissue contrast and multidimensional functional, structural and morphological information. The next frontier is to develop efficient detectors and electronics systems capable of detecting two modality signals at the same time. Not only PET-MR but also MR-US or optic-PET will be introduced in clinical scenarios. Even more, MR diffusion-weighted, pharmacokinetic imaging, spectroscopy or functional BOLD imaging will merge with PET tracers to further increase molecular imaging as a relevant medical discipline. Multimodality imaging techniques will play a leading role in relevant clinical applications. The development of new diagnostic imaging research areas, mainly in the field of oncology, cardiology and neuropsychiatry, will impact the way medicine is performed today. Both clinical and experimental multimodality studies, in

  15. Multimodal Processes Rescheduling

    DEFF Research Database (Denmark)

    Bocewicz, Grzegorz; Banaszak, Zbigniew A.; Nielsen, Peter

    2013-01-01

    Cyclic scheduling problems concerning multimodal processes are usually observed in FMSs producing multi-type parts where the Automated Guided Vehicles System (AGVS) plays a role of a material handling system. Schedulability analysis of concurrently flowing cyclic processes (SCCP) exe-cuted in the......Cyclic scheduling problems concerning multimodal processes are usually observed in FMSs producing multi-type parts where the Automated Guided Vehicles System (AGVS) plays a role of a material handling system. Schedulability analysis of concurrently flowing cyclic processes (SCCP) exe...

  16. Intraoperative Sentinel Lymph Node Evaluation

    DEFF Research Database (Denmark)

    Shaw, Richard; Christensen, Anders; Java, Kapil

    2016-01-01

    BACKGROUND: Intraoperative analysis of sentinel lymph nodes would enhance the care of early-stage oral squamous cell carcinoma (OSCC). We determined the frequency and extent of cytokeratin 19 (CK19) expression in OSCC primary tumours and surrounding tissues to explore the feasibility of a "clinic......-ready" intraoperative diagnostic test (one step nucleic acid amplification-OSNA, sysmex). METHODS: Two cohorts were assembled: cohort 1, OSCC with stage and site that closely match cases suitable for sentinel lymph node biopsy (SLNB); cohort 2, HNSCC with sufficient fresh tumour tissue available for the OSNA assay (>50......% of tumours. Discordance between different techniques indicated that OSNA was more sensitive than qRT-PCR or RNA-ISH, which in turn were more sensitive than IHC. OSNA results showed CK19 expression in 80% of primary cases, so if used for diagnosis of lymph node metastasis would lead to a false-negative result...

  17. Multimode optical fiber

    Science.gov (United States)

    Bigot-Astruc, Marianne; Molin, Denis; Sillard, Pierre

    2014-11-04

    A depressed graded-index multimode optical fiber includes a central core, an inner depressed cladding, a depressed trench, an outer depressed cladding, and an outer cladding. The central core has an alpha-index profile. The depressed claddings limit the impact of leaky modes on optical-fiber performance characteristics (e.g., bandwidth, core size, and/or numerical aperture).

  18. Multimodal training between agents

    DEFF Research Database (Denmark)

    Rehm, Matthias

    2003-01-01

    In the system Locator1, agents are treated as individual and autonomous subjects that are able to adapt to heterogenous user groups. Applying multimodal information from their surroundings (visual and linguistic), they acquire the necessary concepts for a successful interaction. This approach has...

  19. Multimodal news framing effects

    NARCIS (Netherlands)

    Powell, T.E.

    2017-01-01

    Visuals in news media play a vital role in framing citizens’ political preferences. Yet, compared to the written word, visual images are undervalued in political communication research. Using framing theory, this thesis redresses the balance by studying the combined, or multimodal, effects of visual

  20. Multimodal Strategies of Theorization

    DEFF Research Database (Denmark)

    Cartel, Melodie; Colombero, Sylvain; Boxenbaum, Eva

    This paper examines the role of multimodal strategies in processes of theorization. Empirically, we investigate the theorization process of a highly disruptive innovation in the history of architecture: reinforced concrete. Relying on archival data from a dominant French architectural journal from...... with well-known rhetorical strategies and develop a process model of theorization....

  1. Long-Term Outcome and Toxicities of Intraoperative Radiotherapy for High-Risk Neuroblastoma

    International Nuclear Information System (INIS)

    Gillis, Amy M.; Sutton, Elizabeth; DeWitt, Kelly D.; Matthay, Katherine K.; Weinberg, Vivian; Fisch, Benjamin M.; Chan, Albert; Gooding, Charles; Daldrup-Link, Heike; Wara, William M.; Farmer, Diana L.; Harrison, Michael R.; Haas-Kogan, Daphne

    2007-01-01

    Purpose: To review a historical cohort of consecutively accrued patients with high-risk neuroblastoma treated with intraoperative radiotherapy (IORT) to determine the therapeutic effect and late complications of this treatment. Methods and Materials: Between 1986 and 2002, 31 patients with newly diagnosed high-risk neuroblastoma were treated with IORT as part of multimodality therapy. Their medical records were reviewed to determine the outcome and complications. Kaplan-Meier probability estimates of local control, progression-free survival, and overall survival at 36 months after diagnosis were recorded. Results: Intraoperative radiotherapy to the primary site and associated lymph nodes achieved excellent local control at a median follow-up of 44 months. The 3-year estimate of the local recurrence rate was 15%, less than that of most previously published series. Only 1 of 22 patients who had undergone gross total resection developed recurrence at the primary tumor site. The 3-year estimate of local control, progression-free survival, and overall survival was 85%, 47%, and 60%, respectively. Side effects attributable to either the disease process or multimodality treatment were observed in 7 patients who developed either hypertension or vascular stenosis. These late complications resulted in the death of 2 patients. Conclusions: Intraoperative radiotherapy at the time of primary resection offers effective local control in patients with high-risk neuroblastoma. Compared with historical controls, IORT achieved comparable control and survival rates while avoiding many side effects associated with external beam radiotherapy in young children. Although complications were observed, additional analysis is needed to determine the relative contributions of the disease process and specific components of the multimodality treatment to these adverse events

  2. Gestures and multimodal input

    OpenAIRE

    Keates, Simeon; Robinson, Peter

    1999-01-01

    For users with motion impairments, the standard keyboard and mouse arrangement for computer access often presents problems. Other approaches have to be adopted to overcome this. In this paper, we will describe the development of a prototype multimodal input system based on two gestural input channels. Results from extensive user trials of this system are presented. These trials showed that the physical and cognitive loads on the user can quickly become excessive and detrimental to the interac...

  3. Minimalism through intraoperative functional mapping.

    Science.gov (United States)

    Berger, M S

    1996-01-01

    Intraoperative stimulation mapping may be used to avoid unnecessary risk to functional regions subserving language and sensori-motor pathways. Based on the data presented here, language localization is variable in the entire population, with only certainty existing for the inferior frontal region responsible for motor speech. Anatomical landmarks such as the anterior temporal tip for temporal lobe language sites and the posterior aspect of the lateral sphenoid wing for the frontal lobe language zones are unreliable in avoiding postoperative aphasias. Thus, individual mapping to identify essential language sites has the greatest likelihood of avoiding permanent deficits in naming, reading, and motor speech. In a similar approach, motor and sensory pathways from the cortex and underlying white matter may be reliably stimulated and mapped in both awake and asleep patients. Although these techniques require an additional operative time and equipment nominally priced, the result is often gratifying, as postoperative morbidity has been greatly reduced in the process of incorporating these surgical strategies. The patients quality of life is improved in terms of seizure control, with or without antiepileptic drugs. This avoids having to perform a second costly operative procedure, which is routinely done when extraoperative stimulation and recording is done via subdural grids. In addition, an aggressive tumor resection at the initial operation lengthens the time to tumor recurrence and often obviates the need for a subsequent reoperation. Thus, intraoperative functional mapping may be best alluded to as a surgical technique that results in "minimalism in the long term".

  4. INTRAOPERATIVE PREDONATION CONTRIBUTES TO BLOOD SAVING

    NARCIS (Netherlands)

    SCHONBERGER, JPAM; BREDEE, JJ; TJIAN, D; EVERTS, PAM; WILDEVUUR, CRH

    1993-01-01

    The merits of reinfusing prebypass-removed autologous blood (intraoperative predonation) to salvage blood and improve postoperative hemostasis are still debated, specifically for patients at a higher risk for bleeding. To evaluate the effect of intraoperative predonation on the platelet count, blood

  5. Intraoperative digital angiography: Peripheral vascular applications

    International Nuclear Information System (INIS)

    Bell, K.; Reifsteck, J.E.; Binet, E.F.; Fleisher, H.J.

    1986-01-01

    Intraoperative digital angiography is the procedure of choice for the peripheral vascular surgeon who wishes to evaluate his results before terminating anesthesia. Two operating suites at the John L. McClellan Memorial Veterans Hospital are equipped with permanent ceiling-mounted Philips C-arm fluoroscopes and share an ADAC 4100 digital angiographic system. In the last 18 months, 40 peripheral vascular intraoperative digital angiographic procedures have been performed, in all but two cases using direct arterial puncture. In 65% of cases, the intraoperative study showed no significant abnormality. In 12.5%, minor abnormalities not requiring reoperation were seen. In 22.5% of cases, the intraoperative digital angiogram revealed a significant abnormality requiring immediate operative revision. None of the patients who underwent reoperation experienced postoperative sequelae. Intraoperative digital angiography is useful in identifying complications of peripheral vascular operations

  6. Intraoperative radiotherapy in breast cancer: literature review

    International Nuclear Information System (INIS)

    Alfaro Hidalgo, Sabrina A.

    2013-01-01

    A literature review was performed on intraoperative radiotherapy of breast cancer. The strength and attractiveness is established of techniques of partial irradiation in the treatment of breast cancer. The benefit is originated to restrict the area immediate of radiotherapy to the tumor bed or quadrant index and identifying the benefit of being applied during the radiotherapy while surgical lumpectomy. The impact of local recurrence has been established using intraoperative radiotherapy. The advantages of intraoperative radiotherapy was compared in the management of the conservative surgery in early stages of breast cancer with external radiotherapy. Different methods of intraoperative radiotherapy have been compared and individual impact on local recurrence ranges. Intraoperative radiotherapy has had many advantages: radiobiological, technical, clinical, psychological and economical in the handling of conservative surgery in early stages of breast cancer, compared with external radiotherapy [es

  7. A multimodal parallel architecture: A cognitive framework for multimodal interactions.

    Science.gov (United States)

    Cohn, Neil

    2016-01-01

    Human communication is naturally multimodal, and substantial focus has examined the semantic correspondences in speech-gesture and text-image relationships. However, visual narratives, like those in comics, provide an interesting challenge to multimodal communication because the words and/or images can guide the overall meaning, and both modalities can appear in complicated "grammatical" sequences: sentences use a syntactic structure and sequential images use a narrative structure. These dual structures create complexity beyond those typically addressed by theories of multimodality where only a single form uses combinatorial structure, and also poses challenges for models of the linguistic system that focus on single modalities. This paper outlines a broad theoretical framework for multimodal interactions by expanding on Jackendoff's (2002) parallel architecture for language. Multimodal interactions are characterized in terms of their component cognitive structures: whether a particular modality (verbal, bodily, visual) is present, whether it uses a grammatical structure (syntax, narrative), and whether it "dominates" the semantics of the overall expression. Altogether, this approach integrates multimodal interactions into an existing framework of language and cognition, and characterizes interactions between varying complexity in the verbal, bodily, and graphic domains. The resulting theoretical model presents an expanded consideration of the boundaries of the "linguistic" system and its involvement in multimodal interactions, with a framework that can benefit research on corpus analyses, experimentation, and the educational benefits of multimodality. Copyright © 2015.

  8. Intraoperative radiotherapy for pancreatic carcinoma

    International Nuclear Information System (INIS)

    Nishimura, Akira; Iida, Koyo; Sato, Shigehiro; Sakata, Suo

    1986-01-01

    Twenty-eight patients with pancreatic carcinoma, 23 (82 %) of whom had Stage III or IV, received intraoperative radiotherapy (IOR) with curative or non-curative surgery. Electron beams (10 to 18 MeV) with doses of 20 to 40 Gy were delivered to the tumor. Eight of 26 patients with unresectable tumor had postoperative external irradiation of 10.5 to 50 Gy. Abdominal and back pain relief was achieved after IOR in 12 (71 %) and in 6 (60 %) of the 26 patients, respectively. Appetite was promoted in 11 patients. In the case of unresectable carcinoma, survival time tended to prolong in the 8 patients receiving both IOR and postoperative external irradiation. One patient developed perforation of the colon probably caused by IOR. (Namekawa, K.)

  9. Practicality of intraoperative teamwork assessments.

    Science.gov (United States)

    Phitayakorn, Roy; Minehart, Rebecca; Pian-Smith, May C M; Hemingway, Maureen W; Milosh-Zinkus, Tanya; Oriol-Morway, Danika; Petrusa, Emil

    2014-07-01

    High-quality teamwork among operating room (OR) professionals is a key to efficient and safe practice. Quantification of teamwork facilitates feedback, assessment, and improvement. Several valid and reliable instruments are available for assessing separate OR disciplines and teams. We sought to determine the most feasible approach for routine documentation of teamwork in in-situ OR simulations. We compared rater agreement, hypothetical training costs, and feasibility ratings from five clinicians and two nonclinicians with instruments for assessment of separate OR groups and teams. Five teams of anesthesia or surgery residents and OR nurses (RN) or surgical technicians were videotaped in simulations of an epigastric hernia repair where the patient develops malignant hyperthermia. Two anesthesiologists, one OR clinical RN specialist, one educational psychologist, one simulation specialist, and one general surgeon discussed and then independently completed Anesthesiologists' Non-Technical Skills, Non-Technical Skills for Surgeons, Scrub Practitioners' List of Intraoperative Non-Technical Skills, and Observational Teamwork Assessment for Surgery forms to rate nontechnical performance of anesthesiologists, surgeons, nurses, technicians, and the whole team. Intraclass correlations of agreement ranged from 0.17-0.85. Clinicians' agreements were not different from nonclinicians'. Published rater training was 4 h for Anesthesiologists' Non-Technical Skills and Scrub Practitioners' List of Intraoperative Non-Technical Skills, 2.5 h for Non-Technical Skills for Surgeons, and 15.5 h for Observational Teamwork Assessment for Surgery. Estimated costs to train one rater to use all instruments ranged from $442 for a simulation specialist to $6006 for a general surgeon. Additional training is needed to achieve higher levels of agreement; however, costs may be prohibitive. The most cost-effective model for real-time OR teamwork assessment may be to use a simulation technician

  10. Experiments in Multimodal Information Presentation

    NARCIS (Netherlands)

    van Hooijdonk, Charlotte; Bosma, W.E.; Krahmer, Emiel; Maes, Alfons; Theune, Mariet; van den Bosch, Antal; Bouma, Gosse

    In this chapter we describe three experiments investigating multimodal information presentation in the context of a medical QA system. In Experiment 1, we wanted to know how non-experts design (multimodal) answers to medical questions, distinguishing between what questions and how questions. In

  11. Simplified Multimodal Biometric Identification

    Directory of Open Access Journals (Sweden)

    Abhijit Shete

    2014-03-01

    Full Text Available Multibiometric systems are expected to be more reliable than unimodal biometric systems for personal identification due to the presence of multiple, fairly independent pieces of evidence e.g. Unique Identification Project "Aadhaar" of Government of India. In this paper, we present a novel wavelet based technique to perform fusion at the feature level and score level by considering two biometric modalities, face and fingerprint. The results indicate that the proposed technique can lead to substantial improvement in multimodal matching performance. The proposed technique is simple because of no preprocessing of raw biometric traits as well as no feature and score normalization.

  12. Multimodality, politics and ideology

    DEFF Research Database (Denmark)

    Machin, David; Van Leeuwen, T.

    2016-01-01

    This journal's editorial statement is clear that political discourse should be studied not only as regards parliamentary type politics. In this introduction we argue precisely for the need to pay increasing attention to the way that political ideologies are infused into culture more widely...... of power, requires meanings and identities which can hold them in place. We explain the processes by which critical multimodal discourse analysis can best draw out this ideology as it is realized through different semiotics resources. © John Benjamins Publishing Company....

  13. Application of Multimodality Imaging Fusion Technology in Diagnosis and Treatment of Malignant Tumors under the Precision Medicine Plan.

    Science.gov (United States)

    Wang, Shun-Yi; Chen, Xian-Xia; Li, Yi; Zhang, Yu-Ying

    2016-12-20

    The arrival of precision medicine plan brings new opportunities and challenges for patients undergoing precision diagnosis and treatment of malignant tumors. With the development of medical imaging, information on different modality imaging can be integrated and comprehensively analyzed by imaging fusion system. This review aimed to update the application of multimodality imaging fusion technology in the precise diagnosis and treatment of malignant tumors under the precision medicine plan. We introduced several multimodality imaging fusion technologies and their application to the diagnosis and treatment of malignant tumors in clinical practice. The data cited in this review were obtained mainly from the PubMed database from 1996 to 2016, using the keywords of "precision medicine", "fusion imaging", "multimodality", and "tumor diagnosis and treatment". Original articles, clinical practice, reviews, and other relevant literatures published in English were reviewed. Papers focusing on precision medicine, fusion imaging, multimodality, and tumor diagnosis and treatment were selected. Duplicated papers were excluded. Multimodality imaging fusion technology plays an important role in tumor diagnosis and treatment under the precision medicine plan, such as accurate location, qualitative diagnosis, tumor staging, treatment plan design, and real-time intraoperative monitoring. Multimodality imaging fusion systems could provide more imaging information of tumors from different dimensions and angles, thereby offing strong technical support for the implementation of precision oncology. Under the precision medicine plan, personalized treatment of tumors is a distinct possibility. We believe that multimodality imaging fusion technology will find an increasingly wide application in clinical practice.

  14. The role of the neurophysiological intraoperative monitoring to prevention of postoperative neurological complication in the surgical treatment of scoliosis

    Directory of Open Access Journals (Sweden)

    M. A. Khit

    2014-01-01

    Full Text Available Bearing in mind that the technique of surgical treatment of scoliosis and skills are high enough, iatrogenic spinal cord injury is still one of the most feared complication of scoliosis surgery. It is well known that the function of the spinal cord may be estimated by combining somatosensory evoked potentials (SSEP and motor evoked potentials (MEP. We have retrospectively evaluated the results of intraoperative neurophysiological monitoring (IOM in a large population of patients underwent surgical treatment of spinal deformity. Intraoperative neuromonitoring SSEP and transcranial electrostimulation (TES – MEP in conjunction with the assessment of the correct position of the screws was performed in 142 consecutive cases, i. e. all patients who had undergone surgical treatment of idiopathic (127 pts, congenital (10 pts or neurogenic (5 pts scoliosis. A neurophysiological “alarm” was defined as a decrease in amplitude (uni- or bilateral of at least 50 % for SEPs and of 70 % for TES-MEP compared with baseline. Total intravenous anesthesia (TIVA in 138 cases was achieved by infusion of propofol (8–16 mg / kg / h and in 4 cases by halogenate anesthesia – sevoflurane (0.4–1.8 MAC. Seven patients (4.9 % were reported intraoperative neurophysiological parameters significant changes that require action by the surgeons and anesthetists, with deterioration of ostoperative neurologic status in one case. Of these three cases, the amplitude drop SSEPs and TESMEPs-was due, to the pharmacological aspects of anesthetic management, in the other four cases – with surgical procedures (response halo-traction – 1 case, mechanical damage of sheath of the spinal cord by pliers Kerrison – 1case, overcorrection – 2 cases. In five cases (3.5 % required reposting of pedicle screws (1–2 levels. Only one patient (0.7 % had a persistent postoperative neurological disorder (neuropathic pain, respectively from a level of re-reposition of

  15. Strategy of Surgical Resection for Glioma Based on Intraoperative Functional Mapping and Monitoring

    Science.gov (United States)

    TAMURA, Manabu; MURAGAKI, Yoshihiro; SAITO, Taiichi; MARUYAMA, Takashi; NITTA, Masayuki; TSUZUKI, Shunsuke; ISEKI, Hiroshi; OKADA, Yoshikazu

    2015-01-01

    A growing number of papers have pointed out the relationship between aggressive resection of gliomas and survival prognosis. For maximum resection, the current concept of surgical decision-making is in “information-guided surgery” using multimodal intraoperative information. With this, anatomical information from intraoperative magnetic resonance imaging (MRI) and navigation, functional information from brain mapping and monitoring, and histopathological information must all be taken into account in the new perspective for innovative minimally invasive surgical treatment of glioma. Intraoperative neurofunctional information such as neurophysiological functional monitoring takes the most important part in the process to acquire objective visual data during tumor removal and to integrate these findings as digitized data for intraoperative surgical decision-making. Moreover, the analysis of qualitative data and threshold-setting for quantitative data raise difficult issues in the interpretation and processing of each data type, such as determination of motor evoked potential (MEP) decline, underestimation in tractography, and judgments of patient response for neurofunctional mapping and monitoring during awake craniotomy. Neurofunctional diagnosis of false-positives in these situations may affect the extent of resection, while false-negatives influence intra- and postoperative complication rates. Additionally, even though the various intraoperative visualized data from multiple sources contribute significantly to the reliability of surgical decisions when the information is integrated and provided, it is not uncommon for individual pieces of information to convey opposing suggestions. Such conflicting pieces of information facilitate higher-order decision-making that is dependent on the policies of the facility and the priorities of the patient, as well as the availability of the histopathological characteristics from resected tissue. PMID:26185825

  16. Intraoperative Ultrasound for Peripheral Nerve Applications.

    Science.gov (United States)

    Willsey, Matthew; Wilson, Thomas J; Henning, Phillip Troy; Yang, Lynda J-S

    2017-10-01

    Offering real-time, high-resolution images via intraoperative ultrasound is advantageous for a variety of peripheral nerve applications. To highlight the advantages of ultrasound, its extraoperative uses are reviewed. The current intraoperative uses, including nerve localization, real-time evaluation of peripheral nerve tumors, and implantation of leads for peripheral nerve stimulation, are reviewed. Although intraoperative peripheral nerve localization has been performed previously using guide wires and surgical dyes, the authors' approach using ultrasound-guided instrument clamps helps guide surgical dissection to the target nerve, which could lead to more timely operations and shorter incisions. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Intraoperative radiotherapy for adenocarcinoma of the pancreas

    International Nuclear Information System (INIS)

    Yasue, Mitsunori; Yasui, Kenzo; Morimoto, Takeshi; Miyaishi, Seiichi; Morita, Kozo

    1986-01-01

    Thirty-six patients were given intraoperative radiotherapy for adenocarcinoma of the pancreas between April 1980 and March 1986. Twenty-six of those with well-advanced cancer underwent palliative intraoperative radiotherapy of their main primary lesions (1,500 to 3,000 rads). Fourteen of the 19 patients in this group who had intractable back pain before surgery achieved relief within one week after treatment. Of the remaining 10 patients who underwent pancreatectomy and received adjuvant intraoperative radiotherapy (2,000 to 3,000 rads), two remain clinically free of disease five years and six months and four years and six months after palliative distal pancreatectomy. (author)

  18. Multimodal Speaker Diarization.

    Science.gov (United States)

    Noulas, A; Englebienne, G; Krose, B J A

    2012-01-01

    We present a novel probabilistic framework that fuses information coming from the audio and video modality to perform speaker diarization. The proposed framework is a Dynamic Bayesian Network (DBN) that is an extension of a factorial Hidden Markov Model (fHMM) and models the people appearing in an audiovisual recording as multimodal entities that generate observations in the audio stream, the video stream, and the joint audiovisual space. The framework is very robust to different contexts, makes no assumptions about the location of the recording equipment, and does not require labeled training data as it acquires the model parameters using the Expectation Maximization (EM) algorithm. We apply the proposed model to two meeting videos and a news broadcast video, all of which come from publicly available data sets. The results acquired in speaker diarization are in favor of the proposed multimodal framework, which outperforms the single modality analysis results and improves over the state-of-the-art audio-based speaker diarization.

  19. Intraoperative Radiotherapy for Breast Cancer

    Directory of Open Access Journals (Sweden)

    Eleanor E. R. Harris

    2017-12-01

    Full Text Available Intraoperative radiotherapy (IORT for early stage breast cancer is a technique for partial breast irradiation. There are several technologies in clinical use to perform breast IORT. Regardless of technique, IORT generally refers to the delivery of a single dose of radiation to the periphery of the tumor bed in the immediate intraoperative time frame, although some protocols have performed IORT as a second procedure. There are two large prospective randomized trials establishing the safety and efficacy of breast IORT in early stage breast cancer patients with sufficient follow-up time on thousands of women. The advantages of IORT for partial breast irradiation include: direct visualization of the target tissue ensuring treatment of the high-risk tissue and eliminating the risk of marginal miss; the use of a single dose coordinated with the necessary surgical excision thereby reducing omission of radiation and the selection of mastectomy for women without access to a radiotherapy facility or unable to undergo several weeks of daily radiation; favorable toxicity profiles; patient convenience and cost savings; radiobiological and tumor microenvironment conditions which lead to enhanced tumor control. The main disadvantage of IORT is the lack of final pathologic information on the tumor size, histology, margins, and nodal status. When unexpected findings on final pathology such as positive margins or positive sentinel nodes predict a higher risk of local or regional recurrence, additional whole breast radiation may be indicated, thereby reducing some of the convenience and low-toxicity advantages of sole IORT. However, IORT as a tumor bed boost has also been studied and appears to be safe with acceptable toxicity. IORT has potential efficacy advantages related to overall survival related to reduced cardiopulmonary radiation doses. It may also be very useful in specific situations, such as prior to oncoplastic reconstruction to improve accuracy of

  20. Intraoperative neurophysiological monitoring for the anaesthetist

    African Journals Online (AJOL)

    2012-11-15

    Nov 15, 2012 ... ... nerve tracts, and by understanding how anaesthetic agents affect the various ... of the physiologically sensitive nervous system and different ... Keywords: evoked potentials, intraoperative monitoring, brain mapping. Abstract.

  1. [Fusion of MRI, fMRI and intraoperative MRI data. Methods and clinical significance exemplified by neurosurgical interventions].

    Science.gov (United States)

    Moche, M; Busse, H; Dannenberg, C; Schulz, T; Schmitgen, A; Trantakis, C; Winkler, D; Schmidt, F; Kahn, T

    2001-11-01

    The aim of this work was to realize and clinically evaluate an image fusion platform for the integration of preoperative MRI and fMRI data into the intraoperative images of an interventional MRI system with a focus on neurosurgical procedures. A vertically open 0.5 T MRI scanner was equipped with a dedicated navigation system enabling the registration of additional imaging modalities (MRI, fMRI, CT) with the intraoperatively acquired data sets. These merged image data served as the basis for interventional planning and multimodal navigation. So far, the system has been used in 70 neurosurgical interventions (13 of which involved image data fusion--requiring 15 minutes extra time). The augmented navigation system is characterized by a higher frame rate and a higher image quality as compared to the system-integrated navigation based on continuously acquired (near) real time images. Patient movement and tissue shifts can be immediately detected by monitoring the morphological differences between both navigation scenes. The multimodal image fusion allowed a refined navigation planning especially for the resection of deeply seated brain lesions or pathologies close to eloquent areas. Augmented intraoperative orientation and instrument guidance improve the safety and accuracy of neurosurgical interventions.

  2. Multimodal responsive action

    DEFF Research Database (Denmark)

    Oshima, Sae

    ; Raymond 2003; Schegloff and Lerner 2009), including those with multimodal actions (e.g. Olsher 2004; Fasulo & Monzoni 2009). Some responsive actions can also be completed with bodily behavior alone, such as: when an agreement display is achieved by using only nonvocal actions (Jarmon 1996), when...... the recipient’s gaze shift becomes a significant part of the speaker’s turn construction (Goodwin 1980), and when head nods show the recipient’s affiliation with the speaker’s stance (Stivers 2008). Still, much room remains for extending our current understanding of responding actions that necessarily involve...... a hairstylist and a client negotiate the quality of the service that has been provided. Here, the first action is usually the stylist’s question and/or explanation of the new cut that invites the client’s assessment/(dis)agreement, accompanied with embodied actions that project an imminent self...

  3. Integration of intraoperative stereovision imaging for brain shift visualization during image-guided cranial procedures

    Science.gov (United States)

    Schaewe, Timothy J.; Fan, Xiaoyao; Ji, Songbai; Roberts, David W.; Paulsen, Keith D.; Simon, David A.

    2014-03-01

    Dartmouth and Medtronic Navigation have established an academic-industrial partnership to develop, validate, and evaluate a multi-modality neurosurgical image-guidance platform for brain tumor resection surgery that is capable of updating the spatial relationships between preoperative images and the current surgical field. A stereovision system has been developed and optimized for intraoperative use through integration with a surgical microscope and an image-guided surgery system. The microscope optics and stereovision CCD sensors are localized relative to the surgical field using optical tracking and can efficiently acquire stereo image pairs from which a localized 3D profile of the exposed surface is reconstructed. This paper reports the first demonstration of intraoperative acquisition, reconstruction and visualization of 3D stereovision surface data in the context of an industry-standard image-guided surgery system. The integrated system is capable of computing and presenting a stereovision-based update of the exposed cortical surface in less than one minute. Alternative methods for visualization of high-resolution, texture-mapped stereovision surface data are also investigated with the objective of determining the technical feasibility of direct incorporation of intraoperative stereo imaging into future iterations of Medtronic's navigation platform.

  4. A new method for intraoperative localization of epilepsy focus by means of a gamma probe

    International Nuclear Information System (INIS)

    Carneiro Filho, Omar; Vilela Filho, Osvaldo; Ragazzo, Paulo Cesar; Fonseca, Lea Mirian Barbosa da

    2014-01-01

    Objective: to evaluate the utility of a new multimodal image-guided intervention technique to detect epileptogenic areas with a gamma probe as compared with intraoperative electrocorticography. Materials and methods: two symptomatic patients with refractory epilepsy underwent magnetic resonance imaging, videoelectroencephalography, brain SPECT scan, neuropsychological evaluation and were submitted to gamma probe-assisted surgery. Results: in patient 1, maximum radioactive count was initially observed on the temporal gyrus at about 3.5 cm posteriorly to the tip of the left temporal lobe. After corticotomy, the gamma probe indicated maximum count at the head of the hippocampus, in agreement with the findings of intraoperative electrocorticography. In patient 2, maximum count was observed in the occipital region at the transition between the temporal and parietal lobes (right hemisphere). During the surgery, the area of epileptogenic activity mapped at electrocorticography was also delimited, demarcated, and compared with the gamma probe findings. After lesionectomy, new radioactive counts were performed both in the patients and on the surgical specimens (ex-vivo). Conclusion: the comparison between intraoperative electrocorticography and gamma probe-assisted surgery showed similarity of both methods. The advantages of gamma probe include: noninvasiveness, low cost and capacity to demonstrate decrease in the radioactive activity at the site of excision after lesionectomy. (author)

  5. Management of intraoperative fluid balance and blood conservation techniques in adult cardiac surgery.

    Science.gov (United States)

    Vretzakis, George; Kleitsaki, Athina; Aretha, Diamanto; Karanikolas, Menelaos

    2011-02-01

    Blood transfusions are associated with adverse physiologic effects and increased cost, and therefore reduction of blood product use during surgery is a desirable goal for all patients. Cardiac surgery is a major consumer of donor blood products, especially when cardiopulmonary bypass (CPB) is used, because hematocrit drops precipitously during CPB due to blood loss and blood cell dilution. Advanced age, low preoperative red blood cell volume (preoperative anemia or small body size), preoperative antiplatelet or antithrombotic drugs, complex or re-operative procedures or emergency operations, and patient comorbidities were identified as important transfusion risk indicators in a report recently published by the Society of Cardiovascular Anesthesiologists. This report also identified several pre- and intraoperative interventions that may help reduce blood transfusions, including off-pump procedures, preoperative autologous blood donation, normovolemic hemodilution, and routine cell saver use.A multimodal approach to blood conservation, with high-risk patients receiving all available interventions, may help preserve vital organ perfusion and reduce blood product utilization. In addition, because positive intravenous fluid balance is a significant factor affecting hemodilution during cardiac surgery, especially when CPB is used, strategies aimed at limiting intraoperative fluid balance positiveness may also lead to reduced blood product utilization.This review discusses currently available techniques that can be used intraoperatively in an attempt to avoid or minimize fluid balance positiveness, to preserve the patient's own red blood cells, and to decrease blood product utilization during cardiac surgery.

  6. Multimodal label-free microscopy

    Directory of Open Access Journals (Sweden)

    Nicolas Pavillon

    2014-09-01

    Full Text Available This paper reviews the different multimodal applications based on a large extent of label-free imaging modalities, ranging from linear to nonlinear optics, while also including spectroscopic measurements. We put specific emphasis on multimodal measurements going across the usual boundaries between imaging modalities, whereas most multimodal platforms combine techniques based on similar light interactions or similar hardware implementations. In this review, we limit the scope to focus on applications for biology such as live cells or tissues, since by their nature of being alive or fragile, we are often not free to take liberties with the image acquisition times and are forced to gather the maximum amount of information possible at one time. For such samples, imaging by a given label-free method usually presents a challenge in obtaining sufficient optical signal or is limited in terms of the types of observable targets. Multimodal imaging is then particularly attractive for these samples in order to maximize the amount of measured information. While multimodal imaging is always useful in the sense of acquiring additional information from additional modes, at times it is possible to attain information that could not be discovered using any single mode alone, which is the essence of the progress that is possible using a multimodal approach.

  7. Multimodal image registration based on binary gradient angle descriptor.

    Science.gov (United States)

    Jiang, Dongsheng; Shi, Yonghong; Yao, Demin; Fan, Yifeng; Wang, Manning; Song, Zhijian

    2017-12-01

    Multimodal image registration plays an important role in image-guided interventions/therapy and atlas building, and it is still a challenging task due to the complex intensity variations in different modalities. The paper addresses the problem and proposes a simple, compact, fast and generally applicable modality-independent binary gradient angle descriptor (BGA) based on the rationale of gradient orientation alignment. The BGA can be easily calculated at each voxel by coding the quadrant in which a local gradient vector falls, and it has an extremely low computational complexity, requiring only three convolutions, two multiplication operations and two comparison operations. Meanwhile, the binarized encoding of the gradient orientation makes the BGA more resistant to image degradations compared with conventional gradient orientation methods. The BGA can extract similar feature descriptors for different modalities and enable the use of simple similarity measures, which makes it applicable within a wide range of optimization frameworks. The results for pairwise multimodal and monomodal registrations between various images (T1, T2, PD, T1c, Flair) consistently show that the BGA significantly outperforms localized mutual information. The experimental results also confirm that the BGA can be a reliable alternative to the sum of absolute difference in monomodal image registration. The BGA can also achieve an accuracy of [Formula: see text], similar to that of the SSC, for the deformable registration of inhale and exhale CT scans. Specifically, for the highly challenging deformable registration of preoperative MRI and 3D intraoperative ultrasound images, the BGA achieves a similar registration accuracy of [Formula: see text] compared with state-of-the-art approaches, with a computation time of 18.3 s per case. The BGA improves the registration performance in terms of both accuracy and time efficiency. With further acceleration, the framework has the potential for

  8. [Selective intraoperative cholangiography in laparoscopic cholecystectomy].

    Science.gov (United States)

    Pickuth, D; Leutloff, U

    1995-01-01

    Routine use of intraoperative cholangiography during laparoscopic cholecystectomy is still widely advocated and standard in many departments; however, it is controversial. We have developed a new diagnostic strategy for the detection of bile duct stones. The concept is based on an ultrasound examination and on screening for the presence of six risk indicators of choledocholithiasis. A total of 120 patients undergoing laparoscopic cholecystectomy were prospectively screened for the presence of these six risk indicators: history of jaundice, history of pancreatitis, hyperbilirubinemia, hyperamylasemia, dilated bile duct, and unclear ultrasound findings. The sensitivity of ultrasound and intraoperative cholangiography in diagnosing bile duct stones was also evaluated. For the detection of bile duct stones, the sensitivity was 77% for ultrasound and 100% for intraoperative cholangiography. Twenty percent of all patients had at least one risk indicator. The presence of a risk indicator correlated significantly with the presence of choledocholithiasis (P concept, we would have avoided 80% of intraoperative cholangiographies without missing a stone in the bile duct. This study lends further support to the view that routine use of intraoperative cholangiography is not necessary.

  9. Trends in Intraoperative Testing During Cochlear Implantation.

    Science.gov (United States)

    Page, Joshua Cody; Cox, Matthew D; Hollowoa, Blake; Bonilla-Velez, Juliana; Trinidade, Aaron; Dornhoffer, John L

    2018-03-01

    No consensus guidelines exist regarding intraoperative testing during cochlear implantation and wide variation in practice habits exists. The objective of this observational study was to survey otologists/neurotologists to understand practice habits and overall opinion of usefulness of intraoperative testing. Cross-sectional survey. A web-based survey was sent to 194 practicing Otologists/Neurotologists. Questions included practice setting and experience, habits with respect to electrodes used, intraoperative testing modalities used, overall opinion of intraoperative testing, and practice habits in various scenarios. Thirty-nine of 194 (20%) completed the survey. For routine patients, ECAPs and EIs were most commonly used together (38%) while 33% do not perform testing at all. Eighty-nine percent note that testing "rarely" or "never" changes management. Fifty-one percent marked the most important reason for testing is the reassurance provided to the family and/or the surgeon. Intraoperative testing habits and opinions regarding testing during cochlear implantation vary widely among otologic surgeons. The majority of surgeons use testing but many think there is minimal benefit and that surgical decision-making is rarely impacted. The importance of testing may change as electrodes continue to evolve.

  10. The impact of fMRI on multimodal navigation in surgery of cerebral lesions: four years clinical experience

    International Nuclear Information System (INIS)

    Wurm, Gabriele; Schnizer, Mathilde; Fellner, Claudia

    2008-01-01

    Neuronavigation with display of intraoperative structures, instrument locations, orientation and relationships to nearby structures can increase anatomic precision while enhancing the surgeon's confidence and his/her perception of safety. Combination of neuronavigation with functional imaging provides multimodal guidance for surgery of cerebral lesions. We evaluated the impact of functional MRI (fMRI) on surgical decision making and outcome. A neuronavigational device (StealthStation (tm), Medtronic Inc.) was used as platform to merge fMRI data with anatomic images, and to implement intraoperative multimodal guidance. In a 52-month period, where 977 surgical procedures were performed with the aid of neuronavigation, 88 patients underwent image-guided procedures using multimodal guidance. Patient, surgical and outcome data of this series was prospectively collected. Evaluation of 88 procedures on cerebral lesions in complex regions where fMRI data were integrated using the navigation system demonstrated that the additional information was presented in a user-friendly way. Computer assisted fMRI integration was found to be especially helpful in planning the best approach, in assessing alternative approaches, and in defining the extent of the surgical exposure. Furthermore, the surgeons found it more effective to interpret fMRI information when shown in a navigation system as compared to the traditional display on a light board or monitor. Multimodal navigation enhanced by fMRI was judged useful for optimization of surgery of cerebral lesions, especially in and around eloquent regions by experienced neurosurgeons. (orig.)

  11. MO-DE-202-00: Image-Guided Interventions: Advances in Intraoperative Imaging, Guidance, and An Emerging Role for Medical Physics in Surgery

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2016-06-15

    At least three major trends in surgical intervention have emerged over the last decade: a move toward more minimally invasive (or non-invasive) approach to the surgical target; the development of high-precision treatment delivery techniques; and the increasing role of multi-modality intraoperative imaging in support of such procedures. This symposium includes invited presentations on recent advances in each of these areas and the emerging role for medical physics research in the development and translation of high-precision interventional techniques. The four speakers are: Keyvan Farahani, “Image-guided focused ultrasound surgery and therapy” Jeffrey H. Siewerdsen, “Advances in image registration and reconstruction for image-guided neurosurgery” Tina Kapur, “Image-guided surgery and interventions in the advanced multimodality image-guided operating (AMIGO) suite” Raj Shekhar, “Multimodality image-guided interventions: Multimodality for the rest of us” Learning Objectives: Understand the principles and applications of HIFU in surgical ablation. Learn about recent advances in 3D–2D and 3D deformable image registration in support of surgical safety and precision. Learn about recent advances in model-based 3D image reconstruction in application to intraoperative 3D imaging. Understand the multi-modality imaging technologies and clinical applications investigated in the AMIGO suite. Understand the emerging need and techniques to implement multi-modality image guidance in surgical applications such as neurosurgery, orthopaedic surgery, vascular surgery, and interventional radiology. Research supported by the NIH and Siemens Healthcare.; J. Siewerdsen; Grant Support - National Institutes of Health; Grant Support - Siemens Healthcare; Grant Support - Carestream Health; Advisory Board - Carestream Health; Licensing Agreement - Carestream Health; Licensing Agreement - Elekta Oncology.; T. Kapur, P41EB015898; R. Shekhar, Funding: R42CA137886 and R41CA192504

  12. Intraoperative radiotherapy for cancer of the pancreas

    International Nuclear Information System (INIS)

    Manabe, Tadao; Nagai, Toshihiro; Tobe, Takayoshi; Shibamoto, Yuta; Takahashi, Masaharu; Abe, Mitsuyuki

    1985-01-01

    Seven patients treated by intraoperative radiotherapy for cancer of the pancreas were evaluated. Three patients undergoing pancreaticoduodenectomy for cancer of the head of the pancreas received a dose of 2,500--3,000 rad (6--10 MeV Betatron) intraoperatively with or without external beam irradiation at a dose of 2,520 rad (10 MeV lineac X-ray). One patient developed radiation pancreatitis and died 0.8 month after surgery. Autopsy revealed the degeneration of cancer cells in the involved superior mesenteric artery. One died of hepatic metastasis 8.5 months after surgery, however, recurrence was not found in the irradiation field. The other patient who had external beam irradiation combined with intraoperative radiotherapy is alive 7.5 months after surgery. Four patients with unresectable cancer of the body of the pancreas received a dose of 2,500--3,000 rad (13--18 MeV Betatron) intraoperatively with or without external beam irradiation at a dose of 1,500--5,520 rad (10 MeV lineac X-ray). One patient died of peritonitis carcinomatosa 3.0 months after surgery. One patient died of DIC 0.6 month after surgery. Two patients are alive 1.0 and 6.5 months after surgery. In these patients with intraoperative radiotherapy for unresectable cancer of the pancreas, remarkable effects on relief of pain and shrinkage of tumor were obtained. Further pursuit of intraoperative and external beam radiotherapies in combination with pancreatectomy should be indicated in an attempt to prolong survival of patient with cancer of the pancreas. (author)

  13. MO-DE-202-04: Multimodality Image-Guided Surgery and Intervention: For the Rest of Us

    Energy Technology Data Exchange (ETDEWEB)

    Shekhar, R. [Children’s National Health System (United States)

    2016-06-15

    At least three major trends in surgical intervention have emerged over the last decade: a move toward more minimally invasive (or non-invasive) approach to the surgical target; the development of high-precision treatment delivery techniques; and the increasing role of multi-modality intraoperative imaging in support of such procedures. This symposium includes invited presentations on recent advances in each of these areas and the emerging role for medical physics research in the development and translation of high-precision interventional techniques. The four speakers are: Keyvan Farahani, “Image-guided focused ultrasound surgery and therapy” Jeffrey H. Siewerdsen, “Advances in image registration and reconstruction for image-guided neurosurgery” Tina Kapur, “Image-guided surgery and interventions in the advanced multimodality image-guided operating (AMIGO) suite” Raj Shekhar, “Multimodality image-guided interventions: Multimodality for the rest of us” Learning Objectives: Understand the principles and applications of HIFU in surgical ablation. Learn about recent advances in 3D–2D and 3D deformable image registration in support of surgical safety and precision. Learn about recent advances in model-based 3D image reconstruction in application to intraoperative 3D imaging. Understand the multi-modality imaging technologies and clinical applications investigated in the AMIGO suite. Understand the emerging need and techniques to implement multi-modality image guidance in surgical applications such as neurosurgery, orthopaedic surgery, vascular surgery, and interventional radiology. Research supported by the NIH and Siemens Healthcare.; J. Siewerdsen; Grant Support - National Institutes of Health; Grant Support - Siemens Healthcare; Grant Support - Carestream Health; Advisory Board - Carestream Health; Licensing Agreement - Carestream Health; Licensing Agreement - Elekta Oncology.; T. Kapur, P41EB015898; R. Shekhar, Funding: R42CA137886 and R41CA192504

  14. MO-DE-202-04: Multimodality Image-Guided Surgery and Intervention: For the Rest of Us

    International Nuclear Information System (INIS)

    Shekhar, R.

    2016-01-01

    At least three major trends in surgical intervention have emerged over the last decade: a move toward more minimally invasive (or non-invasive) approach to the surgical target; the development of high-precision treatment delivery techniques; and the increasing role of multi-modality intraoperative imaging in support of such procedures. This symposium includes invited presentations on recent advances in each of these areas and the emerging role for medical physics research in the development and translation of high-precision interventional techniques. The four speakers are: Keyvan Farahani, “Image-guided focused ultrasound surgery and therapy” Jeffrey H. Siewerdsen, “Advances in image registration and reconstruction for image-guided neurosurgery” Tina Kapur, “Image-guided surgery and interventions in the advanced multimodality image-guided operating (AMIGO) suite” Raj Shekhar, “Multimodality image-guided interventions: Multimodality for the rest of us” Learning Objectives: Understand the principles and applications of HIFU in surgical ablation. Learn about recent advances in 3D–2D and 3D deformable image registration in support of surgical safety and precision. Learn about recent advances in model-based 3D image reconstruction in application to intraoperative 3D imaging. Understand the multi-modality imaging technologies and clinical applications investigated in the AMIGO suite. Understand the emerging need and techniques to implement multi-modality image guidance in surgical applications such as neurosurgery, orthopaedic surgery, vascular surgery, and interventional radiology. Research supported by the NIH and Siemens Healthcare.; J. Siewerdsen; Grant Support - National Institutes of Health; Grant Support - Siemens Healthcare; Grant Support - Carestream Health; Advisory Board - Carestream Health; Licensing Agreement - Carestream Health; Licensing Agreement - Elekta Oncology.; T. Kapur, P41EB015898; R. Shekhar, Funding: R42CA137886 and R41CA192504

  15. Multimodal Friction Ignition Tester

    Science.gov (United States)

    Davis, Eddie; Howard, Bill; Herald, Stephen

    2009-01-01

    The multimodal friction ignition tester (MFIT) is a testbed for experiments on the thermal and mechanical effects of friction on material specimens in pressurized, oxygen-rich atmospheres. In simplest terms, a test involves recording sensory data while rubbing two specimens against each other at a controlled normal force, with either a random stroke or a sinusoidal stroke having controlled amplitude and frequency. The term multimodal in the full name of the apparatus refers to a capability for imposing any combination of widely ranging values of the atmospheric pressure, atmospheric oxygen content, stroke length, stroke frequency, and normal force. The MFIT was designed especially for studying the tendency toward heating and combustion of nonmetallic composite materials and the fretting of metals subjected to dynamic (vibrational) friction forces in the presence of liquid oxygen or pressurized gaseous oxygen test conditions approximating conditions expected to be encountered in proposed composite material oxygen tanks aboard aircraft and spacecraft in flight. The MFIT includes a stainless-steel pressure vessel capable of retaining the required test atmosphere. Mounted atop the vessel is a pneumatic cylinder containing a piston for exerting the specified normal force between the two specimens. Through a shaft seal, the piston shaft extends downward into the vessel. One of the specimens is mounted on a block, denoted the pressure block, at the lower end of the piston shaft. This specimen is pressed down against the other specimen, which is mounted in a recess in another block, denoted the slip block, that can be moved horizontally but not vertically. The slip block is driven in reciprocating horizontal motion by an electrodynamic vibration exciter outside the pressure vessel. The armature of the electrodynamic exciter is connected to the slip block via a horizontal shaft that extends into the pressure vessel via a second shaft seal. The reciprocating horizontal

  16. Postoperative recovery profile after elective abdominal hysterectomy: a prospective, observational study of a multimodal anaesthetic regime

    DEFF Research Database (Denmark)

    Jensen, Kenneth; Kehlet, Henrik; Lund, Claus M

    2009-01-01

    insufficiency and time of discharge readiness. RESULTS: The structured regime consisting of total intravenous anaesthesia (propofol-remifentanil), well defined fluid administration, prophylactic antiemetics (dexamethasone, ondansetron, droperidol), weak analgesics (celecoxib, paracetamol) and intraoperative......BACKGROUND AND OBJECTIVE: To evaluate the applicability, effectiveness, immediate postoperative complaints and requirements for a postanaesthesia care unit stay after elective abdominal hysterectomy under a well defined, multimodal anaesthetic regime. METHODS: Observational study of 145 consecutive......, was seen in 52%. CONCLUSION: We conclude that a structured multimodal anaesthetic regime is feasible in daily clinical practice and advantageous, and that postoperative pain and oxygen requirements (to sustain an SpO2 >92%) are the major determinants for length of stay in the postanaesthesia care unit...

  17. Multimodal Discourse Analysis of the Movie "Argo"

    Science.gov (United States)

    Bo, Xu

    2018-01-01

    Based on multimodal discourse theory, this paper makes a multimodal discourse analysis of some shots in the movie "Argo" from the perspective of context of culture, context of situation and meaning of image. Results show that this movie constructs multimodal discourse through particular context, language and image, and successfully…

  18. Intra-operative radiotherapy in oncology

    International Nuclear Information System (INIS)

    Gerard, J.P.; Braillon, G.; Sentenac, I.; Calvo, F.; Dubois, J.B.; Saint-Aubert, B.; Guillemin, C.; Roussel, A.

    1991-01-01

    This article is about a treatment used more and more frequently in the world, for some neoplasms: Intra-operative radiotherapy under electron beams. The main neoplasms concerned by this treatment are the stomach, pancreas, rectum, bladder, uterus cervix neoplasms and peritoneal sarcoma [fr

  19. Intraoperative and recovery room outcome | Edomwonyi | East ...

    African Journals Online (AJOL)

    Objectives: To identify and quantitate anaesthesia related complications in the intraoperative period and in the post anaesthesia recovery room. Design: A prospective study. Setting: University of Benin Teaching Hospital; a University - affiliated tertiary centre. Subjects: Patients scheduled for elective and emergency surgery ...

  20. Intraoperative Electron Radiotherapy for the Management of Aggressive Fibromatosis

    International Nuclear Information System (INIS)

    Roeder, Falk; Timke, Carmen; Oertel, Susanne; Hensley, Frank W.; Bischof, Marc; Muenter, Marc W.; Weitz, Juergen; Buchler, Markus W.; Lehner, Burkhard; Debus, Juergen; Krempien, Robert

    2010-01-01

    Purpose: We analyzed our experience with intraoperative electron radiotherapy (IOERT) followed by moderate doses of external beam radiotherapy (EBRT) after organ-sparing surgery in patients with primary or recurrent aggressive fibromatosis. Methods and Materials: Indication for IOERT and postoperative EBRT as an individual treatment approach to avoid mutilating surgical procedures was seen when complete surgical removal seemed to be unlikely or impossible. A total of 31 lesions in 30 patients were treated by surgery and IOERT with a median dose of 12 Gy. Median age was 31 years (range, 13-59 years). Resection status was close margin in six lesions, microscopically positive in 13, and macroscopically positive in 12. Median tumor size was 9 cm. In all, 25 patients received additional EBRT, with a median dose of 45 Gy (range, 36-54 Gy). Results: After a median follow-up of 32 months (range, 3-139 months), no disease-related deaths occurred. A total of five local recurrences were seen, resulting in actuarial 3-year local control rates of 82% overall and 91% inside the IOERT areas. Trends to improved local control were seen for older age (>31 years) and negative margins, but none of these factors reached significance. Perioperative complications were found in six patients, in particular as wound healing disturbances in five patients and venous thrombosis in one patient. Late toxicity was seen in five patients. Conclusion: Introduction of IOERT into a multimodal treatment approach in patients with aggressive fibromatosis is feasible with low toxicity and yielded good local control rates even in patients with microscopical or gross residual disease.

  1. INTRAOPERATIVE PHOTODYNAMIC THERAPY FOR METASTATIC PERITONEAL TUMORS

    Directory of Open Access Journals (Sweden)

    E. A. Suleimanov

    2016-01-01

    Full Text Available This review is devoted to the cytoreductive treatment of malignant tumors of the abdominal organs. The actuality of the issue is determined both by increase of the incidence of abdominal cancer in Russia and in majority of developed countries and by high rate diagnosis on late stages of disease. The methods of treatment of peritoneal carcinomatosis, based on possible effects on the secondary peritoneal tumors after surgical cytoreduction to reduce the risk of local recurrence and disease progression are described. These methods of additional intraoperative specific antitumor action include intraoperative radiation therapy, hyperthermic intraperitoneal chemotherapy, intraoperative photodynamic therapy characterized by differences in difficulty of performance, mechanisms of effect on tumor and healthy tissues, efficiency. Benefits, opportunities and possibilities of application of intraoperative photodynamic therapy (IOPDT for secondary peritoneal tumors are described in details, the results of a number of domestic and foreign clinical studies are shown, the successful application of intraoperative photodynamic therapy in clinical oncology, which allows reducing the risk of secondary tumor lesions of the peritoneum significantly, is demonstrated. Photodynamic therapy – a method with high efficiency and almost no side effects and complications, based on the ability of photosensitizer to accumulate selectively and retain in the high proliferative tissues. The advantages of this type of treatment of patients with peritoneal carcinomatosis are a selective effect on the peritoneal carcinomatosis and on visually detected tumor tissue, high efficiency in patients with malignant tumors of the abdominal cavity and pelvis combined with surgical cytoreduction, minimal effect on normal organs and tissues of the patient, well tolerated procedure.

  2. Near-infrared intraoperative imaging during resection of an anterior mediastinal soft tissue sarcoma.

    Science.gov (United States)

    Predina, Jarrod D; Newton, Andrew D; Desphande, Charuhas; Singhal, Sunil

    2018-01-01

    Sarcomas are rare malignancies that are generally treated with multimodal therapy protocols incorporating complete local resection, chemotherapy and radiation. Unfortunately, even with this aggressive approach, local recurrences are common. Near-infrared intraoperative imaging is a novel technology that provides real-time visual feedback that can improve identification of disease during resection. The presented study describes utilization of a near-infrared agent (indocyanine green) during resection of an anterior mediastinal sarcoma. Real-time fluorescent feedback provided visual information that helped the surgeon during tumor localization, margin assessment and dissection from mediastinal structures. This rapidly evolving technology may prove useful in patients with primary sarcomas arising from other locations or with other mediastinal neoplasms.

  3. Multimodal Aspects of Corporate Social Responsibility Communication

    Directory of Open Access Journals (Sweden)

    Carmen Daniela Maier

    2014-12-01

    Full Text Available This article addresses how the multimodal persuasive strategies of corporate social responsibility communication can highlight a company’s commitment to gender empowerment and environmental protection while advertising simultaneously its products. Drawing on an interdisciplinary methodological framework related to CSR communication, multimodal discourse analysis and gender theory, the article proposes a multimodal analysis model through which it is possible to map and explain the multimodal persuasive strategies employed by Coca-Cola company in their community-related films. By examining the semiotic modes’ interconnectivity and functional differentiation, this analytical endeavour expands the existing research work as the usual textual focus is extended to a multimodal one.

  4. The Multimodal Possibilities of Online Instructions

    DEFF Research Database (Denmark)

    Kampf, Constance

    2006-01-01

    The WWW simplifies the process of delivering online instructions through multimodal channels because of the ease of use for voice, video, pictures, and text modes of communication built into it.  Given that instructions are being produced in multimodal format for the WWW, how do multi-modal analy......The WWW simplifies the process of delivering online instructions through multimodal channels because of the ease of use for voice, video, pictures, and text modes of communication built into it.  Given that instructions are being produced in multimodal format for the WWW, how do multi...

  5. A Learning Algorithm for Multimodal Grammar Inference.

    Science.gov (United States)

    D'Ulizia, A; Ferri, F; Grifoni, P

    2011-12-01

    The high costs of development and maintenance of multimodal grammars in integrating and understanding input in multimodal interfaces lead to the investigation of novel algorithmic solutions in automating grammar generation and in updating processes. Many algorithms for context-free grammar inference have been developed in the natural language processing literature. An extension of these algorithms toward the inference of multimodal grammars is necessary for multimodal input processing. In this paper, we propose a novel grammar inference mechanism that allows us to learn a multimodal grammar from its positive samples of multimodal sentences. The algorithm first generates the multimodal grammar that is able to parse the positive samples of sentences and, afterward, makes use of two learning operators and the minimum description length metrics in improving the grammar description and in avoiding the over-generalization problem. The experimental results highlight the acceptable performances of the algorithm proposed in this paper since it has a very high probability of parsing valid sentences.

  6. Multimodal network design and assessment

    NARCIS (Netherlands)

    Brands, Ties; Alkim, T.P.; van Eck, Gijs; van Arem, Bart; Arentze, T.

    2010-01-01

    A framework is proposed for the design of an optimal multimodal transport network for the Randstad area. This research framework consists of a multi-objective optimization heuristic and a fast network assessment module, which results in a set of Pareto optimal solutions. Subsequently, a proper

  7. Advanced approach for intraoperative MRI guidance and potential benefit for neurosurgical applications.

    Science.gov (United States)

    Busse, Harald; Schmitgen, Arno; Trantakis, Christos; Schober, Ralf; Kahn, Thomas; Moche, Michael

    2006-07-01

    To present an advanced approach for intraoperative image guidance in an open 0.5 T MRI and to evaluate its effectiveness for neurosurgical interventions by comparison with a dynamic scan-guided localization technique. The built-in scan guidance mode relied on successive interactive MRI scans. The additional advanced mode provided real-time navigation based on reformatted high-quality, intraoperatively acquired MR reference data, allowed multimodal image fusion, and used the successive scans of the built-in mode for quick verification of the position only. Analysis involved tumor resections and biopsies in either scan guidance (N = 36) or advanced mode (N = 59) by the same three neurosurgeons. Technical, surgical, and workflow aspects were compared. The image quality and hand-eye coordination of the advanced approach were improved. While the average extent of resection, neurologic outcome after functional MRI (fMRI) integration, and diagnostic yield appeared to be slightly better under advanced guidance, particularly for the main surgeon, statistical analysis revealed no significant differences. Resection times were comparable, while biopsies took around 30 minutes longer. The presented approach is safe and provides more detailed images and higher navigation speed at the expense of actuality. The surgical outcome achieved with advanced guidance is (at least) as good as that obtained with dynamic scan guidance. (c) 2006 Wiley-Liss, Inc.

  8. MEDIASSIST: medical assistance for intraoperative skill transfer in minimally invasive surgery using augmented reality

    Science.gov (United States)

    Sudra, Gunther; Speidel, Stefanie; Fritz, Dominik; Müller-Stich, Beat Peter; Gutt, Carsten; Dillmann, Rüdiger

    2007-03-01

    Minimally invasive surgery is a highly complex medical discipline with various risks for surgeon and patient, but has also numerous advantages on patient-side. The surgeon has to adapt special operation-techniques and deal with difficulties like the complex hand-eye coordination, limited field of view and restricted mobility. To alleviate with these new problems, we propose to support the surgeon's spatial cognition by using augmented reality (AR) techniques to directly visualize virtual objects in the surgical site. In order to generate an intelligent support, it is necessary to have an intraoperative assistance system that recognizes the surgical skills during the intervention and provides context-aware assistance surgeon using AR techniques. With MEDIASSIST we bundle our research activities in the field of intraoperative intelligent support and visualization. Our experimental setup consists of a stereo endoscope, an optical tracking system and a head-mounted-display for 3D visualization. The framework will be used as platform for the development and evaluation of our research in the field of skill recognition and context-aware assistance generation. This includes methods for surgical skill analysis, skill classification, context interpretation as well as assistive visualization and interaction techniques. In this paper we present the objectives of MEDIASSIST and first results in the fields of skill analysis, visualization and multi-modal interaction. In detail we present a markerless instrument tracking for surgical skill analysis as well as visualization techniques and recognition of interaction gestures in an AR environment.

  9. The Art of Intraoperative Glioma Identification

    Directory of Open Access Journals (Sweden)

    Zoe Z Zhang

    2015-07-01

    Full Text Available A major dilemma in brain tumor surgery is the identification of tumor boundaries to maximize tumor excision and minimize postoperative neurological damage. Gliomas, especially low-grade tumors, and normal brain have a similar color and texture which poses a challenge to the neurosurgeon. Advances in glioma resection techniques combine the experience of the neurosurgeon and various advanced technologies. Intraoperative methods to delineate gliomas from normal tissue consist of 1 image-based navigation, 2 intraoperative sampling, 3 electrophysiological monitoring, and 4 enhanced visual tumor demarcation. The advantages and disadvantages of each technique are discussed. A combination of these methods is becoming widely accepted in routine glioma surgery. Gross total resection in conjunction with radiation, chemotherapy, or immune/gene therapy may increase the rates of cure in this devastating disease.

  10. Multimode-singlemode-multimode fiber sensor for alcohol sensing application

    Science.gov (United States)

    Rofi'ah, Iftihatur; Hatta, A. M.; Sekartedjo, Sekartedjo

    2016-11-01

    Alcohol is volatile and flammable liquid which is soluble substances both on polar and non polar substances that has been used in some industrial sectors. Alcohol detection method now widely used one of them is the optical fiber sensor. In this paper used fiber optic sensor based on Multimode-Single-mode-Multimode (MSM) to detect alcohol solution at a concentration range of 0-3%. The working principle of sensor utilizes the modal interference between the core modes and the cladding modes, thus make the sensor sensitive to environmental changes. The result showed that characteristic of the sensor not affect the length of the single-mode fiber (SMF). We obtain that the sensor with a length of 5 mm of single-mode can sensing the alcohol with a sensitivity of 0.107 dB/v%.

  11. Tolerance of bile duct to intraoperative irradiation

    International Nuclear Information System (INIS)

    Sindelar, W.F.; Tepper, J.; Travis, E.L.

    1982-01-01

    In order to determine the effects of intraoperative radiation therapy of the bile duct and surrounding tissues, seven adult dogs were subjected to laparotomy and intraoperative irradiation with 11 MeV electrons. Two animals were treated at each dose level of 2000, 3000, and 4500 rads. A single dog which received a laparotomy and sham irradiation served as a control. The irradiation field consisted of a 5 cm diameter circle encompassing the extrahepatic bile duct, portal vein, hepatic artery, and lateral duodenal wall. The animals were followed clinically for mor than 18 months after treatment, and autopsies were performed on dogs that died to assess radiation-induced complications or tissue damage. All dogs developed fibrosis and mural thickening of the common duct, which appeared by 6 weeks following irradiation and which was dose-related, being mild at low doses and more severe at high doses. Hepatic changes were seen as early as 6 weeks after irradiation, consisting of periportal inflammation and fibrosis. The hepatic changes appeared earliest at the highest doses. Frank biliary cirrhosis eventually developed at all dose levels. Duodenal fibrosis appeared in the irradiation portal, being most severe at the highest doses and in some animals resulting in duodenal obstruction. No changes were observed in irradiated portions of portal vein and hepatic artery at any dose level. It was concluded that intraoperative radiation therapy delivered to the region of the common duct leads to ductal fibrosis, partial biliary obstruction with secondary hepatic changes, and duodenal fibrosis if bowel wall is included in the field. Clinical use of intraoperative radiation therapy to the bile duct in humans may require routine use of biliary and duodenal bypass to prevent obstructive complications

  12. Experimental and clinical studies with intraoperative radiotherapy

    International Nuclear Information System (INIS)

    Sindelar, W.F.; Kinsella, T.; Tepper, J.; Travis, E.L.; Rosenberg, S.A.; Glatstein, E.

    1983-01-01

    Studies of normal tissue tolerance to intraoperative radiotherapy were done upon 65 dogs subjected to laparotomy and 11 million electron volt electron irradiation in doses ranging from zero to 5,000 rads. Results of studies indicated that intact aorta and vena cava tolerate up to 5,000 rads without loss of structural integrity. Ureteral fibrosis and stenosis develop at doses of 3,000 rads or more. Arterial anastomoses heal after doses of 4,500 rads, but fibrosis can lead to occlusion. Intestinal suture lines heal after doses of 4,500 rads. Bile duct fibrosis and stenosis develop at doses of 2,000 rads or more. Biliary-enteric anastomoses fail to heal at any dose level. A clinical trial of intraoperative radiotherapy combined with radical surgery was performed upon 20 patients with advanced malignant tumors which were considered unlikely to be cured by conventional therapies and which included carcinomas of the stomach, carcinomas of the pancreas, carcinomas involving the hilus of the liver, retroperitoneal sarcomas and osteosarcomas of the pelvis. All patients underwent resection of gross tumor, followed by intraoperative irradiation of the tumor bed and regional nodal basins. Some patients received additional postoperative external beam radiotherapy. Treatment mortality for combined operation and radiotherapy occurred in four of 20 patients. Postoperative complications occurred in four of the 16 surviving patients. Local tumor control was achieved in 11 of the 16 surviving patients, with an over-all median follow-up period of 18 months. The clinical trial suggested that intraoperative radiotherapy is a feasible adjunct to resection in locally advanced tumors, that the resulting mortality and morbidity is similar to that expected from operation alone and that local tumor control may be improved

  13. Near-Infrared Intraoperative Chemiluminescence Imaging

    KAUST Repository

    Büchel, Gabriel E.

    2016-08-03

    Intraoperative imaging technologies recently entered the operating room, and their implementation is revolutionizing how physicians plan, monitor, and perform surgical interventions. In this work, we present a novel surgical imaging reporter system: intraoperative chemiluminescence imaging (ICI). To this end, we have leveraged the ability of a chemiluminescent metal complex to generate near-infrared light upon exposure to an aqueous solution of Ce4+ in the presence of reducing tissue or blood components. An optical camera spatially resolves the resulting photon flux. We describe the construction and application of a prototype imaging setup, which achieves a detection limit as low as 6.9pmolcm-2 of the transition-metal-based ICI agent. As a proof of concept, we use ICI for the invivo detection of our transition metal tracer following both systemic and subdermal injections. The very high signal-to-noise ratios make ICI an interesting candidate for the development of new intraoperative imaging technologies. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  14. Near-Infrared Intraoperative Chemiluminescence Imaging

    KAUST Repository

    Bü chel, Gabriel E.; Carney, Brandon; Shaffer, Travis M.; Tang, Jun; Austin, Christine; Arora, Manish; Zeglis, Brian M.; Grimm, Jan; Eppinger, Jö rg; Reiner, Thomas

    2016-01-01

    Intraoperative imaging technologies recently entered the operating room, and their implementation is revolutionizing how physicians plan, monitor, and perform surgical interventions. In this work, we present a novel surgical imaging reporter system: intraoperative chemiluminescence imaging (ICI). To this end, we have leveraged the ability of a chemiluminescent metal complex to generate near-infrared light upon exposure to an aqueous solution of Ce4+ in the presence of reducing tissue or blood components. An optical camera spatially resolves the resulting photon flux. We describe the construction and application of a prototype imaging setup, which achieves a detection limit as low as 6.9pmolcm-2 of the transition-metal-based ICI agent. As a proof of concept, we use ICI for the invivo detection of our transition metal tracer following both systemic and subdermal injections. The very high signal-to-noise ratios make ICI an interesting candidate for the development of new intraoperative imaging technologies. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  15. Intraoperative dynamic dosimetry for prostate implants

    Energy Technology Data Exchange (ETDEWEB)

    Todor, D A [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021 (United States); Zaider, M [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021 (United States); Cohen, G N [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021 (United States); Worman, M F [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021 (United States); Zelefsky, M J [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021 (United States)

    2003-05-07

    This paper describes analytic tools in support of a paradigm shift in brachytherapy treatment planning for prostate cancer - a shift from standard pre-planning to intraoperative planning using dosimetric feedback based on the actual deposited seed positions within the prostate. The method proposed is guided by several desiderata: (a) bringing both planning and evaluation in the operating room (i.e. make post-implant evaluation superfluous) therefore making rectifications - if necessary - still achievable; (b) making planning and implant evaluation consistent by using the same imaging system (ultrasound); and (c) using only equipment commonly found in a hospital operating room. The intraoperative dosimetric evaluation is based on the fusion between ultrasound images and 3D seed coordinates reconstructed from fluoroscopic projections. Automatic seed detection and registration of the fluoroscopic and ultrasound information, two of the three key ingredients needed for the intraoperative dynamic dosimetry optimization (IDDO), are explained in detail. The third one, the reconstruction of 3D coordinates from projections, was reported in a previous article. The algorithms were validated using a custom-designed phantom with non-radioactive (dummy) seeds. Also, fluoroscopic images were taken at the conclusion of an actual permanent prostate implant and compared with data on the same patient obtained from radiographic-based post-implant evaluation. To offset the effect of organ motion the comparison was performed in terms of the proximity function of the two seed distributions. The agreement between the intra- and post-operative seed distributions was excellent.

  16. Multispectral open-air intraoperative fluorescence imaging.

    Science.gov (United States)

    Behrooz, Ali; Waterman, Peter; Vasquez, Kristine O; Meganck, Jeff; Peterson, Jeffrey D; Faqir, Ilias; Kempner, Joshua

    2017-08-01

    Intraoperative fluorescence imaging informs decisions regarding surgical margins by detecting and localizing signals from fluorescent reporters, labeling targets such as malignant tissues. This guidance reduces the likelihood of undetected malignant tissue remaining after resection, eliminating the need for additional treatment or surgery. The primary challenges in performing open-air intraoperative fluorescence imaging come from the weak intensity of the fluorescence signal in the presence of strong surgical and ambient illumination, and the auto-fluorescence of non-target components, such as tissue, especially in the visible spectral window (400-650 nm). In this work, a multispectral open-air fluorescence imaging system is presented for translational image-guided intraoperative applications, which overcomes these challenges. The system is capable of imaging weak fluorescence signals with nanomolar sensitivity in the presence of surgical illumination. This is done using synchronized fluorescence excitation and image acquisition with real-time background subtraction. Additionally, the system uses a liquid crystal tunable filter for acquisition of multispectral images that are used to spectrally unmix target fluorescence from non-target auto-fluorescence. Results are validated by preclinical studies on murine models and translational canine oncology models.

  17. Intraoperative lung ultrasound: A clinicodynamic perspective

    Directory of Open Access Journals (Sweden)

    Amit Kumar Mittal

    2016-01-01

    Full Text Available In the era of evidence-based medicine, ultrasonography has emerged as an important and indispensable tool in clinical practice in various specialties including critical care. Lung ultrasound (LUS has a wide potential in various surgical and clinical situations for timely and easy detection of an impending crisis such as pulmonary edema, endobronchial tube migration, pneumothorax, atelectasis, pleural effusion, and various other causes of desaturation before it clinically ensues to critical level. Although ultrasonography is frequently used in nerve blocks, airway handling, and vascular access, LUS for routine intraoperative monitoring and in crisis management still necessitates recognition. After reviewing the various articles regarding the use of LUS in critical care, we found, that LUS can be used in various intraoperative circumstances similar to Intensive Care Unit with some limitations. Except for few attempts in the intraoperative detection of pneumothorax, LUS is hardly used but has wider perspective for routine and crisis management in real-time. If anesthesiologists add LUS in their routine monitoring armamentarium, it can assist to move a step ahead in the dynamic management of critically ill and high-risk patients.

  18. Practice and bias in intraoperative pain management: results of a cross-sectional patient study and a survey of anesthesiologists

    Directory of Open Access Journals (Sweden)

    Ward S

    2018-03-01

    in the dose–effect estimates with the average applied dose operating on an ED63 instead of an ED95 level. Conclusion: This study confirmed a high prevalence of pain in PACU. It also indicated conservative intraoperative analgesic administration by anesthesiologists. The modest morphine usage and overreliance on LA application, which are not supported by published evidence, additionally suggest bias in current intraoperative pain management. Keywords: intraoperative morphine, multimodal analgesia, local anesthetic infiltration, clinical decision making, effective-dose, postoperative pain

  19. Gastric Adenocarcinoma: A Multimodal Approach

    Directory of Open Access Journals (Sweden)

    Humair S. Quadri

    2017-08-01

    Full Text Available Despite its declining incidence, gastric cancer (GC remains a leading cause of cancer-related deaths worldwide. A multimodal approach to GC is critical to ensure optimal patient outcomes. Pretherapy fine resolution contrast-enhanced cross-sectional imaging, endoscopic ultrasound and staging laparoscopy play an important role in patients with newly diagnosed ostensibly operable GC to avoid unnecessary non-therapeutic laparotomies. Currently, margin negative gastrectomy and adequate lymphadenectomy performed at high volume hospitals remain the backbone of GC treatment. Importantly, adequate GC surgery should be integrated in the setting of a multimodal treatment approach. Treatment for advanced GC continues to expand with the emergence of additional lines of systemic and targeted therapies.

  20. Robustness of multimodal processes itineraries

    DEFF Research Database (Denmark)

    Bocewicz, G.; Banaszak, Z.; Nielsen, Izabela Ewa

    2013-01-01

    itineraries for assumed (O-D) trip. Since itinerary planning problem, constitutes a common routing and scheduling decision faced by travelers, hence the main question regards of itinerary replanning and particularly a method aimed at prototyping of mode sequences and paths selections. The declarative model......This paper concerns multimodal transport systems (MTS) represented by a supernetworks in which several unimodal networks are connected by transfer links and focuses on the scheduling problems encountered in these systems. Assuming unimodal networks are modeled as cyclic lines, i.e. the routes...... of multimodal processes driven itinerary planning problem is our main contribution. Illustrative examples providing alternative itineraries in some cases of MTS malfunction are presented....

  1. Inorganic Nanoparticles for Multimodal Molecular Imaging

    Directory of Open Access Journals (Sweden)

    Magdalena Swierczewska

    2011-01-01

    Full Text Available Multimodal molecular imaging can offer a synergistic improvement of diagnostic ability over a single imaging modality. Recent development of hybrid imaging systems has profoundly impacted the pool of available multimodal imaging probes. In particular, much interest has been focused on biocompatible, inorganic nanoparticle-based multimodal probes. Inorganic nanoparticles offer exceptional advantages to the field of multimodal imaging owing to their unique characteristics, such as nanometer dimensions, tunable imaging properties, and multifunctionality. Nanoparticles mainly based on iron oxide, quantum dots, gold, and silica have been applied to various imaging modalities to characterize and image specific biologic processes on a molecular level. A combination of nanoparticles and other materials such as biomolecules, polymers, and radiometals continue to increase functionality for in vivo multimodal imaging and therapeutic agents. In this review, we discuss the unique concepts, characteristics, and applications of the various multimodal imaging probes based on inorganic nanoparticles.

  2. Coherent multimoded dielectric wakefield accelerators

    International Nuclear Information System (INIS)

    Power, J.

    1998-01-01

    There has recently been a study of the potential uses of multimode dielectric structures for wakefield acceleration [1]. This technique is based on adjusting the wakefield modes of the structure to constructively interfere at certain delays with respect to the drive bunch, thus providing an accelerating gradient enhancement over single mode devices. In this report we examine and attempt to clarify the issues raised by this work in the light of the present state of the art in wakefield acceleration

  3. Evaluation of multimodal ground cues

    DEFF Research Database (Denmark)

    Nordahl, Rolf; Lecuyer, Anatole; Serafin, Stefania

    2012-01-01

    This chapter presents an array of results on the perception of ground surfaces via multiple sensory modalities,with special attention to non visual perceptual cues, notably those arising from audition and haptics, as well as interactions between them. It also reviews approaches to combining...... synthetic multimodal cues, from vision, haptics, and audition, in order to realize virtual experiences of walking on simulated ground surfaces or other features....

  4. Multimodality imaging of pulmonary infarction

    International Nuclear Information System (INIS)

    Bray, T.J.P.; Mortensen, K.H.; Gopalan, D.

    2014-01-01

    Highlights: • A plethora of pulmonary and systemic disorders, often associated with grave outcomes, may cause pulmonary infarction. • A stereotypical infarct is a peripheral wedge shaped pleurally based opacity but imaging findings can be highly variable. • Multimodality imaging is key to diagnosing the presence, aetiology and complications of pulmonary infarction. • Multimodality imaging of pulmonary infarction together with any ancillary features often guide to early targeted treatment. • CT remains the principal imaging modality with MRI increasingly used alongside nuclear medicine studies and ultrasound. - Abstract: The impact of absent pulmonary arterial and venous flow on the pulmonary parenchyma depends on a host of factors. These include location of the occlusive insult, the speed at which the occlusion develops and the ability of the normal dual arterial supply to compensate through increased bronchial arterial flow. Pulmonary infarction occurs when oxygenation is cut off secondary to sudden occlusion with lack of recruitment of the dual supply arterial system. Thromboembolic disease is the commonest cause of such an insult but a whole range of disease processes intrinsic and extrinsic to the pulmonary arterial and venous lumen may also result in infarcts. Recognition of the presence of infarction can be challenging as imaging manifestations often differ from the classically described wedge shaped defect and a number of weighty causes need consideration. This review highlights aetiologies and imaging appearances of pulmonary infarction, utilising cases to illustrate the essential role of a multimodality imaging approach in order to arrive at the appropriate diagnosis

  5. Multimodality imaging of pulmonary infarction

    Energy Technology Data Exchange (ETDEWEB)

    Bray, T.J.P., E-mail: timothyjpbray@gmail.com [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom); Mortensen, K.H., E-mail: mortensen@doctors.org.uk [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom); University Department of Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Box 318, Cambridge CB2 0QQ (United Kingdom); Gopalan, D., E-mail: deepa.gopalan@btopenworld.com [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom)

    2014-12-15

    Highlights: • A plethora of pulmonary and systemic disorders, often associated with grave outcomes, may cause pulmonary infarction. • A stereotypical infarct is a peripheral wedge shaped pleurally based opacity but imaging findings can be highly variable. • Multimodality imaging is key to diagnosing the presence, aetiology and complications of pulmonary infarction. • Multimodality imaging of pulmonary infarction together with any ancillary features often guide to early targeted treatment. • CT remains the principal imaging modality with MRI increasingly used alongside nuclear medicine studies and ultrasound. - Abstract: The impact of absent pulmonary arterial and venous flow on the pulmonary parenchyma depends on a host of factors. These include location of the occlusive insult, the speed at which the occlusion develops and the ability of the normal dual arterial supply to compensate through increased bronchial arterial flow. Pulmonary infarction occurs when oxygenation is cut off secondary to sudden occlusion with lack of recruitment of the dual supply arterial system. Thromboembolic disease is the commonest cause of such an insult but a whole range of disease processes intrinsic and extrinsic to the pulmonary arterial and venous lumen may also result in infarcts. Recognition of the presence of infarction can be challenging as imaging manifestations often differ from the classically described wedge shaped defect and a number of weighty causes need consideration. This review highlights aetiologies and imaging appearances of pulmonary infarction, utilising cases to illustrate the essential role of a multimodality imaging approach in order to arrive at the appropriate diagnosis.

  6. Diffusion Maps for Multimodal Registration

    Directory of Open Access Journals (Sweden)

    Gemma Piella

    2014-06-01

    Full Text Available Multimodal image registration is a difficult task, due to the significant intensity variations between the images. A common approach is to use sophisticated similarity measures, such as mutual information, that are robust to those intensity variations. However, these similarity measures are computationally expensive and, moreover, often fail to capture the geometry and the associated dynamics linked with the images. Another approach is the transformation of the images into a common space where modalities can be directly compared. Within this approach, we propose to register multimodal images by using diffusion maps to describe the geometric and spectral properties of the data. Through diffusion maps, the multimodal data is transformed into a new set of canonical coordinates that reflect its geometry uniformly across modalities, so that meaningful correspondences can be established between them. Images in this new representation can then be registered using a simple Euclidean distance as a similarity measure. Registration accuracy was evaluated on both real and simulated brain images with known ground-truth for both rigid and non-rigid registration. Results showed that the proposed approach achieved higher accuracy than the conventional approach using mutual information.

  7. Multimodal Estimation of Distribution Algorithms.

    Science.gov (United States)

    Yang, Qiang; Chen, Wei-Neng; Li, Yun; Chen, C L Philip; Xu, Xiang-Min; Zhang, Jun

    2016-02-15

    Taking the advantage of estimation of distribution algorithms (EDAs) in preserving high diversity, this paper proposes a multimodal EDA. Integrated with clustering strategies for crowding and speciation, two versions of this algorithm are developed, which operate at the niche level. Then these two algorithms are equipped with three distinctive techniques: 1) a dynamic cluster sizing strategy; 2) an alternative utilization of Gaussian and Cauchy distributions to generate offspring; and 3) an adaptive local search. The dynamic cluster sizing affords a potential balance between exploration and exploitation and reduces the sensitivity to the cluster size in the niching methods. Taking advantages of Gaussian and Cauchy distributions, we generate the offspring at the niche level through alternatively using these two distributions. Such utilization can also potentially offer a balance between exploration and exploitation. Further, solution accuracy is enhanced through a new local search scheme probabilistically conducted around seeds of niches with probabilities determined self-adaptively according to fitness values of these seeds. Extensive experiments conducted on 20 benchmark multimodal problems confirm that both algorithms can achieve competitive performance compared with several state-of-the-art multimodal algorithms, which is supported by nonparametric tests. Especially, the proposed algorithms are very promising for complex problems with many local optima.

  8. Intraoperative floppy iris and prevalence of intraoperative complications: results from ophthalmic surgery outcomes database.

    Science.gov (United States)

    Vollman, David E; Gonzalez-Gonzalez, Luis A; Chomsky, Amy; Daly, Mary K; Baze, Elizabeth; Lawrence, Mary

    2014-06-01

    To estimate the prevalence of untoward events during cataract surgery with the use of pupillary expansion devices and intraoperative floppy iris (IFIS). Retrospective analysis of 4923 cataract surgery cases from the Veterans Affairs Ophthalmic Surgical Outcomes Data Project. Outcomes from 5 Veterans Affairs medical centers were analyzed, including use of alpha-blockers (both selective and nonselective), IFIS, intraoperative iris trauma, intraoperative iris prolapse, posterior capsular tear, anterior capsule tear, intraoperative vitreous prolapse, and use of pupillary expansion devices. P values were calculated using the χ(2) test. A total of 1254 patients (25.5%) took alpha-blockers preoperatively (selective, 587; nonselective, 627; both, 40). Of these 1254 patients, 428 patients (34.1%) had documented IFIS. However, 75.2% of patients with IFIS (428/569) had taken alpha-blockers preoperatively (P < .00001). A total of 430 patients (8.7%) had a pupillary expansion device used during their cataract surgery, of which 186 patients (43.4%) had IFIS (P < .0001). Eighty-six patients with IFIS had at least 1 intraoperative complication and 39 patients with IFIS had more than 1 intraoperative complication (P < .001). The use of either selective or nonselective alpha-antagonists preoperatively demonstrated a significant risk of IFIS. Nonselective alpha-antagonists caused IFIS at a higher prevalence than previously reported. This study did demonstrate statistically significant increased odds of surgical complications in patients with IFIS vs those without IFIS in all groups (those taking selective and nonselective alpha-antagonists and also those not taking medications). Published by Elsevier Inc.

  9. Multimodal Diversity of Postmodernist Fiction Text

    Directory of Open Access Journals (Sweden)

    U. I. Tykha

    2016-12-01

    Full Text Available The article is devoted to the analysis of structural and functional manifestations of multimodal diversity in postmodernist fiction texts. Multimodality is defined as the coexistence of more than one semiotic mode within a certain context. Multimodal texts feature a diversity of semiotic modes in the communication and development of their narrative. Such experimental texts subvert conventional patterns by introducing various semiotic resources – verbal or non-verbal.

  10. Multimodal exemplification: The expansion of meaning in electronic ...

    African Journals Online (AJOL)

    Functional Multimodal Discourse Analysis (SF-MDA) and argues for improving their exemplifica-tion multimodally. Multimodal devices, if well coordinated, can help optimize e-dictionary exam-ples in informativity, diversity, dynamicity and ...

  11. Intraoperative mechanical ventilation: state of the art.

    Science.gov (United States)

    Ball, Lorenzo; Costantino, Federico; Orefice, Giulia; Chandrapatham, Karthikka; Pelosi, Paolo

    2017-10-01

    Mechanical ventilation is a cornerstone of the intraoperative management of the surgical patient and is still mandatory in several surgical procedures. In the last decades, research focused on preventing postoperative pulmonary complications (PPCs), both improving risk stratification through the use of predictive scores and protecting the lung adopting so-called protective ventilation strategies. The aim of this review was to give an up-to-date overview of the currently suggested intraoperative ventilation strategies, along with their pathophysiologic rationale, with a focus on challenging conditions, such as obesity, one-lung ventilation and cardiopulmonary bypass. While anesthesia and mechanical ventilation are becoming increasingly safe practices, the contribution to surgical mortality attributable to postoperative lung injury is not negligible: for these reasons, the prevention of PPCs, including the use of protective mechanical ventilation is mandatory. Mechanical ventilation should be optimized providing an adequate respiratory support while minimizing unwanted negative effects. Due to the high number of surgical procedures performed daily, the impact on patients' health and healthcare costs can be relevant, even when new strategies result in an apparently small improvement of outcome. A protective intraoperative ventilation should include a low tidal volume of 6-8 mL/kg of predicted body weight, plateau pressures ideally below 16 cmH2O, the lowest possible driving pressure, moderate-low PEEP levels except in obese patients, laparoscopy and long surgical procedures that might benefit of a slightly higher PEEP. The work of the anesthesiologist should start with a careful preoperative visit to assess the risk, and a close postoperative monitoring.

  12. Tolerance of retroperitoneal structures to intraoperative radiation

    International Nuclear Information System (INIS)

    Sindelar, W.F.; Tepper, J.; Travis, E.L.; Terrill, R.

    1982-01-01

    In conjunction with the clinical development of intraoperative radiotherapy, a study was undertaken in dogs to define the tolerance of normal anatomic structures in the retroperitoneum to radiation delivered during operation. Twenty adult dogs were subjected to laparotomy and intraoperative 11 MeV electron irradiation in single doses ranging from 0.to 5000 rad. Animals were followed regularly with clinical observation, blood count, serum chemistries, pyelography, and angiography. Animals were sacrificed and autopsied at regular intervals up to 12 months following treatment to assess radiation-induced complications or tissue damage. Irradiation field in all dogs consisted of a 4 X 15 cm rectangle extending in the retroperitoneum from the level of the renal vessels to the bifurcation of aorta and vena cava. The field included aorta, vena cava, inferior portion of left kidney, and distal portion of left ureter. No complications or histologic changes occurred in any animal given doses of 2000 rad, with a follow-up in excess of 18 months. A dose of 3000 rad was well tolerated, except for left ureteral occlusion in one animal. Mild vascular fibrosis was present inthe aorta and vena cava, and significant ureteral fibrosis developed by six months after doses of 4000 or 5000 rad. All animals that received 5000 rad died of radiation-related complications, including ureteral obstruction and rectal perforation. It was concluded that major vessels tolerate intraoperative irradiation well up to and including 3000 rad and that no clinically significant vascular problems develop after 4000 and 5000 rad, although some fibrosis does occur. The ureter and kidney appear to be the most radiosensitive structures inthe retroperitoneum, showing progressive changes at 300 rad or greater and showing the potential for serious complications after doses of 4000 rad or more

  13. Study on intraoperative radiotherapy of brain tumors

    International Nuclear Information System (INIS)

    Uozumi, Akimasa

    1990-01-01

    Effects of a single large dose radiation on the brain of dogs were investigated for the purpose of determining the optimal dose and radiation field in intraoperative radiotherapy. The right parietal lobe of dogs (three groups, four dogs in each) were radiated at the dose of 30, 40 and 50 Gy respectively at the depth of 1.5 cm by 11 Nev electron beam with field size of 2 cm. CT and histopathological study were performed 2, 6, 12 and 24 months after radiation. L-hemiparesis developed 14 months after radiation in the 30 Gy group and 8 months in the 40 Gy group, 6 months in the 50 Gy group. All animals in the 40 Gy and 50 Gy groups died before 15 months of radiation. CT showed delayed radiation necrosis in all groups. Brain swelling and ventricular displacement in the radiated hemisphere and contralateral ventricular dilatation were depicted on plain CT. Diffuse heterogeneous contrast enhancement (CE) was observed on CE-CT. CT revealed disappearance of radiation necrosis in the 30 Gy group 24 months of radiation, suggesting that radiation necrosis may be dependent on the term after radiation. Histological findings of radiation necrosis were similar in all animals, and the vascular change preceding the parechymal necrosis was not observed. This supports the theory that the vascular alternation dose not play a major role in the production of radiation necrosis. The necrotic area grossly reflected the isodose curve and was observed in the radiation field with 15 to 20 Gy at the depth of 3 to 4.5 cm. Thus, the intraoperative radiotherapy should be planned on the basis of two such factors as electron beam energy and the field size, and the area out of the target should not be radiated at the dose of more than 15 Gy. The author believes that the information would contribute to safer and more effective application of intraoperative radiotherapy on malignant brain tumors. (J.P.N.) 63 refs

  14. INTRAOPERATIVE PHOTODYNAMIC THERAPY FOR PERITONEAL MESOTHELIOMA

    Directory of Open Access Journals (Sweden)

    A. D. Kaprin

    2017-01-01

    Full Text Available Abstract Results of application of a new technology of intraoperative photodynamic therapy (IOFDT in patients with peritoneal mesothelioma developed at P. Herzen Moscow Oncology Research Institute are presented. The study included 8 patients. 3 patients underwent surgery in various amount: 1 – limited peritonectomy in the volume of tumor foci resection and resection of a large omentum, 1 – limited peritonectomy in the volume of tumor foci resection and atypical resection of the right lobe of the liver, 1 – only resection of the large omentum due to the fact that the tumor was located only in a large omentum and no signs of lesions of the parietal peritoneum was revealed by intraoperative revision. Surgical intervention in these patients was concluded by IOPDT. The remaining 5 patients underwent only IOPDT. After the treatment, two patients underwent additional courses of laparoscopic IOPDT. Of the 8 patients enrolled in the study, 4 died from the underlying disease, 1 from cardiovascular disease with recurrence of the disease, 1 from cardiovascular disease without signs of recurrence, 2 were monitored for 6 months and 146 months (12 years. Thus, in the group of patients with peritoneal mesothelioma, the maximum observation period was 146.44 months, the median survival was 48.4 months, the total specific 1-year survival was 85.7±13.2%, the three-year survival was 68.5±18.6%, the 5-year survival was 45.7 ± 22.4 %. The average life expectancy after treatment of patients with repeated courses of laparoscopic IOPDT was 87 months, without repeated courses – 35.8 months. Thus, life expectancy was higher in patients with repeated courses of laparoscopic IOPDT. Small sample size caused to the rarity of this pathology does not allow for statistically significant conclusions. However, the results of the study indicate the prospects of multi-course intraoperative photodynamic therapy in patients with peritoneal mesothelioma.

  15. MO-DE-202-03: Image-Guided Surgery and Interventions in the Advanced Multimodality Image-Guided Operating (AMIGO) Suite

    Energy Technology Data Exchange (ETDEWEB)

    Kapur, T. [Brigham & Women’s Hospital (United States)

    2016-06-15

    At least three major trends in surgical intervention have emerged over the last decade: a move toward more minimally invasive (or non-invasive) approach to the surgical target; the development of high-precision treatment delivery techniques; and the increasing role of multi-modality intraoperative imaging in support of such procedures. This symposium includes invited presentations on recent advances in each of these areas and the emerging role for medical physics research in the development and translation of high-precision interventional techniques. The four speakers are: Keyvan Farahani, “Image-guided focused ultrasound surgery and therapy” Jeffrey H. Siewerdsen, “Advances in image registration and reconstruction for image-guided neurosurgery” Tina Kapur, “Image-guided surgery and interventions in the advanced multimodality image-guided operating (AMIGO) suite” Raj Shekhar, “Multimodality image-guided interventions: Multimodality for the rest of us” Learning Objectives: Understand the principles and applications of HIFU in surgical ablation. Learn about recent advances in 3D–2D and 3D deformable image registration in support of surgical safety and precision. Learn about recent advances in model-based 3D image reconstruction in application to intraoperative 3D imaging. Understand the multi-modality imaging technologies and clinical applications investigated in the AMIGO suite. Understand the emerging need and techniques to implement multi-modality image guidance in surgical applications such as neurosurgery, orthopaedic surgery, vascular surgery, and interventional radiology. Research supported by the NIH and Siemens Healthcare.; J. Siewerdsen; Grant Support - National Institutes of Health; Grant Support - Siemens Healthcare; Grant Support - Carestream Health; Advisory Board - Carestream Health; Licensing Agreement - Carestream Health; Licensing Agreement - Elekta Oncology.; T. Kapur, P41EB015898; R. Shekhar, Funding: R42CA137886 and R41CA192504

  16. MO-DE-202-03: Image-Guided Surgery and Interventions in the Advanced Multimodality Image-Guided Operating (AMIGO) Suite

    International Nuclear Information System (INIS)

    Kapur, T.

    2016-01-01

    At least three major trends in surgical intervention have emerged over the last decade: a move toward more minimally invasive (or non-invasive) approach to the surgical target; the development of high-precision treatment delivery techniques; and the increasing role of multi-modality intraoperative imaging in support of such procedures. This symposium includes invited presentations on recent advances in each of these areas and the emerging role for medical physics research in the development and translation of high-precision interventional techniques. The four speakers are: Keyvan Farahani, “Image-guided focused ultrasound surgery and therapy” Jeffrey H. Siewerdsen, “Advances in image registration and reconstruction for image-guided neurosurgery” Tina Kapur, “Image-guided surgery and interventions in the advanced multimodality image-guided operating (AMIGO) suite” Raj Shekhar, “Multimodality image-guided interventions: Multimodality for the rest of us” Learning Objectives: Understand the principles and applications of HIFU in surgical ablation. Learn about recent advances in 3D–2D and 3D deformable image registration in support of surgical safety and precision. Learn about recent advances in model-based 3D image reconstruction in application to intraoperative 3D imaging. Understand the multi-modality imaging technologies and clinical applications investigated in the AMIGO suite. Understand the emerging need and techniques to implement multi-modality image guidance in surgical applications such as neurosurgery, orthopaedic surgery, vascular surgery, and interventional radiology. Research supported by the NIH and Siemens Healthcare.; J. Siewerdsen; Grant Support - National Institutes of Health; Grant Support - Siemens Healthcare; Grant Support - Carestream Health; Advisory Board - Carestream Health; Licensing Agreement - Carestream Health; Licensing Agreement - Elekta Oncology.; T. Kapur, P41EB015898; R. Shekhar, Funding: R42CA137886 and R41CA192504

  17. Spinal infection: Evaluation with MR imaging and intraoperative spinal US

    International Nuclear Information System (INIS)

    Donovan Post, M.J.; Montalvo, B.M.; Quencer, R.M.; Katz, B.H.; Green, B.A.; Elsmont, F.

    1987-01-01

    MR spine images and/or intraoperative US scans in 15 patients were reviewed retrospectively and correlated with clinical and pathologic data to determine the diagnostic value of these modalities in spinal infection. In osteomyelitis and retrospinal abscess MR imaging was definitive; in myelitis it was positive but nonspecific. In epidural abscess concomitant with meningitis, myelography with CT and intraoperative US were superior to MR imaging. Intraoperative US could be used to distinguish these processes and to monitor surgical decompression. The authors recommend that MR imaging be performed at the screening examination in cases of spinal infection, accompanied by intraoperative US in all surgical cases

  18. In vivo virtual intraoperative surgical photoacoustic microscopy

    International Nuclear Information System (INIS)

    Han, Seunghoon; Kim, Sehui; Kim, Jeehyun; Lee, Changho; Jeon, Mansik; Kim, Chulhong

    2013-01-01

    We developed a virtual intraoperative surgical photoacoustic microscopy system by combining with a commercial surgical microscope and photoacoustic microscope (PAM). By sharing the common optical path in the microscope and PAM system, we could acquire the PAM and microscope images simultaneously. Moreover, by employing a beam projector to back-project 2D PAM images onto the microscope view plane as augmented reality, the conventional microscopic and 2D cross-sectional PAM images are concurrently mapped on the plane via an ocular lens of the microscope in real-time. Further, we guided needle insertion into phantom ex vivo and mice skins in vivo

  19. Intraoperative radiation therapy for glioblastoma multiforme

    International Nuclear Information System (INIS)

    Matsutani, Masao; Tanaka, Yoshiaki; Matsuda, Tadayoshi

    1986-01-01

    Intraoperative radiation therapy (IOR) is quite applicable for radioresistant malignant gliomas, because of precise demarcations of the treatment volume under direct vision, minimum damage to surrounding normal tissues, and a high target absorbed dose of 1500 to 2000 rad. Fifteen patients with glioblatoma were treated with IOR, and the 2-year survival rate was 61.1 %. The result apparently indicate that areas adjacent to the margin of almost complete removal should be irradated with a sufficient dose to sterilize the remaining malignant remnants, and IOR is one of the logical treatment modalities for local control of malignant gliomas. (author)

  20. In vivo virtual intraoperative surgical photoacoustic microscopy

    Energy Technology Data Exchange (ETDEWEB)

    Han, Seunghoon, E-mail: hsh860504@gmail.com; Kim, Sehui, E-mail: sehui0916@nate.com; Kim, Jeehyun, E-mail: jeehk@knu.ac.kr, E-mail: chulhong@postech.edu [School of Electrical Engineering and Computer Science, Kyungpook National University, Daegu 702-701 (Korea, Republic of); Lee, Changho, E-mail: ch31037@postech.edu; Jeon, Mansik, E-mail: msjeon@postech.edu [Department of Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang 790-784 (Korea, Republic of); Kim, Chulhong, E-mail: jeehk@knu.ac.kr, E-mail: chulhong@postech.edu [Department of Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang 790-784 (Korea, Republic of); Department of Biomedical Engineering, The State University of New York at Buffalo, Buffalo, New York 14221 (United States)

    2013-11-11

    We developed a virtual intraoperative surgical photoacoustic microscopy system by combining with a commercial surgical microscope and photoacoustic microscope (PAM). By sharing the common optical path in the microscope and PAM system, we could acquire the PAM and microscope images simultaneously. Moreover, by employing a beam projector to back-project 2D PAM images onto the microscope view plane as augmented reality, the conventional microscopic and 2D cross-sectional PAM images are concurrently mapped on the plane via an ocular lens of the microscope in real-time. Further, we guided needle insertion into phantom ex vivo and mice skins in vivo.

  1. Versatile intraoperative MRI in neurosurgery and radiology.

    Science.gov (United States)

    Yrjänä, S K; Katisko, J P; Ojala, R O; Tervonen, O; Schiffbauer, H; Koivukangas, J

    2002-03-01

    Several models for the application of intra-operative magnetic resonance imaging (IMRI) have recently been reported, most of them unique. Two fundamental issues need to be addressed: optimal use of the scanner to ensure a wide base for research, development and clinical application, and an organisational model that facilitates such use. While in our setting the IMRI project was initiated by the neurosurgeons, the need for wider use of the facilities was recognised since the beginning of the planning phase in 1996. An organisational model was developed that allowed for development of neurosurgical applications, radiological imaging, and radiological interventions and for the research and development work of the vendor. A resistive 0.23 T MR scanner was installed in a dedicated operating room environment. Unique to this scanner is the ability to turn off the magnet, allowing for normal OR activities and devices, and to turn on the magnet as needed with a relatively short six-minute ramp up time. A staged surgical technique was perfected, allowing for transfer of data to the neuronavigator outside the scanner during surgery. In neurosurgery, IMRI was used as one part of a neuronavigational system that included ultrasound imaging, intra-operative cortical stimulation during awake procedures, electrocorticography and two neuronavigators. 34 neurosurgical cases included 27 brain tumour resections, 5 brain tumour biopsies, 1 extirpation of an arterio-venous malformation, and 1 haematoma evacuation. The scanner could also be used for normal clinical imaging where obese patients, children, claustophobic patients and postoperative control examinations were the major groups. The radiologists performed 110 interventions, including bone and abdominal biopsies, nerve root infiltrations and local pain therapies, with the optical needle tracking system under continuous MRI guidance. The organisational model allowed frequent use of the facilities for both neurosurgery and radiology

  2. Intraoperative radiation therapy for locally advanced gynecological malignancies

    International Nuclear Information System (INIS)

    Haddock, M.G.; Petersen, I.A.; Webb, M.J.; Wilson, T.O.; Podratz, K.C.; Gunderson, L.L.

    1996-01-01

    Purpose: Evaluate disease control and survival in patients with locally advanced gynecological malignancies who received intraoperative radiation therapy with electrons (IOERT) as a component of treatment. Methods and Materials: Between March 1983 and June 1995, 63 patients (pts) with locally advanced primary (9 pts) or recurrent (54 pts) gynecological malignancies received IOERT as a component of attempted curative therapy. The site of origin was uterine cervix in 40 pts, uterine corpus in 16 pts, vagina in 5 pts, and ovary in 2 pts. Thirty-eight patients with recurrent disease had been previously irradiated (median prior RT dose 5040 cGy, range 900-8400). External beam radiotherapy (EBRT) was given to 43 of 63 pts either before or after IOERT (900-6570 cGy, median 4960 cGy). Chemotherapy was given to 21 pts prior to IOERT and following IOERT in 2 pts. IOERT doses ranged from 800 cGy to 2500 cGy with a median of 1750 cGy. The median IOERT dose was 2000 cGy in 20 patients with gross residual disease and 1500 cGy in 43 patients with microscopic residual disease. Endpoints included central control within the IOERT cone, local control, distant failure, disease free survival and overall survival. Variables evaluated for impact on disease outcome included tumor grade, primary site, prior RT, IOERT dose, EBRT dose, residual disease at time of IOERT, and use of chemotherapy. Results: Survival and disease control data are presented in the table below. There was no impact of any disease or treatment related variable on local or central failure. Pts with microscopic residual disease at the time of IOERT had significantly fewer distant metastases than pts with gross residual (5 yr 31% vs. 77%, p = 0.001) and improved survival (5 yr 37% vs. 10%, p = 0.02). Patients with recurrent disease after previous RT had survival and disease control rates which were similar to those seen in pts without priot RT. Toxicity ≥ grade 3 due to IOERT was observed in 11 pts (17%). Conclusion: A

  3. Multimodal Pedagogies for Teacher Education in TESOL

    Science.gov (United States)

    Yi, Youngjoo; Angay-Crowder, Tuba

    2016-01-01

    As a growing number of English language learners (ELLs) engage in digital and multimodal literacy practices in their daily lives, teachers are starting to incorporate multimodal approaches into their instruction. However, anecdotal and empirical evidence shows that teachers often feel unprepared for integrating such practices into their curricula…

  4. Modeling multimodal human-computer interaction

    NARCIS (Netherlands)

    Obrenovic, Z.; Starcevic, D.

    2004-01-01

    Incorporating the well-known Unified Modeling Language into a generic modeling framework makes research on multimodal human-computer interaction accessible to a wide range off software engineers. Multimodal interaction is part of everyday human discourse: We speak, move, gesture, and shift our gaze

  5. Multimode optical fibers: steady state mode exciter.

    Science.gov (United States)

    Ikeda, M; Sugimura, A; Ikegami, T

    1976-09-01

    The steady state mode power distribution of the multimode graded index fiber was measured. A simple and effective steady state mode exciter was fabricated by an etching technique. Its insertion loss was 0.5 dB for an injection laser. Deviation in transmission characteristics of multimode graded index fibers can be avoided by using the steady state mode exciter.

  6. Filter. Remix. Make.: Cultivating Adaptability through Multimodality

    Science.gov (United States)

    Dusenberry, Lisa; Hutter, Liz; Robinson, Joy

    2015-01-01

    This article establishes traits of adaptable communicators in the 21st century, explains why adaptability should be a goal of technical communication educators, and shows how multimodal pedagogy supports adaptability. Three examples of scalable, multimodal assignments (infographics, research interviews, and software demonstrations) that evidence…

  7. (Re-)Examination of Multimodal Augmented Reality

    NARCIS (Netherlands)

    Rosa, N.E.; Werkhoven, P.J.; Hürst, W.O.

    2016-01-01

    The majority of augmented reality (AR) research has been concerned with visual perception, however the move towards multimodality is imminent. At the same time, there is no clear vision of what multimodal AR is. The purpose of this position paper is to consider possible ways of examining AR other

  8. Multimodal pain management after arthroscopic surgery

    DEFF Research Database (Denmark)

    Rasmussen, Sten

    Multimodal Pain Management after Arthroscopic Surgery By Sten Rasmussen, M.D. The thesis is based on four randomized controlled trials. The main hypothesis was that multimodal pain treatment provides faster recovery after arthroscopic surgery. NSAID was tested against placebo after knee arthroscopy...

  9. Brain tumors in eloquent areas: A European multicenter survey of intraoperative mapping techniques, intraoperative seizures occurrence, and antiepileptic drug prophylaxis.

    Science.gov (United States)

    Spena, Giannantonio; Schucht, Philippe; Seidel, Kathleen; Rutten, Geert-Jan; Freyschlag, Christian Franz; D'Agata, Federico; Costi, Emanule; Zappa, Francesca; Fontanella, Marco; Fontaine, Denys; Almairac, Fabien; Cavallo, Michele; De Bonis, Pasquale; Conesa, Gerardo; Foroglou, Nicholas; Gil-Robles, Santiago; Mandonnet, Emanuel; Martino, Juan; Picht, Thomas; Viegas, Catarina; Wager, Michel; Pallud, Johan

    2017-04-01

    Intraoperative mapping and monitoring techniques for eloquent area tumors are routinely used world wide. Very few data are available regarding mapping and monitoring methods and preferences, intraoperative seizures occurrence and perioperative antiepileptic drug management. A questionnaire was sent to 20 European centers with experience in intraoperative mapping or neurophysiological monitoring for the treatment of eloquent area tumors. Fifteen centers returned the completed questionnaires. Data was available on 2098 patients. 863 patients (41.1%) were operated on through awake surgery and intraoperative mapping, while 1235 patients (58.8%) received asleep surgery and intraoperative electrophysiological monitoring or mapping. There was great heterogeneity between centers with some totally AW oriented (up to 100%) and other almost totally ASL oriented (up to 92%) (31% SD). For awake surgery, 79.9% centers preferred an asleep-awake-asleep anesthesia protocol. Only 53.3% of the centers used ECoG or transcutaneous EEG. The incidence of intraoperative seizures varied significantly between centers, ranging from 2.5% to 54% (p mapping technique and the risk of intraoperative seizures. Moreover, history of preoperative seizures can significantly increase the risk of intraoperative seizures (p mapping and monitoring protocols and the management of peri- and intraoperative seizures. This data can help identify specific aspects that need to be investigated in prospective and controlled studies.

  10. Drusen Characterization with Multimodal Imaging

    Science.gov (United States)

    Spaide, Richard F.; Curcio, Christine A.

    2010-01-01

    Summary Multimodal imaging findings and histological demonstration of soft drusen, cuticular drusen, and subretinal drusenoid deposits provided information used to develop a model explaining their imaging characteristics. Purpose To characterize the known appearance of cuticular drusen, subretinal drusenoid deposits (reticular pseudodrusen), and soft drusen as revealed by multimodal fundus imaging; to create an explanatory model that accounts for these observations. Methods Reported color, fluorescein angiographic, autofluorescence, and spectral domain optical coherence tomography (SD-OCT) images of patients with cuticular drusen, soft drusen, and subretinal drusenoid deposits were reviewed, as were actual images from affected eyes. Representative histological sections were examined. The geometry, location, and imaging characteristics of these lesions were evaluated. A hypothesis based on the Beer-Lambert Law of light absorption was generated to fit these observations. Results Cuticular drusen appear as numerous uniform round yellow-white punctate accumulations under the retinal pigment epithelium (RPE). Soft drusen are larger yellow-white dome-shaped mounds of deposit under the RPE. Subretinal drusenoid deposits are polymorphous light-grey interconnected accumulations above the RPE. Based on the model, both cuticular and soft drusen appear yellow due to the removal of shorter wavelength light by a double pass through the RPE. Subretinal drusenoid deposits, which are located on the RPE, are not subjected to short wavelength attenuation and therefore are more prominent when viewed with blue light. The location and morphology of extracellular material in relationship to the RPE, and associated changes to RPE morphology and pigmentation, appeared to be primary determinants of druse appearance in different imaging modalities. Conclusion Although cuticular drusen, subretinal drusenoid deposits, and soft drusen are composed of common components, they are distinguishable

  11. Intraoperative MRI in pediatric brain tumors

    Energy Technology Data Exchange (ETDEWEB)

    Choudhri, Asim F. [Le Bonheur Children' s Hospital, Department of Radiology, Memphis, TN (United States); University of Tennessee Health Science Center, Department of Radiology, Memphis, TN (United States); University of Tennessee Health Science Center, Department of Neurosurgery, Memphis, TN (United States); University of Tennessee Health Science Center, Department of Ophthalmology, Memphis, TN (United States); Le Bonheur Children' s Hospital, Le Bonheur Neuroscience Institute, Memphis, TN (United States); Siddiqui, Adeel [University of Tennessee Health Science Center, Department of Radiology, Memphis, TN (United States); Le Bonheur Children' s Hospital, Le Bonheur Neuroscience Institute, Memphis, TN (United States); Klimo, Paul; Boop, Frederick A. [University of Tennessee Health Science Center, Department of Neurosurgery, Memphis, TN (United States); Le Bonheur Children' s Hospital, Le Bonheur Neuroscience Institute, Memphis, TN (United States); Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (United States); St. Jude Children' s Hospital, Division of Neurosurgery, Department of Surgery, Memphis, TN (United States)

    2015-09-15

    Intraoperative magnetic resonance imaging (iMRI) has emerged as an important tool in guiding the surgical management of children with brain tumors. Recent advances have allowed utilization of high field strength systems, including 3-tesla MRI, resulting in diagnostic-quality scans that can be performed while the child is on the operating table. By providing information about the possible presence of residual tumor, it allows the neurosurgeon to both identify and resect any remaining tumor that is thought to be safely accessible. By fusing the newly obtained images with the surgical guidance software, the images have the added value of aiding in navigation to any residual tumor. This is important because parenchyma often shifts during surgery. It also gives the neurosurgeon insight into whether any immediate postoperative complications have occurred. If any complications have occurred, the child is already in the operating room and precious minutes lost in transport and communications are saved. In this article we review the three main approaches to an iMRI system design. We discuss the possible roles for iMRI during intraoperative planning and provide guidance to help radiologists and neurosurgeons alike in the collaborative management of these children. (orig.)

  12. Intraoperative MRI in pediatric brain tumors

    International Nuclear Information System (INIS)

    Choudhri, Asim F.; Siddiqui, Adeel; Klimo, Paul; Boop, Frederick A.

    2015-01-01

    Intraoperative magnetic resonance imaging (iMRI) has emerged as an important tool in guiding the surgical management of children with brain tumors. Recent advances have allowed utilization of high field strength systems, including 3-tesla MRI, resulting in diagnostic-quality scans that can be performed while the child is on the operating table. By providing information about the possible presence of residual tumor, it allows the neurosurgeon to both identify and resect any remaining tumor that is thought to be safely accessible. By fusing the newly obtained images with the surgical guidance software, the images have the added value of aiding in navigation to any residual tumor. This is important because parenchyma often shifts during surgery. It also gives the neurosurgeon insight into whether any immediate postoperative complications have occurred. If any complications have occurred, the child is already in the operating room and precious minutes lost in transport and communications are saved. In this article we review the three main approaches to an iMRI system design. We discuss the possible roles for iMRI during intraoperative planning and provide guidance to help radiologists and neurosurgeons alike in the collaborative management of these children. (orig.)

  13. [Threefold intraoperative electrophysiological monitoring of vestibular neurectomy].

    Science.gov (United States)

    Hausler, R; Kasper, A

    1991-01-01

    A threefold intraoperative monitoring of facial nerve, auditory nerve and vestibular nerve function was performed in 14 cases of retrosigmoidal neurectomy. The facial nerve was monitoring with a pressure transducer placed against the cheek (Opalarm system). The auditory nerve was monitored with acoustically (click) evoked early potentials and the vestibular nerve was monitored with electrically evoked vestibular potentials obtained by direct stimulation (biphasic current pulses of 0.75-mA p-p, 100 us, 20/s) of the exposed vestibular nerve in the cerebellopontine angle before, during and after neurectomy. A characteristic vertex negative peak having a latency of approximately 2 ms and approximately 0.5 uV amplitude was obtained between a forehead and an ipsilateral ear lobe electrode (2 x 1,000 averaged responses over 10 ms) before the neurectomy. This response disappeared after selective vestibular nerve section proximal to the stimulation site. A diminished response amplitude was measured after incomplete nerve section. Simultaneous acoustic masking had no influence on the vestibular potential. The 14 operated patients became all free of vertiginous spells and drop-attacks except one patient who developed a contralateral Menière's. Facial nerve function remained normal in all. Hearing preservation was obtained in 12 patients (86%). The threefold intraoperative monitoring has turned out to be an additional safety factor for facial and auditory nerve preservation and, thanks to the recording of vestibular potentials, it increased the efficiency of vestibular neurectomy.

  14. Intraoperative irradiation in advanced cervical cancer

    International Nuclear Information System (INIS)

    Delgado, G.; Goldson, A.L.; Ashayeri, E.; Petrilli, E.S.

    1987-01-01

    Conventional treatment of cervical cancer, such as radical hysterectomy with lymphadenectomy or pelvic exenteration, is limited to the pelvis. Standard radio-therapeutic treatment is a combination of external-beam radiotherapy to the pelvis and intracavitary applications. However, there is a group of patients for whom external radiotherapy alone has limitations. This group consists primarily of patients with large pelvic lymph nodes containing metastatic cancer, metastatically involved paraaortic lymph nodes outside the usual pelvic radiation field, or large central tumors with parametrial involvement. In patients with cancer of the cervix, the incidence of metastasis to paraaortic lymph nodes is high. Attempts to treat paraaortic nodes with external radiotherapy have resulted in high complication rates because the treatment field includes the highly sensitive gastrointestinal tract. External radiation therapy after retroperitoneal exploration of lymph nodes does not seem to improve survival. In an attempt to circumvent the morbidity and mortality associated with conventional external-beam irradiation, the authors initiated a pilot study of intraoperative electron-beam irradiation of the paraaortic nodes and of the large metastatic lymph nodes in the pelvis. The intraoperative boost was followed by conventional fractionated external-beam irradiation. The theoretical advantages of this procedure include a higher radiation tumor dose without a concomitant increase in treatment morbidity and mortality

  15. Multifuel multimodal network design; Projeto de redes multicombustiveis multimodal

    Energy Technology Data Exchange (ETDEWEB)

    Lage, Carolina; Dias, Gustavo; Bahiense, Laura; Ferreira Filho, Virgilio J.M. [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Coordenacao dos Programas de Pos-graduacao de Engenharia (COPPE). Programa de Engenharia de Producao

    2008-07-01

    The objective of the Multi commodity Multimodal Network Project is the development of modeling tools and methodologies for the optimal sizing of production networks and multimodal distribution of multiple fuel and its incomes, considering investments and transportation costs. Given the inherently non-linear combinatory nature of the problem, the resolution of real instances by the complete model, in an exact way, becomes computationally intractable. Thus, the strategy for resolution should contain a combination of exacts and heuristics methods, that must be applied to subdivisions of the original problem. This paper deals with one of these subdivisions, tackling the problem of modeling a network of pipelines in order to drain the production of ethanol away from the producing plants. The objective consists in defining the best network topology, minimizing investment and operational costs, and attending the total demand. In order to do that, the network was considered a tree, where the nodes are the center of producing regions and the edges are the pipelines, trough where the ethanol produced by plants must be drained away. The main objective also includes the decision over the optimal diameter of each pipeline and the optimal size of the bombs, in order to minimize the pumping costs. (author)

  16. Metawidgets in the multimodal interface

    Energy Technology Data Exchange (ETDEWEB)

    Blattner, M.M. (Lawrence Livermore National Lab., CA (United States) Anderson (M.D.) Cancer Center, Houston, TX (United States)); Glinert, E.P.; Jorge, J.A.; Ormsby, G.R. (Rensselaer Polytechnic Inst., Troy, NY (United States). Dept. of Computer Science)

    1991-01-01

    We analyze two intertwined and fundamental issues concerning computer-to-human communication in the multimodal interfaces: the interplay between sound and graphics, and the role of object persistence. Our observations lead us to introduce metawidgets as abstract entities capable of manifesting themselves to users as image, as sound, or as various combinations and/or sequences of the two media. We show examples of metawidgets in action, and discuss mechanisms for choosing among alternative media for metawidget instantiation. Finally, we describe a couple of experimental microworlds we have implemented to test out some of our ideas. 17 refs., 7 figs.

  17. Multimodal approach to postoperative recovery

    DEFF Research Database (Denmark)

    Kehlet, Henrik

    2009-01-01

    PURPOSE OF REVIEW: To provide updated information on recent developments within individual components of multimodal interventions to improve postoperative outcome (fast-track methodology). RECENT FINDINGS: The value of the fast-track methodology to improve recovery and decrease hospital stay...... and morbidity has been firmly consolidated, especially in colorectal procedures. An increasing amount of data from other procedures supports the value of the fast-track concept across procedures. Fast-track programs should be based on the analysis of procedure-specific factors that may influence outcome...

  18. Ketamina en analgesia multimodal postcesarea

    OpenAIRE

    Monzón Rubio, Eva María

    2011-01-01

    Mediante la analgesia multimodal influimos en las diferentes vías del dolor a la vez que minimizamos los potenciales efectos adversos de los diferentes fármacos administrados. En el caso del dolor postcesárea esto adquiere un importante matiz debido a la necesidad de disminuir el uso de opioides que pasan a la leche materna en caso de lactancia natural. El uso de dosis subanestésicas de Ketamina ha demostrado en diferentes estudios la disminución de requerimientos de opioides en las primer...

  19. The Resection Map : A proposal for intraoperative hepatectomy guidance

    NARCIS (Netherlands)

    Lamata, P.; Jalote-Parmar, A.; Lamata, F.; Declerck, J.

    2008-01-01

    Objective - To propose a new concept of an intra-operative 3D visualisation system to support hepatectomies. This system aims at improving the transfer of pre-operative planning into the intra-operative stage, both in laparoscopic and open approaches. Materials and methods - User (surgeon) centred

  20. Multimodality localization of epileptic foci

    Science.gov (United States)

    Desco, Manuel; Pascau, Javier; Pozo, M. A.; Santos, Andres; Reig, Santiago; Gispert, Juan D.; Garcia-Barreno, Pedro

    2001-05-01

    This paper presents a multimodality approach for the localization of epileptic foci using PET, MRI and EEG combined without the need of external markers. Mutual Information algorithm is used for MRI-PET registration. Dipole coordinates (provided by BESA software) are projected onto the MRI using a specifically developed algorithm. The four anatomical references used for electrode positioning (nasion, inion and two preauricular points) are located on the MRI using a triplanar viewer combined with a surface-rendering tool. Geometric transformation using deformation of the ideal sphere used for dipole calculations is then applied to match the patient's brain size and shape. Eight treatment-refractory epileptic patients have been studied. The combination of the anatomical information from the MRI, hipoperfusion areas in PET and dipole position and orientation helped the physician in the diagnosis of epileptic focus location. Neurosurgery was not indicated for patients where PET and dipole results were inconsistent; in two cases it was clinically indicated despite the mismatch, showing a negative follow up. The multimodality approach presented does not require external markers for dipole projection onto the MRI, this being the main difference with previous methods. The proposed method may play an important role in the indication of surgery for treatment- refractory epileptic patients.

  1. Cardiac imaging. A multimodality approach

    Energy Technology Data Exchange (ETDEWEB)

    Thelen, Manfred [Johannes Gutenberg University Hospital, Mainz (Germany); Erbel, Raimund [University Hospital Essen (Germany). Dept. of Cardiology; Kreitner, Karl-Friedrich [Johannes Gutenberg University Hospital, Mainz (Germany). Clinic and Polyclinic for Diagnostic and Interventional Radiology; Barkhausen, Joerg (eds.) [University Hospital Schleswig-Holstein, Luebeck (Germany). Dept. of Radiology and Nuclear Medicine

    2009-07-01

    An excellent atlas on modern diagnostic imaging of the heart Written by an interdisciplinary team of experts, Cardiac Imaging: A Multimodality Approach features an in-depth introduction to all current imaging modalities for the diagnostic assessment of the heart as well as a clinical overview of cardiac diseases and main indications for cardiac imaging. With a particular emphasis on CT and MRI, the first part of the atlas also covers conventional radiography, echocardiography, angiography and nuclear medicine imaging. Leading specialists demonstrate the latest advances in the field, and compare the strengths and weaknesses of each modality. The book's second part features clinical chapters on heart defects, endocarditis, coronary heart disease, cardiomyopathies, myocarditis, cardiac tumors, pericardial diseases, pulmonary vascular diseases, and diseases of the thoracic aorta. The authors address anatomy, pathophysiology, and clinical features, and evaluate the various diagnostic options. Key features: - Highly regarded experts in cardiology and radiology off er image-based teaching of the latest techniques - Readers learn how to decide which modality to use for which indication - Visually highlighted tables and essential points allow for easy navigation through the text - More than 600 outstanding images show up-to-date technology and current imaging protocols Cardiac Imaging: A Multimodality Approach is a must-have desk reference for cardiologists and radiologists in practice, as well as a study guide for residents in both fields. It will also appeal to cardiac surgeons, general practitioners, and medical physicists with a special interest in imaging of the heart. (orig.)

  2. Cardiac imaging. A multimodality approach

    International Nuclear Information System (INIS)

    Thelen, Manfred; Erbel, Raimund; Kreitner, Karl-Friedrich; Barkhausen, Joerg

    2009-01-01

    An excellent atlas on modern diagnostic imaging of the heart Written by an interdisciplinary team of experts, Cardiac Imaging: A Multimodality Approach features an in-depth introduction to all current imaging modalities for the diagnostic assessment of the heart as well as a clinical overview of cardiac diseases and main indications for cardiac imaging. With a particular emphasis on CT and MRI, the first part of the atlas also covers conventional radiography, echocardiography, angiography and nuclear medicine imaging. Leading specialists demonstrate the latest advances in the field, and compare the strengths and weaknesses of each modality. The book's second part features clinical chapters on heart defects, endocarditis, coronary heart disease, cardiomyopathies, myocarditis, cardiac tumors, pericardial diseases, pulmonary vascular diseases, and diseases of the thoracic aorta. The authors address anatomy, pathophysiology, and clinical features, and evaluate the various diagnostic options. Key features: - Highly regarded experts in cardiology and radiology off er image-based teaching of the latest techniques - Readers learn how to decide which modality to use for which indication - Visually highlighted tables and essential points allow for easy navigation through the text - More than 600 outstanding images show up-to-date technology and current imaging protocols Cardiac Imaging: A Multimodality Approach is a must-have desk reference for cardiologists and radiologists in practice, as well as a study guide for residents in both fields. It will also appeal to cardiac surgeons, general practitioners, and medical physicists with a special interest in imaging of the heart. (orig.)

  3. Overview of intraoperative MRI in neurosurgery

    International Nuclear Information System (INIS)

    Shiino, Akihiko; Matsuda, Masayuki

    2002-01-01

    This review describes usefulness, prospect and present problems of intraoperative MRI in neurosurgery. MRI equipments for the surgery have to have a wide, open space and have those magnets of short cylindrical, biplanar (clam shell), dual air core superconducting solenoidal (double doughnut) and targeted FOV (field of view) type. Devices required for the surgery are specific and in author's facility, they are classified into 4 zones depending on the region of their use. Application of the surgery involves biopsy, drainage of cyst and abscess, hematoma evacuation, nerve block, thermotherapy (interstitial laser, RF ablation, focused untrasonic and cryosurgery), local drug therapy, chemoablation, vascular intervention and tumor extraction, of which actual procedures and pictures are presented together with, in particular, MR-guided thermotherapy, ablation therapy of brain tumors, endoscopic surgery and minimally invasive therapy of the spine. A navigation software, 3D SlicerTM system, is introduced for interventional imaging. Safety measures are emphasized for the operation. (K.H.)

  4. Overview of intraoperative MRI in neurosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Shiino, Akihiko; Matsuda, Masayuki [Shiga Univ. of Medical Science, Otsu (Japan)

    2002-01-01

    This review describes usefulness, prospect and present problems of intraoperative MRI in neurosurgery. MRI equipments for the surgery have to have a wide, open space and have those magnets of short cylindrical, biplanar (clam shell), dual air core superconducting solenoidal (double doughnut) and targeted FOV (field of view) type. Devices required for the surgery are specific and in author's facility, they are classified into 4 zones depending on the region of their use. Application of the surgery involves biopsy, drainage of cyst and abscess, hematoma evacuation, nerve block, thermotherapy (interstitial laser, RF ablation, focused untrasonic and cryosurgery), local drug therapy, chemoablation, vascular intervention and tumor extraction, of which actual procedures and pictures are presented together with, in particular, MR-guided thermotherapy, ablation therapy of brain tumors, endoscopic surgery and minimally invasive therapy of the spine. A navigation software, 3D SlicerTM system, is introduced for interventional imaging. Safety measures are emphasized for the operation. (K.H.)

  5. Intraoperative radiotherapy. Clinical experiences and results

    Energy Technology Data Exchange (ETDEWEB)

    Calvo, F.A.; Santos, M. (Clinica Universitaria, Dept. of Oncology, Service of Radiotherapy, Pamplona (Spain)); Brady, L.W. (Hahnemann Univ., Dept. of Radiation Oncology, Philadelphia, PA (United States)) (eds.)

    1992-01-01

    This monograph reports on the largest clinical series to date in which intraoperative radiation therapy (IORT) has been used in mulitdisciplinary treatment programs for tumors of various sites and differing histological sybtype. It represents the product of 5 years' intensive work by physicians active at a leading European institution. The findings are supplemented by a thorough review of the data presented worldwide during the last two decades. The results in this book are meticulously presented and focus on the most important features of clinical research reports based on phase I-II studies (toxicity, local tumor control, and survival data). The tumor sites and histologies analyzed are: head and neck cancer, lung cancer, gastric cancer, pancreatic cancer, colorectal cancer, bladder cancer, gynecologic cancer, soft tissue sarcomas of the extremities, retroperitoneal and other central soft issue sarcomas, Ewing's sarcoma, osteosarcoma, and intracranial tumors. (orig./MG) With 60 figs.

  6. Intra-operative radiation treatment of cancers

    International Nuclear Information System (INIS)

    Dubois, J.B.; Joyeux, H.; Solassol, C.; Pujol, H.

    1986-01-01

    Intra-operative radiation treatment (I.O.R.T.) is concerning the treatment either of an unresectable tumor or of tumor bed after complete excision of a primary tumor and its first draining lymph nodes. We describe X-ray and electrons techniques and we discuss the delivered doses according to experimental and clinical data. According to the residual disease (macroscopic or microscopic), to the healthy tissues in the target volume, and the histological type, single doses from 20 Gy to 40 Gy can be delivered. Our preliminary results are reported: 25 patients with resectable tumors of the cardia, the stomach and the pancreas, 5 patients with pelvic recurrences of colon and rectum carcinomas. Therapeutic results of the I.O.R.T. providing from the literature are discussed. The I.O.R.T. indications are defined as palliative (unresectable tumors) and curative (irradiation of tumor bed after complete excision of the tumor) [fr

  7. Intraoperative radiotherapy for locally advanced refractory cancer

    Energy Technology Data Exchange (ETDEWEB)

    Abe, Mitsuyuki; Takahashi, Masaji; Ono, Koji; Dodo, Yoshihiro; Hiraoka, Masahiro [Kyoto Univ. (Japan). Faculty of Medicine

    1983-05-01

    Clinical results of intraoperative radiotherapy (IOR) in carcinoma of the stomach and prostate, and malignant soft tissue tumors are reported. The 5-year survival rate was found to be increased by IOR in stages II-IV gastric cancer. From the analysis of the clinical results of prostatic cancer, a single dose of 3,500 rad was considered to be a potential curative dose for the tumor less than 3 cm in diameter. The local recurrence rate of patients with malignant soft tissue tumors who received a single dose ranging from 3,000 to 4,500 rad was 5.9 and the 5-year survival rate was 64.6 %.

  8. Practical multimodal care for cancer cachexia.

    Science.gov (United States)

    Maddocks, Matthew; Hopkinson, Jane; Conibear, John; Reeves, Annie; Shaw, Clare; Fearon, Ken C H

    2016-12-01

    Cancer cachexia is common and reduces function, treatment tolerability and quality of life. Given its multifaceted pathophysiology a multimodal approach to cachexia management is advocated for, but can be difficult to realise in practice. We use a case-based approach to highlight practical approaches to the multimodal management of cachexia for patients across the cancer trajectory. Four cases with lung cancer spanning surgical resection, radical chemoradiotherapy, palliative chemotherapy and no anticancer treatment are presented. We propose multimodal care approaches that incorporate nutritional support, exercise, and anti-inflammatory agents, on a background of personalized oncology care and family-centred education. Collectively, the cases reveal that multimodal care is part of everyone's remit, often focuses on supported self-management, and demands buy-in from the patient and their family. Once operationalized, multimodal care approaches can be tested pragmatically, including alongside emerging pharmacological cachexia treatments. We demonstrate that multimodal care for cancer cachexia can be achieved using simple treatments and without a dedicated team of specialists. The sharing of advice between health professionals can help build collective confidence and expertise, moving towards a position in which every team member feels they can contribute towards multimodal care.

  9. Brain mapping in tumors: intraoperative or extraoperative?

    Science.gov (United States)

    Duffau, Hugues

    2013-12-01

    In nontumoral epilepsy surgery, the main goal for all preoperative investigation is to first determine the epileptogenic zone, and then to analyze its relation to eloquent cortex, in order to control seizures while avoiding adverse postoperative neurologic outcome. To this end, in addition to neuropsychological assessment, functional neuroimaging and scalp electroencephalography, extraoperative recording, and electrical mapping, especially using subdural strip- or grid-electrodes, has been reported extensively. Nonetheless, in tumoral epilepsy surgery, the rationale is different. Indeed, the first aim is rather to maximize the extent of tumor resection while minimizing postsurgical morbidity, in order to increase the median survival as well as to preserve quality of life. As a consequence, as frequently seen in infiltrating tumors such as gliomas, where these lesions not only grow but also migrate along white matter tracts, the resection should be performed according to functional boundaries both at cortical and subcortical levels. With this in mind, extraoperative mapping by strips/grids is often not sufficient in tumoral surgery, since in essence, it allows study of the cortex but cannot map subcortical pathways. Therefore, intraoperative electrostimulation mapping, especially in awake patients, is more appropriate in tumor surgery, because this technique allows real-time detection of areas crucial for cerebral functions--eloquent cortex and fibers--throughout the resection. In summary, rather than choosing one or the other of different mapping techniques, methodology should be adapted to each pathology, that is, extraoperative mapping in nontumoral epilepsy surgery and intraoperative mapping in tumoral surgery. Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

  10. Best practices to optimize intraoperative photography.

    Science.gov (United States)

    Gaujoux, Sébastien; Ceribelli, Cecilia; Goudard, Geoffrey; Khayat, Antoine; Leconte, Mahaut; Massault, Pierre-Philippe; Balagué, Julie; Dousset, Bertrand

    2016-04-01

    Intraoperative photography is used extensively for communication, research, or teaching. The objective of the present work was to define, using a standardized methodology and literature review, the best technical conditions for intraoperative photography. Using either a smartphone camera, a bridge camera, or a single-lens reflex (SLR) camera, photographs were taken under various standard conditions by a professional photographer. All images were independently assessed blinded to technical conditions to define the best shooting conditions and methods. For better photographs, an SLR camera with manual settings should be used. Photographs should be centered and taken vertically and orthogonal to the surgical field with a linear scale to avoid error in perspective. The shooting distance should be about 75 cm using an 80-100-mm focal lens. Flash should be avoided and scialytic low-powered light should be used without focus. The operative field should be clean, wet surfaces should be avoided, and metal instruments should be hidden to avoid reflections. For SLR camera, International Organization for Standardization speed should be as low as possible, autofocus area selection mode should be on single point AF, shutter speed should be above 1/100 second, and aperture should be as narrow as possible, above f/8. For smartphone, use high dynamic range setting if available, use of flash, digital filter, effect apps, and digital zoom is not recommended. If a few basic technical rules are known and applied, high-quality photographs can be taken by amateur photographers and fit the standards accepted in clinical practice, academic communication, and publications. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Mediating multimodal environmental knowledge across animation techniques

    DEFF Research Database (Denmark)

    Maier, Carmen Daniela

    2011-01-01

    ://www.sustainlane.com/. The multimodal discourse analysis is meant to reveal how selection and representation of environmental knowledge about social actors, social actions, resources, time and space are influenced by animation techniques. Furthermore, in the context of this multimodal discourse analysis, their influence upon......The growing awareness of and concern about present environmental problems generate a proliferation of new forms of environmental discourses that are mediated in various ways. This chapter explores issues related to the ways in which environmental knowledge is multimodally communicated...

  12. Multimodal Image-Based Virtual Reality Presurgical Simulation and Evaluation for Trigeminal Neuralgia and Hemifacial Spasm.

    Science.gov (United States)

    Yao, Shujing; Zhang, Jiashu; Zhao, Yining; Hou, Yuanzheng; Xu, Xinghua; Zhang, Zhizhong; Kikinis, Ron; Chen, Xiaolei

    2018-05-01

    To address the feasibility and predictive value of multimodal image-based virtual reality in detecting and assessing features of neurovascular confliction (NVC), particularly regarding the detection of offending vessels, degree of compression exerted on the nerve root, in patients who underwent microvascular decompression for nonlesional trigeminal neuralgia and hemifacial spasm (HFS). This prospective study includes 42 consecutive patients who underwent microvascular decompression for classic primary trigeminal neuralgia or HFS. All patients underwent preoperative 1.5-T magnetic resonance imaging (MRI) with T2-weighted three-dimensional (3D) sampling perfection with application-optimized contrasts by using different flip angle evolutions, 3D time-of-flight magnetic resonance angiography, and 3D T1-weighted gadolinium-enhanced sequences in combination, whereas 2 patients underwent extra experimental preoperative 7.0-T MRI scans with the same imaging protocol. Multimodal MRIs were then coregistered with open-source software 3D Slicer, followed by 3D image reconstruction to generate virtual reality (VR) images for detection of possible NVC in the cerebellopontine angle. Evaluations were performed by 2 reviewers and compared with the intraoperative findings. For detection of NVC, multimodal image-based VR sensitivity was 97.6% (40/41) and specificity was 100% (1/1). Compared with the intraoperative findings, the κ coefficients for predicting the offending vessel and the degree of compression were >0.75 (P < 0.001). The 7.0-T scans have a clearer view of vessels in the cerebellopontine angle, which may have significant impact on detection of small-caliber offending vessels with relatively slow flow speed in cases of HFS. Multimodal image-based VR using 3D sampling perfection with application-optimized contrasts by using different flip angle evolutions in combination with 3D time-of-flight magnetic resonance angiography sequences proved to be reliable in detecting NVC

  13. Multimodal integration in statistical learning

    DEFF Research Database (Denmark)

    Mitchell, Aaron; Christiansen, Morten Hyllekvist; Weiss, Dan

    2014-01-01

    , we investigated the ability of adults to integrate audio and visual input during statistical learning. We presented learners with a speech stream synchronized with a video of a speaker’s face. In the critical condition, the visual (e.g., /gi/) and auditory (e.g., /mi/) signals were occasionally...... facilitated participants’ ability to segment the speech stream. Our results therefore demonstrate that participants can integrate audio and visual input to perceive the McGurk illusion during statistical learning. We interpret our findings as support for modality-interactive accounts of statistical learning.......Recent advances in the field of statistical learning have established that learners are able to track regularities of multimodal stimuli, yet it is unknown whether the statistical computations are performed on integrated representations or on separate, unimodal representations. In the present study...

  14. Multimodality image analysis work station

    International Nuclear Information System (INIS)

    Ratib, O.; Huang, H.K.

    1989-01-01

    The goal of this project is to design and implement a PACS (picture archiving and communication system) workstation for quantitative analysis of multimodality images. The Macintosh II personal computer was selected for its friendly user interface, its popularity among the academic and medical community, and its low cost. The Macintosh operates as a stand alone workstation where images are imported from a central PACS server through a standard Ethernet network and saved on a local magnetic or optical disk. A video digitizer board allows for direct acquisition of images from sonograms or from digitized cine angiograms. The authors have focused their project on the exploration of new means of communicating quantitative data and information through the use of an interactive and symbolic user interface. The software developed includes a variety of image analysis, algorithms for digitized angiograms, sonograms, scintigraphic images, MR images, and CT scans

  15. Multimodal signalling in estrildid finches

    DEFF Research Database (Denmark)

    Gomes, A. C. R.; Funghi, C.; Soma, M.

    2017-01-01

    Sexual traits (e.g. visual ornaments, acoustic signals, courtship behaviour) are often displayed together as multimodal signals. Some hypotheses predict joint evolution of different sexual signals (e.g. to increase the efficiency of communication) or that different signals trade off with each other...... (e.g. due to limited resources). Alternatively, multiple signals may evolve independently for different functions, or to communicate different information (multiple message hypothesis). We evaluated these hypotheses with a comparative study in the family Estrildidae, one of the largest songbird...... compromise, but generally courtship dance also evolved independently from other signals. Instead of correlated evolution, we found that song, dance and colour are each related to different socio-ecological traits. Song complexity evolved together with ecological generalism, song performance with investment...

  16. The value of intraoperative sonography in low grade glioma surgery.

    Science.gov (United States)

    Petridis, Athanasios K; Anokhin, Maxim; Vavruska, Jan; Mahvash, Mehran; Scholz, Martin

    2015-04-01

    There is a number of different methods to localize a glioma intraoperatively. Neuronavigation, intraoperative MRI, 5-aminolevulinic acid, as well as intraoperative sonography. Every method has its advantages and disadvantages. Low grade gliomas do not show a specific signal with 5-aminolevulinic acid and are difficult to distinguish macroscopically from normal tissue. In the present study we stress out the importance of intraoperative diagnostic ultrasound for localization of low grade gliomas. We retrospectively evaluated the charts and MRIs of 34 patients with low grade gliomas operated in our department from 2011 until December 2014. The efficacy of ultrasound as an intraoperative navigational tool was assessed. In 15 patients ultrasound was used and in 19 not. Only histologically proven low grades gliomas (astrocytomas grade II) were evaluated. In none of the patients where ultrasound (combined with neuronavigation) was used (N=15) to find the tumors, the target was missed, whereas the exclusive use of neuronavigation missed the target in 5 of 19 cases of small subcortical low grade gliomas. Intraoperative ultrasound is an excellent tool in localizing low grade gliomas intraoperatively. It is an inexpensive, real time neuronavigational tool, which overcomes brain shift. Even when identifying the tumors with ultrasound is very reliable, the extend of resection and the decision to remove any residual tumor with the help of ultrasound is at the moment unreliable. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. Multispectral analysis of multimodal images

    Energy Technology Data Exchange (ETDEWEB)

    Kvinnsland, Yngve; Brekke, Njaal (Dept. of Surgical Sciences, Univ. of Bergen, Bergen (Norway)); Taxt, Torfinn M.; Gruener, Renate (Dept. of Biomedicine, Univ. of Bergen, Bergen (Norway))

    2009-02-15

    An increasing number of multimodal images represent a valuable increase in available image information, but at the same time it complicates the extraction of diagnostic information across the images. Multispectral analysis (MSA) has the potential to simplify this problem substantially as unlimited number of images can be combined, and tissue properties across the images can be extracted automatically. Materials and methods. We have developed a software solution for MSA containing two algorithms for unsupervised classification, an EM-algorithm finding multinormal class descriptions and the k-means clustering algorithm, and two for supervised classification, a Bayesian classifier using multinormal class descriptions and a kNN-algorithm. The software has an efficient user interface for the creation and manipulation of class descriptions, and it has proper tools for displaying the results. Results. The software has been tested on different sets of images. One application is to segment cross-sectional images of brain tissue (T1- and T2-weighted MR images) into its main normal tissues and brain tumors. Another interesting set of images are the perfusion maps and diffusion maps, derived images from raw MR images. The software returns segmentation that seem to be sensible. Discussion. The MSA software appears to be a valuable tool for image analysis with multimodal images at hand. It readily gives a segmentation of image volumes that visually seems to be sensible. However, to really learn how to use MSA, it will be necessary to gain more insight into what tissues the different segments contain, and the upcoming work will therefore be focused on examining the tissues through for example histological sections.

  18. Driver Education for New Multimodal Facilities

    Science.gov (United States)

    2016-05-24

    Local and state transportation agencies are redesigning roads to accommodate multimodal travel, including the addition of new configurations, infrastructures, and rules that may be unfamiliar to current drivers and other road users. Education and out...

  19. Responsive Multimodal Transportation Management Strategies And IVHS

    Science.gov (United States)

    1995-02-01

    THE PURPOSE OF THIS STUDY WAS TO INVESTIGATE NEW AND INNOVATIVE WAYS TO INCORPORATE IVHS TECHNOLOGIES INTO MULTIMODAL TRANSPORTATION MANAGEMENT STRATEGIES. MUCH OF THE IVHS RESEARCH DONE TO DATE HAS ADDRESSED THE MODES INDIVIDUALLY. THIS PROJECT FOCU...

  20. Influence of Blood Contamination During Multimode Adhesive ...

    African Journals Online (AJOL)

    2018-01-30

    Jan 30, 2018 ... (μTBS) of multimode adhesives to dentin when using the self‑etch approach. Materials and Methods: ... adhesion, the collagen fibers collapse during the. Introduction ..... The failure mode was determined using an optical.

  1. Quantifying Quality Aspects of Multimodal Interactive Systems

    CERN Document Server

    Kühnel, Christine

    2012-01-01

    This book systematically addresses the quantification of quality aspects of multimodal interactive systems. The conceptual structure is based on a schematic view on human-computer interaction where the user interacts with the system and perceives it via input and output interfaces. Thus, aspects of multimodal interaction are analyzed first, followed by a discussion of the evaluation of output and input and concluding with a view on the evaluation of a complete system.

  2. [Cost analysis of intraoperative neurophysiological monitoring (IOM)].

    Science.gov (United States)

    Kombos, T; Suess, O; Brock, M

    2002-01-01

    A number of studies demonstrate that a significant reduction of postoperative neurological deficits can be achieved by applying intraoperative neurophysiological monitoring (IOM) methods. A cost analysis of IOM is imperative considering the strained financial situation in the public health services. The calculation model presented here comprises two cost components: material and personnel. The material costs comprise consumer goods and depreciation of capital goods. The computation base was 200 IOM cases per year. Consumer goods were calculated for each IOM procedure respectively. The following constellation served as a basis for calculating personnel costs: (a) a medical technician (salary level BAT Vc) for one hour per case; (b) a resident (BAT IIa) for the entire duration of the measurement, and (c) a senior resident (BAT Ia) only for supervision. An IOM device consisting of an 8-channel preamplifier, an electrical and acoustic stimulator and special software costs 66,467 euros on the average. With an annual depreciation of 20%, the costs are 13,293 euros per year. This amounts to 66.46 euros per case for the capital goods. For reusable materials a sum of 0.75 euro; per case was calculated. Disposable materials were calculate for each procedure respectively. Total costs of 228.02 euro; per case were,s a sum of 0.75 euros per case was calculated. Disposable materials were calculate for each procedure respectively. Total costs of 228.02 euros per case were, calculated for surgery on the peripheral nervous system. They amount to 196.40 euros per case for spinal interventions and to 347.63 euros per case for more complex spinal operations. Operations in the cerebellopontine angle and brain stem cost 376.63 euros and 397.33 euros per case respectively. IOM costs amount to 328.03 euros per case for surgical management of an intracranial aneurysm and to 537.15 euros per case for functional interventions. Expenses run up to 833.63 euros per case for operations near the

  3. A non-docking intraoperative electron beam applicator system

    International Nuclear Information System (INIS)

    Palta, J.R.; Suntharalingam, N.

    1989-01-01

    A non-docking intraoperative radiation therapy electron beam applicator system for a linear accelerator has been designed to minimize the mechanical, electrical, and tumor visualization problems associated with a docking system. A number of technical innovations have been used in the design of this system. These include: (a) a new intraoperative radiation therapy cone design that gives a better dose uniformity in the treatment volume at all depths; (b) a collimation system which reduces the leakage radiation dose to tissues outside the intraoperative radiation therapy cone; (c) a non-docking system with a translational accuracy of 2 mm and a rotational accuracy of 0.5 degrees; and (d) a rigid clamping system for the cones. A comprehensive set of dosimetric characteristics of the intraoperative radiation therapy applicator system is presented

  4. Disparities between resident and attending surgeon perceptions of intraoperative teaching.

    Science.gov (United States)

    Butvidas, Lynn D; Anderson, Cheryl I; Balogh, Daniel; Basson, Marc D

    2011-03-01

    This study aimed to assess attending surgeon and resident recall of good and poor intraoperative teaching experiences and how often these experiences occur at present. By web-based survey, we asked US surgeons and residents to describe their best and worst intraoperative teaching experiences during training and how often 26 common intraoperative teaching behaviors occur in their current environment. A total of 346 residents and 196 surgeons responded (51 programs; 26 states). Surgeons and residents consistently identified trainee autonomy, teacher confidence, and communication as positive, while recalling negatively contemptuous, arrogant, accusatory, or uncommunicative teachers. Residents described intraoperative teaching behaviors by faculty as substantially less frequent than faculty self-reports. Neither sex nor seniority explained these results, although women reported communicative behaviors more frequently than men. Although veteran surgeons and current trainees agree on what constitutes effective and ineffective teaching in the operating room, they disagree on how often these behaviors occur, leaving substantial room for improvement. Published by Elsevier Inc.

  5. Presurgical mapping with magnetic source imaging. Comparisons with intraoperative findings

    International Nuclear Information System (INIS)

    Roberts, T.P.L.; Ferrari, P.; Perry, D.; Rowley, H.A.; Berger, M.S.

    2000-01-01

    We compare noninvasive preoperative mapping with magnetic source imaging to intraoperative cortical stimulation mapping. These techniques were directly compared in 17 patients who underwent preoperative and postoperative somatosensory mapping of a total of 22 comparable anatomic sites (digits, face). Our findings are presented in the context of previous studies that used magnetic source imaging and functional magnetic resonance imaging as noninvasive surrogates of intraoperative mapping for the identification of sensorimotor and language-specific brain functional centers in patients with brain tumors. We found that magnetic source imaging results were reasonably concordant with intraoperative mapping findings in over 90% of cases, and that concordance could be defined as 'good' in 77% of cases. Magnetic source imaging therefore provides a viable, if coarse, identification of somatosensory areas and, consequently, can guide and reduce the time taken for intraoperative mapping procedures. (author)

  6. Intraoperative contamination influences wound discharge and periprosthetic infection

    NARCIS (Netherlands)

    Knobben, Bas A. S.; Engelsma, Yde; Neut, Danielle

    Intraoperative bacterial contamination increases risk for postoperative wound-healing problems and periprosthetic infection, but to what extent remains unclear. We asked whether bacterial contamination of the instruments and bone during primary prosthesis insertion was associated with prolonged

  7. Intraoperative management of ETT and LMA cufi pressures: a survey ...

    African Journals Online (AJOL)

    2008-07-16

    Jul 16, 2008 ... A study done by Stein et al. highlighted the inability of advanced life support ... Conclusion. There is increasing importance placed on quality assurance ... pressures – the worrying reality: a comparative audit of intra-operative.

  8. Association between intraoperative hypotension and myocardial injury after vascular surgery

    NARCIS (Netherlands)

    van Waes, JAR; Van Klei, Wilton A.; Wijeysundera, Duminda N.; Van Wolfswinkel, Leo; Lindsay, Thomas F.; Beattie, W. Scott

    2016-01-01

    Background: Postoperative myocardial injury occurs frequently after noncardiac surgery and is strongly associated with mortality. Intraoperative hypotension (IOH) is hypothesized to be a possible cause. The aim of this study was to determine the association between IOH and postoperative myocardial

  9. Intraoperative contamination influences wound discharge and periprosthetic infection

    NARCIS (Netherlands)

    Knobben, Bas A. S.; Engelsma, Yde; Neut, Danielle

    2006-01-01

    Intraoperative bacterial contamination increases risk for postoperative wound-healing problems and periprosthetic infection, but to what extent remains unclear. We asked whether bacterial contamination of the instruments and bone during primary prosthesis insertion was associated with prolonged

  10. Intraoperative transesophageal echocardiography in congenital heart diseases surgery

    International Nuclear Information System (INIS)

    Ozores Suarez, Francisco Javier; Perez de Ordaz, Luis Bravo

    2010-01-01

    The intraoperative transesophageal echocardiography is very used in pediatric cardiovascular surgery. The aim of present paper was to determine its impact on the surgery immediate results after a previous experience of authors with this type of procedure

  11. Sentinel lymph node biopsy: An audit of intraoperative assessment ...

    African Journals Online (AJOL)

    2015-07-02

    Jul 2, 2015 ... Sentinel lymph node biopsy: An audit of ... cytotechnology service ... To audit results from intraoperative assessment of sentinel lymph node ..... out, and turnaround time in gynecologic cytology quality assurance: Findings.

  12. Results of intraoperative radiotherapy for pancreatic cancers

    International Nuclear Information System (INIS)

    Okazaki, Atsushi; Shinozaki, Jun; Noda, Masanobu

    1991-01-01

    Reported are the results and observations of the authors who, from July 1986 through December 1989, have used electron beam intraoperative radiotherapy (IORT) on 20 patients with locally advanced pancreatic cancers, said number including 3 patients given a resection. In 14 of the 17 unresected patients, a chief symptom was pain, and 8 patients were given a celiac plexus block at the same time. The results and observations are given below. Life-threatening complications occurred in two patients, i.e., an insufficient pancreatojejunostomy, and a perforative peritonitis. In 12 of 13 evaluable patients, pain control was achieved for a mean period of 5 months, indicating that an IORT with celiac plexus block may be useful for palliation. In the resected patients, the mean survival time was 6 months, whereas in the unresected patients, the mean survival time was 7 months. The common cause of death in the unresected patients was a metastatic dissemination. Finally, in 3 of the 5 unresected patients, marked effects such as massive fibrosis were seen in the pancreatic tumor on autopsy. (author)

  13. Intraoperative radiation therapy for malignant glioma

    Energy Technology Data Exchange (ETDEWEB)

    Sakai, Noboru; Yamada, Hiromu; Andoh, Takashi; Hirata, Toshifumi; Nishimura, Yasuaki; Miwa, Yoshiaki; Shimizu, Kotoyuki; Yanagawa, Shigeo [Gifu Univ. (Japan). Faculty of Medicine

    1991-11-01

    Intraoperative radiation therapy (IORT) was used as part of the initial therapy for malignant glioma in 32 of 73 patients with histologically verified anaplastic astrocytoma (grade III astrocytoma) and glioblastoma multiforme. The initial treatment for all cases was subtotal or total tumor resection combined with external irradiation and chemotherapy. IORT was performed 1 week after tumor resection, with doses of 10-50 Gy (mean 26.7 Gy) in one session. Fourteen of 32 cases had IORT two times because of tumor recurrence. The IORT patients had survival rates at 24 and 36 months after initial treatment of 57.1 and 33.5% (median survival 26.2 months). The other 41 patients had 23.6 and 13.1% survivals (median survival 20.7 months), which were significantly lower (p<0.01). Tumor recurrence within the original lesion site was suspected because of clinical condition, computed tomography, and magnetic resonance imaging studies in 65.6% of the IORT group (21 cases) 12 months after initial treatment. Twenty cases of death in the IORT group, including five autopsy cases, demonstrated regional tumor recurrence with a high incidence of intraventricular tumor invasion. The authors consider IORT is beneficial for selected malignant glioma patients, including tumor recurrence, because of prolonged survival. (author).

  14. Perspectives in Intraoperative Diagnostics of Human Gliomas

    Directory of Open Access Journals (Sweden)

    O. Tyurikova

    2015-01-01

    Full Text Available Amongst large a variety of oncological diseases, malignant gliomas represent one of the most severe types of tumors. They are also the most common type of the brain tumors and account for over half of the astrocytic tumors. According to different sources, the average life expectancy of patients with various glioblastomas varies between 10 and 12 months and that of patients with anaplastic astrocytic tumors between 20 and 24 months. Therefore, studies of the physiology of transformed glial cells are critical for the development of treatment methods. Modern medical approaches offer complex procedures, including the microsurgical tumor removal, radiotherapy, and chemotherapy, supplemented with photodynamic therapy and immunotherapy. The most radical of them is surgical resection, which allows removing the largest part of the tumor, reduces the intracranial hypertension, and minimizes the degree of neurological deficit. However, complete removal of the tumor remains impossible. The main limitations are insufficient visualization of glioma boundaries, due to its infiltrative growth, and the necessity to preserve healthy tissue. This review is devoted to the description of advantages and disadvantages of modern intraoperative diagnostics of human gliomas and highlights potential perspectives for development of their treatment.

  15. Intraoperative Assessment of Tricuspid Valve Function After Conservative Repair

    Science.gov (United States)

    Revuelta, J.M.; Gomez-Duran, C.; Garcia-Rinaldi, R.; Gallagher, M.W.

    1982-01-01

    It is desirable to repair coexistent tricuspid valve pathology at the time of mitral valve corrections. Conservative tricuspid repair may consist of commissurotomy, annuloplasty, or both. It is important that the repair be appropriate or tricuspid valve replacement may be necessary. A simple reproducible method of intraoperative testing for tricuspid valve insufficiency has been developed and used in 25 patients. Fifteen patients have been recatheterized, and the correlation between the intraoperative and postoperative findings has been consistent. PMID:15226931

  16. Lumbar Lordosis of Spinal Stenosis Patients during Intraoperative Prone Positioning

    OpenAIRE

    Lee, Su-Keon; Lee, Seung-Hwan; Song, Kyung-Sub; Park, Byung-Moon; Lim, Sang-Youn; Jang, Geun; Lee, Beom-Seok; Moon, Seong-Hwan; Lee, Hwan-Mo

    2016-01-01

    Background To evaluate the effect of spondylolisthesis on lumbar lordosis on the OSI (Jackson; Orthopaedic Systems Inc.) frame. Restoration of lumbar lordosis is important for maintaining sagittal balance. Physiologic lumbar lordosis has to be gained by intraoperative prone positioning with a hip extension and posterior instrumentation technique. There are some debates about changing lumbar lordosis on the OSI frame after an intraoperative prone position. We evaluated the effect of spondyloli...

  17. Intraoperative ultrasonography in detection of hepatic metastases from colorectal cancer

    DEFF Research Database (Denmark)

    Rafaelsen, Søren Rafael; Kronborg, Ole; Fenger, Claus

    1995-01-01

    PURPOSE: This study was designed to compare diagnostic accuracies of measuring liver enzymes, preoperative ultrasonography, surgical examination, and intraoperative ultrasonography for detection of liver metastases from colorectal cancer. METHODS: Blind, prospective comparisons of diagnostic...... examinations mentioned above were performed in 295 consecutive patients with colorectal cancer. An experienced ultrasonologist performed the preoperative examinations, and results were unknown to the other experienced ultrasonologist who performed the intraoperative examinations. The latter, also was unaware...

  18. Near-infrared laparoscopy for real-time intra-operative arterial and lymphatic perfusion imaging.

    LENUS (Irish Health Repository)

    Cahill, R A

    2012-02-01

    Multimodal laparoscopic imaging systems possessing the capability for extended spectrum irradiation and visualization within a unified camera system are now available to provide enhanced intracorporeal operative anatomic and dynamic perfusion assessment and potentially augmented patient outcome. While ultraviolet-range energies have limited penetration and hence are probably more useful for endoscopic mucosal interrogation, the near-infrared (NIR) spectrum is of greater potential utility for the purposes of examining inducible fluorescence in abdominopelvic tissue that can be achieved by administration of specific tracer agents, either directly into the circulation (e.g. for anastomotic perfusion assessment at the time of stapling) or into the lymphatic system (e.g. for lymph basin road-mapping and\\/or focussed target nodal assessment). This technology is also capable of supplementing anatomic recognition of the biliary system while implantable fibres can also be inserted intraoperatively for the purpose of safeguarding vital structures such as the oesphagus and ureters especially in difficult reoperations. It is likely that this technological capability will find a clear and common indication in colorectal specialist and general surgical departments worldwide in the near future.

  19. Intraoperative Electron-Beam Radiation Therapy for Pediatric Ewing Sarcomas and Rhabdomyosarcomas: Long-Term Outcomes

    International Nuclear Information System (INIS)

    Sole, Claudio V.; Calvo, Felipe A.; Polo, Alfredo; Cambeiro, Mauricio; Gonzalez, Carmen; Desco, Manuel; Martinez-Monge, Rafael

    2015-01-01

    Purpose: To assess long-term outcomes and toxicity of intraoperative electron-beam radiation therapy (IOERT) in the management of pediatric patients with Ewing sarcomas (EWS) and rhabdomyosarcomas (RMS). Methods and Materials: Seventy-one sarcoma (EWS n=37, 52%; RMS n=34, 48%) patients underwent IOERT for primary (n=46, 65%) or locally recurrent sarcomas (n=25, 35%) from May 1983 to November 2012. Local control (LC), overall survival (OS), and disease-free survival were estimated using Kaplan-Meier methods. For survival outcomes, potential associations were assessed in univariate and multivariate analyses using the Cox proportional hazards model. Results: After a median follow-up of 72 months (range, 4-310 months), 10-year LC, disease-free survival, and OS was 74%, 57%, and 68%, respectively. In multivariate analysis after adjustment for other covariates, disease status (P=.04 and P=.05) and R1 margin status (P<.01 and P=.04) remained significantly associated with LC and OS. Nine patients (13%) reported severe chronic toxicity events (all grade 3). Conclusions: A multimodal IOERT-containing approach is a well-tolerated component of treatment for pediatric EWS and RMS patients, allowing reduction or substitution of external beam radiation exposure while maintaining high local control rates

  20. Intraoperative magnetic resonance imaging to update interactive navigation in neurosurgery: method and preliminary experience.

    Science.gov (United States)

    Wirtz, C R; Bonsanto, M M; Knauth, M; Tronnier, V M; Albert, F K; Staubert, A; Kunze, S

    1997-01-01

    We report on the first successful intraoperative update of interactive image guidance based on an intraoperatively acquired magnetic resonance imaging (MRI) date set. To date, intraoperative imaging methods such as ultrasound, computerized tomography (CT), or MRI have not been successfully used to update interactive navigation. We developed a method of imaging patients intraoperatively with the surgical field exposed in an MRI scanner (Magnetom Open; Siemens Corp., Erlangen, Germany). In 12 patients, intraoperatively acquired 3D data sets were used for successful recalibration of neuronavigation, accounting for any anatomical changes caused by surgical manipulations. The MKM Microscope (Zeiss Corp., Oberkochen, Germany) was used as navigational system. With implantable fiducial markers, an accuracy of 0.84 +/- 0.4 mm for intraoperative reregistration was achieved. Residual tumor detected on MRI was consequently resected using navigation with the intraoperative data. No adverse effects were observed from intraoperative imaging or the use of navigation with intraoperative images, demonstrating the feasibility of recalibrating navigation with intraoperative MRI.

  1. Intraoperative Secondary Insults During Orthopedic Surgery in Traumatic Brain Injury.

    Science.gov (United States)

    Algarra, Nelson N; Lele, Abhijit V; Prathep, Sumidtra; Souter, Michael J; Vavilala, Monica S; Qiu, Qian; Sharma, Deepak

    2017-07-01

    Secondary insults worsen outcomes after traumatic brain injury (TBI). However, data on intraoperative secondary insults are sparse. The primary aim of this study was to examine the prevalence of intraoperative secondary insults during orthopedic surgery after moderate-severe TBI. We also examined the impact of intraoperative secondary insults on postoperative head computed tomographic scan, intracranial pressure (ICP), and escalation of care within 24 hours of surgery. We reviewed medical records of TBI patients 18 years and above with Glasgow Coma Scale score Secondary insults examined were: systemic hypotension (systolic blood pressurehypertension (ICP>20 mm Hg), cerebral hypotension (cerebral perfusion pressure40 mm Hg), hypocarbia (end-tidal CO2hypertension), hyperglycemia (glucose>200 mg/dL), hypoglycemia (glucose38°C). A total of 78 patients (41 [18 to 81] y, 68% male) met the inclusion criteria. The most common intraoperative secondary insults were systemic hypotension (60%), intracranial hypertension and cerebral hypotension (50% and 45%, respectively, in patients with ICP monitoring), hypercarbia (32%), and hypocarbia (29%). Intraoperative secondary insults were associated with worsening of head computed tomography, postoperative decrease of Glasgow Coma Scale score by ≥2, and escalation of care. After Bonferroni correction, association between cerebral hypotension and postoperative escalation of care remained significant (Psecondary insults were common during orthopedic surgery in patients with TBI and were associated with postoperative escalation of care. Strategies to minimize intraoperative secondary insults are needed.

  2. Intraoperative complications in pediatric neurosurgery: review of 1807 cases.

    Science.gov (United States)

    van Lindert, Erik J; Arts, Sebastian; Blok, Laura M; Hendriks, Mark P; Tielens, Luc; van Bilsen, Martine; Delye, Hans

    2016-09-01

    OBJECTIVE Minimal literature exists on the intraoperative complication rate of pediatric neurosurgical procedures with respect to both surgical and anesthesiological complications. The aim of this study, therefore, was to establish intraoperative complication rates to provide patients and parents with information on which to base their informed consent and to establish a baseline for further targeted improvement of pediatric neurosurgical care. METHODS A clinical complication registration database comprising a consecutive cohort of all pediatric neurosurgical procedures carried out in a general neurosurgical department from January 1, 2004, until July 1, 2012, was analyzed. During the study period, 1807 procedures were performed on patients below the age of 17 years. RESULTS Sixty-four intraoperative complications occurred in 62 patients (3.5% of procedures). Intraoperative mortality was 0.17% (n = 3). Seventy-eight percent of the complications (n = 50) were related to the neurosurgical procedures, whereas 22% (n = 14) were due to anesthesiology. The highest intraoperative complication rates were for cerebrovascular surgery (7.7%) and tumor surgery (7.4%). The most frequently occurring complications were cerebrovascular complications (33%). CONCLUSIONS Intraoperative complications are not exceptional during pediatric neurosurgical procedures. Awareness of these complications is the first step in preventing them.

  3. Intraoperative MRI to control the extent of brain tumor surgery

    International Nuclear Information System (INIS)

    Knauth, M.; Sartor, K.; Wirtz, C.R.; Tronnier, V.M.; Staubert, A.; Kunze, S.

    1998-01-01

    Intraoperative MRI definitely showed residual tumor in 6 of the 18 patients and resulted in ambiguous findings in 3 patients. In 7 patients surgery was continued. Early postoperative MRI showed residual tumor in 3 patients and resulted in uncertain findings in 2 patients. The rate of patients in whom complete removal of enhancing tumor could be achieved was 50% at the time of the intraoperative MR examination and 72% at the time of the early postoperative MR control. The difference in proportion of patients with 'complete tumor removal' between the groups who had been operated on using neuronavigation (NN) and intraoperative MRI (ioMRI) and those who had been operated on using only modern neurosurgical techniques except NN and ioMRI was statistically highly significant (Fisher exact test; P=0.008). Four different types of surgically induced contrast enhancement were observed. These phenomena carry different confounding potentials with residual tumor. Conclusion: Our preliminary experience with intraoperative MRI in patients with enhancing intraaxial tumors is encouraging. Combined use of neuronavigation and intraoperative MRI was able to increase the proportion of patients in whom complete removal of the enhancing parts of the tumor was achieved. Surgically induced enhancement requires careful analysis of the intraoperative MRI in order not to confuse it with residual tumor. (orig.) [de

  4. Selective serotonin reuptake inhibitors and intraoperative blood pressure.

    Science.gov (United States)

    van Haelst, Ingrid M M; van Klei, Wilton A; Doodeman, Hieronymus J; Kalkman, Cor J; Egberts, Toine C G

    2012-02-01

    The influence of selective serotonin reuptake inhibitors (SSRIs) on blood pressure is poorly understood. We hypothesized that if SSRIs have an influence on blood pressure, this might become manifest in changes in intraoperative blood pressure. We aimed to study the association between perioperative use of SSRIs and changes in intraoperative blood pressure by measuring the occurrence of intraoperative hyper- and hypotension. We conducted a retrospective observational follow-up study among patients who underwent elective primary total hip arthroplasty. The index group included users of SSRIs. The reference group included a random sample (ratio 1:3) of nonusers of an antidepressant agent. The outcome was the occurrence of intraoperative hypo- and hypertensive episodes (number, mean and total duration, and area under the curve (AUC)). The outcome was adjusted for confounding factors using regression techniques. The index group included 20 users of an SSRI. The reference group included 60 nonusers. Users of SSRIs showed fewer intraoperative hypotensive episodes, a shorter mean and total duration, and a smaller AUC when compared to the reference group. After adjustment for confounders, SSRI use was associated with a significantly shorter total duration of hypotension: mean difference of -29.4 min (95% confidence interval (CI) -50.4 to -8.3). Two users of an SSRI and two patients in the reference group had a hypertensive episode. Continuation of treatment with SSRIs before surgery was associated with a briefer duration of intraoperative hypotension.

  5. Patterns of Failure and Local Control After Intraoperative Electron Boost Radiotherapy to the Presacral Space in Combination with Total Mesorectal Excision in Patients with Locally Advanced Rectal Cancer

    International Nuclear Information System (INIS)

    Roeder, Falk; Treiber, Martina; Oertel, Susanne; Dinkel, Julien; Timke, Carmen; Funk, Angela; Garcia-Huttenlocher, Helena; Bischof, Marc; Weitz, Juergen; Harms, Wolfgang; Hensley, Frank W.; Buchler, Markus W.; Debus, Juergen; Krempien, Robert

    2007-01-01

    Purpose: To evaluate local control and patterns of failure in patients treated with intraoperative electron beam radiotherapy (IOERT) after total mesorectal excision (TME), to appraise the effectiveness of intraoperative target definition. Methods and Materials: We analyzed the outcome of 243 patients with rectal cancer treated with IOERT (median dose, 10 Gy) after TME. Eighty-eight patients received neoadjuvant and 122 patients adjuvant external beam radiotherapy (EBRT) (median dose, 41.4 Gy), and in 88% simultaneous chemotherapy was applied. Median follow-up was 59 months. Results: Local failure was observed in 17 patients (7%), resulting in a 5-year local control rate of 92%. Only complete resection and absence of nodal involvement correlated positively with local control. Considering IOERT fields, seven infield recurrences were seen in the presacral space, resulting in a 5-year local control rate of 97%. The remaining local relapses were located as follows: retrovesical/retroprostatic (5), anastomotic site (2), promontorium (1), ileocecal (1), and perineal (1). Conclusion: Intraoperative electron beam radiotherapy as part of a multimodal treatment approach including TME is a highly effective regimen to prevent local failure. The presacral space remains the site of highest risk for local failure, but IOERT can decrease the percentage of relapses in this area

  6. Intraoperative HDR brachytherapy for rectal cancer using a flexible intraoperative template: standard plans versus individual planning

    International Nuclear Information System (INIS)

    Kolkman-Deurloo, Inger-Karine K.; Nuyttens, Joost J.; Hanssens, Patrick E.J.; Levendag, Peter C.

    2004-01-01

    HDR intraoperative brachytherapy (IOBT) is applied to locally advanced rectal tumors using a 5 mm thick flexible intraoperative template (FIT). To reduce the procedure time, treatment planning is performed using standard plans that neglect the curvature of the FIT. We have calculated the individual treatment plan, based on the real geometry of the FIT, and the dose at clips placed during surgery. A mean treatment dose of 9.55±0.21 Gy was found for the individual plan, compared to the prescribed 10 Gy (P<0.0001). The mean central dose was 10.03±0.10 Gy in the standard plan and 9.20±0.32 Gy in the individual plan (P<0.0001). The mean dose at the corners of the FIT was 10.3 Gy in the standard plan and ranged between 10.3 and 10.5 Gy in the individual plan. In 63% of the clips, the dose was larger than 15.0 Gy, which is equivalent to a gap between the FIT and the target smaller than 5 mm. In 18% of the clips, the dose was smaller than 13.0 Gy indicating that locally the gap was larger than 5 mm. Clinical practice will have to prove if these small dose deviations influence the clinical outcome

  7. From Grey Scale B-Mode to Elastosonography: Multimodal Ultrasound Imaging in Meningioma Surgery-Pictorial Essay and Literature Review.

    Science.gov (United States)

    Prada, Francesco; Del Bene, Massimiliano; Moiraghi, Alessandro; Casali, Cecilia; Legnani, Federico Giuseppe; Saladino, Andrea; Perin, Alessandro; Vetrano, Ignazio Gaspare; Mattei, Luca; Richetta, Carla; Saini, Marco; DiMeco, Francesco

    2015-01-01

    The main goal in meningioma surgery is to achieve complete tumor removal, when possible, while improving or preserving patient neurological functions. Intraoperative imaging guidance is one fundamental tool for such achievement. In this regard, intra-operative ultrasound (ioUS) is a reliable solution to obtain real-time information during surgery and it has been applied in many different aspect of neurosurgery. In the last years, different ioUS modalities have been described: B-mode, Fusion Imaging with pre-operative acquired MRI, Doppler, contrast enhanced ultrasound (CEUS), and elastosonography. In this paper, we present our US based multimodal approach in meningioma surgery. We describe all the most relevant ioUS modalities and their intraoperative application to obtain precise and specific information regarding the lesion for a tailored approach in meningioma surgery. For each modality, we perform a review of the literature accompanied by a pictorial essay based on our routinely use of ioUS for meningioma resection.

  8. The clinical utility of multimodal MR image-guided needle biopsy in cerebral gliomas.

    Science.gov (United States)

    Yao, Chengjun; Lv, Shunzeng; Chen, Hong; Tang, Weijun; Guo, Jun; Zhuang, Dongxiao; Chrisochoides, Nikos; Wu, Jinsong; Mao, Ying; Zhou, Liangfu

    2016-01-01

    Our aim was to evaluate the diagnostic value of multimodal Magnetic Resonance (MR) Image in the stereotactic biopsy of cerebral gliomas, and investigate its implications. Twenty-four patients with cerebral gliomas underwent (1)H Magnetic Resonance Spectroscopy ((1)H-MRS)- and intraoperative Magnetic Resonance Imaging (iMRI)-supported stereotactic biopsy, and 23 patients underwent only the preoperative MRI-guided biopsy. The diagnostic yield, morbidity and mortality rates were analyzed. In addition, 20 patients underwent subsequent tumor resection, thus the diagnostic accuracy of the biopsy was further evaluated. The diagnostic accuracies of biopsies evaluated by tumor resection in the trial groups were better than control groups (92.3% and 42.9%, respectively, p = 0.031). The diagnostic yield in the trial groups was better than the control groups, but the difference was not statistically significant (100% and 82.6%, respectively, p = 0.05). The morbidity and mortality rates were similar in both groups. Multimodal MR image-guided glioma biopsy is practical and valuable. This technique can increase the diagnostic accuracy in the stereotactic biopsy of cerebral gliomas. Besides, it is likely to increase the diagnostic yield but requires further validation.

  9. Intraoperative radiation therapy for malignant glioma

    Energy Technology Data Exchange (ETDEWEB)

    Sakai, Noboru; Yamada, Hiromu; Andoh, Takashi; Takada, Mitsuaki; Hirata, Toshifumi; Funakoshi, Takashi; Doi, Hidetaka; Yanagawa, Shigeo [Gifu Univ. (Japan). Faculty of Medicine

    1989-04-01

    Intraoperative radiation therapy (IOR) is an ideal means of exterminating residual tumor after surgical resection. In this study, the clinical results of IOR using a Scanditronix Microtron MM-22 were evaluated in 14 patients with malignant glioma, five of whom had recurrent tumors. Between July, 1985 and October, 1986, 11 patients with glioblastoma multiforme (GB) were irradiated 18 times (mean, 1.6 times/case), and three with astrocytoma (Kernohan grade III) underwent IOR once each. The target-absorbed dose at 1 to 2 cm deeper than the tumor resection surface was 15 to 50 Gy. During irradiation, a cotton bolus was placed in the dead space after over 91% of the tumor had been resected. As a rule, external irradiation therapy was also given postoperatively at a dose of 30 to 52 Gy. One patient died of pneumonia and disseminated intravascular coagulation syndrome 1 month postoperatively. The 1- and 2-year survival rates of the ramaining 13 patients were 84.6% and 61.5%, respectively; among the 10 with GB, they were 80% and 50%. Generally, the smaller the tumor size, the better the results. There were no adverse effects, despite the dose 15 to 50 Gy applied temporally to the tumor bed. IOR was especially effective against small, localized tumors, but was not always beneficial in cases of large tumors, particularly those with a contralateral focus. The improved survival rate in this series demonstrates that IOR is significantly effective in the 'induction of remission' following surgical excision of malignant gliomas. (author).

  10. How do pediatric anesthesiologists define intraoperative hypotension?

    Science.gov (United States)

    Nafiu, Olubukola O; Voepel-Lewis, Terri; Morris, Michelle; Chimbira, Wilson T; Malviya, Shobha; Reynolds, Paul I; Tremper, Kevin K

    2009-11-01

    Although blood pressure (BP) monitoring is a recommended standard of care by the ASA, and pediatric anesthesiologists routinely monitor the BP of their patients and when appropriate treat deviations from 'normal', there is no robust definition of hypotension in any of the pediatric anesthesia texts or journals. Consequently, what constitutes hypotension in pediatric anesthesia is currently unknown. We designed a questionnaire-based survey of pediatric anesthesiologists to determine the BP ranges and thresholds used to define intraoperative hypotension (IOH). Members of the Society of Pediatric Anesthesia (SPA) and the Association of Paediatric Anaesthetists (APA) of Great Britain and Ireland were contacted through e-mail to participate in this survey. We asked a few demographic questions and five questions about specific definitions of hypotension for different age groups of patients undergoing inguinal herniorraphy, a common pediatric surgical procedure. The overall response rate was 56% (483/860), of which 76% were SPA members. Majority of the respondents (72%) work in academic institutions, while 8.9% work in institutions with fewer than 1000 annual pediatric surgical caseload. About 76% of respondents indicated that a 20-30% reduction in baseline systolic blood pressure (SBP) indicates significant hypotension in children under anesthesia. Most responders (86.7%) indicated that they use mean arterial pressure or SBP (72%) to define IOH. The mean SBP values for hypotension quoted by SPA members was about 5-7% lower across all pediatric age groups compared to values quoted by APA members (P = 0.001 for all age groups). There is great variability in the BP parameters used and the threshold used for defining and treating IOH among pediatric anesthesiologists. The majority of respondents considered a 20-30% reduction from baseline in SBP as indicative of significant hypotension. Lack of a consensus definition for a common clinical condition like IOH could have

  11. Automated intraoperative calibration for prostate cancer brachytherapy

    International Nuclear Information System (INIS)

    Kuiran Chen, Thomas; Heffter, Tamas; Lasso, Andras; Pinter, Csaba; Abolmaesumi, Purang; Burdette, E. Clif; Fichtinger, Gabor

    2011-01-01

    Purpose: Prostate cancer brachytherapy relies on an accurate spatial registration between the implant needles and the TRUS image, called ''calibration''. The authors propose a new device and a fast, automatic method to calibrate the brachytherapy system in the operating room, with instant error feedback. Methods: A device was CAD-designed and precision-engineered, which mechanically couples a calibration phantom with an exact replica of the standard brachytherapy template. From real-time TRUS images acquired from the calibration device and processed by the calibration system, the coordinate transformation between the brachytherapy template and the TRUS images was computed automatically. The system instantly generated a report of the target reconstruction accuracy based on the current calibration outcome. Results: Four types of validation tests were conducted. First, 50 independent, real-time calibration trials yielded an average of 0.57 ± 0.13 mm line reconstruction error (LRE) relative to ground truth. Second, the averaged LRE was 0.37 ± 0.25 mm relative to ground truth in tests with six different commercial TRUS scanners operating at similar imaging settings. Furthermore, testing with five different commercial stepper systems yielded an average of 0.29 ± 0.16 mm LRE relative to ground truth. Finally, the system achieved an average of 0.56 ± 0.27 mm target registration error (TRE) relative to ground truth in needle insertion tests through the template in a water tank. Conclusions: The proposed automatic, intraoperative calibration system for prostate cancer brachytherapy has achieved high accuracy, precision, and robustness.

  12. Neurophysiologic intraoperative monitoring of the vestibulocochlear nerve.

    Science.gov (United States)

    Simon, Mirela V

    2011-12-01

    Neurosurgical procedures involving the skull base and structures within can pose a significant risk of damage to the brain stem and cranial nerves. This can have life-threatening consequences and/or result in devastating neurologic deficits. Over the past decade, intraoperative neurophysiology has significantly evolved and currently offers a great tool for live monitoring of the integrity of nervous structures. Thus, dysfunction can be identified early and prompt modification of the surgical management or operating conditions, leads to avoidance of permanent structural damage.Along these lines, the vestibulocochlear nerve (CN VIII) and, to a greater extent, the auditory pathways as they pass through the brain stem are especially at risk during cerebelopontine angle (CPA), posterior/middle fossa, or brain stem surgery. CN VIII can be damaged by several mechanisms, from vascular compromise to mechanical injury by stretch, compression, dissection, and heat injury. Additionally, cochlea itself can be significantly damaged during temporal bone drilling, by noise, mechanical destruction, or infarction, and because of rupture, occlusion, or vasospasm of the internal auditory artery.CN VIII monitoring can be successfully achieved by live recording of the function of one of its parts, the cochlear or auditory nerve (AN), using the brain stem auditory evoked potentials (BAEPs), electrocochleography (ECochG), and compound nerve action potentials (CNAPs) of the cochlear nerve.This is a review of these techniques, their principle, applications, methodology, interpretation of the evoked responses, and their change from baseline, within the context of surgical and anesthesia environments, and finally the appropriate management of these changes.

  13. Recent developments in multimodality fluorescence imaging probes

    Directory of Open Access Journals (Sweden)

    Jianhong Zhao

    2018-05-01

    Full Text Available Multimodality optical imaging probes have emerged as powerful tools that improve detection sensitivity and accuracy, important in disease diagnosis and treatment. In this review, we focus on recent developments of optical fluorescence imaging (OFI probe integration with other imaging modalities such as X-ray computed tomography (CT, magnetic resonance imaging (MRI, positron emission tomography (PET, single-photon emission computed tomography (SPECT, and photoacoustic imaging (PAI. The imaging technologies are briefly described in order to introduce the strengths and limitations of each techniques and the need for further multimodality optical imaging probe development. The emphasis of this account is placed on how design strategies are currently implemented to afford physicochemically and biologically compatible multimodality optical fluorescence imaging probes. We also present studies that overcame intrinsic disadvantages of each imaging technique by multimodality approach with improved detection sensitivity and accuracy. KEY WORDS: Optical imaging, Fluorescence, Multimodality, Near-infrared fluorescence, Nanoprobe, Computed tomography, Magnetic resonance imaging, Positron emission tomography, Single-photon emission computed tomography, Photoacoustic imaging

  14. Multimodality, creativity and children's meaning-making: Drawings ...

    African Journals Online (AJOL)

    Multimodality, creativity and children's meaning-making: Drawings, writings, imaginings. ... Framed by social semiotic theories of communication, multimodal ... to create imaginary worlds and express meanings according to their interests.

  15. Multimodal Behavior Therapy: Case Study of a High School Student.

    Science.gov (United States)

    Seligman, Linda

    1981-01-01

    A case study of a high school student concerned with weight problems illustrates multimodal behavior therapy and its use in a high school setting. Multimodal therapy allows the school counselor to maximize referral sources while emphasizing growth and actualization. (JAC)

  16. Polarization Characterization of a Multi-Moded Feed Structure

    Data.gov (United States)

    National Aeronautics and Space Administration — The Polarization Characterization of a Multi-Moded Feed Structure projects characterize the polarization response of a multi-moded feed horn as an innovative...

  17. Optically neuronavigated ultrasonography in an intraoperative magnetic resonance imaging environment.

    Science.gov (United States)

    Katisko, Jani P A; Koivukangas, John P

    2007-04-01

    To develop a clinically useful method that shows the corresponding planes of intraoperative two-dimensional ultrasonography and intraoperative magnetic resonance imaging (MRI) scans determined with an optical neuronavigator from an intraoperative three-dimensional MRI scan data set, and to determine the qualitative and the quantitative spatial correspondence between the ultrasonography and MRI scans. An ultrasound probe was interlinked with an ergonomic and MRI scan-compatible ultrasonography probe tracker to the optical neuronavigator used in a low-field intraoperative MRI scan environment for brain surgery. Spatial correspondence measurements were performed using a custom-made ultrasonography/MRI scan phantom. In this work, instruments to combine intraoperatively collected ultrasonography and MRI scan data with an optical localization method in a magnetic environment were developed. The ultrasonography transducer tracker played an important role. Furthermore, a phantom for ultrasonography and MRI scanning was produced. This is the first report, to our knowledge, regarding the possibility of combining the two most important intraoperative imaging modalities used in neurosurgery, ultrasonography and MRI scanning, to guide brain tumor surgery. The method was feasible and, as shown in an illustrative surgical case, has direct clinical impact on image-guided brain surgery. The spatial deviation between the ultrasonography and the MRI scans was, on average, 1.90 +/- 1.30 mm at depths of 0 to 120 mm from the ultrasonography probe. The overall result of this work is a unique method to guide the neurosurgical operation with neuronavigated ultrasonography imaging in an intraoperative MRI scanning environment. The relevance of the method is emphasized in minimally invasive neurosurgery.

  18. Multimodale trafiknet i GIS (Multimodal Traffic Network in GIS)

    DEFF Research Database (Denmark)

    Kronbak, Jacob; Brems, Camilla Riff

    1996-01-01

    The report introduces the use of multi-modal traffic networks within a geographical Information System (GIS). The necessary theory of modelling multi-modal traffic network is reviewed and applied to the ARC/INFO GIS by an explorative example.......The report introduces the use of multi-modal traffic networks within a geographical Information System (GIS). The necessary theory of modelling multi-modal traffic network is reviewed and applied to the ARC/INFO GIS by an explorative example....

  19. Multimodality instrument for tissue characterization

    Science.gov (United States)

    Mah, Robert W. (Inventor); Andrews, Russell J. (Inventor)

    2004-01-01

    A system with multimodality instrument for tissue identification includes a computer-controlled motor driven heuristic probe with a multisensory tip. For neurosurgical applications, the instrument is mounted on a stereotactic frame for the probe to penetrate the brain in a precisely controlled fashion. The resistance of the brain tissue being penetrated is continually monitored by a miniaturized strain gauge attached to the probe tip. Other modality sensors may be mounted near the probe tip to provide real-time tissue characterizations and the ability to detect the proximity of blood vessels, thus eliminating errors normally associated with registration of pre-operative scans, tissue swelling, elastic tissue deformation, human judgement, etc., and rendering surgical procedures safer, more accurate, and efficient. A neural network program adaptively learns the information on resistance and other characteristic features of normal brain tissue during the surgery and provides near real-time modeling. A fuzzy logic interface to the neural network program incorporates expert medical knowledge in the learning process. Identification of abnormal brain tissue is determined by the detection of change and comparison with previously learned models of abnormal brain tissues. The operation of the instrument is controlled through a user friendly graphical interface. Patient data is presented in a 3D stereographics display. Acoustic feedback of selected information may optionally be provided. Upon detection of the close proximity to blood vessels or abnormal brain tissue, the computer-controlled motor immediately stops probe penetration. The use of this system will make surgical procedures safer, more accurate, and more efficient. Other applications of this system include the detection, prognosis and treatment of breast cancer, prostate cancer, spinal diseases, and use in general exploratory surgery.

  20. Multimodality Data Integration in Epilepsy

    Directory of Open Access Journals (Sweden)

    Otto Muzik

    2007-01-01

    Full Text Available An important goal of software development in the medical field is the design of methods which are able to integrate information obtained from various imaging and nonimaging modalities into a cohesive framework in order to understand the results of qualitatively different measurements in a larger context. Moreover, it is essential to assess the various features of the data quantitatively so that relationships in anatomical and functional domains between complementing modalities can be expressed mathematically. This paper presents a clinically feasible software environment for the quantitative assessment of the relationship among biochemical functions as assessed by PET imaging and electrophysiological parameters derived from intracranial EEG. Based on the developed software tools, quantitative results obtained from individual modalities can be merged into a data structure allowing a consistent framework for advanced data mining techniques and 3D visualization. Moreover, an effort was made to derive quantitative variables (such as the spatial proximity index, SPI characterizing the relationship between complementing modalities on a more generic level as a prerequisite for efficient data mining strategies. We describe the implementation of this software environment in twelve children (mean age 5.2±4.3 years with medically intractable partial epilepsy who underwent both high-resolution structural MR and functional PET imaging. Our experiments demonstrate that our approach will lead to a better understanding of the mechanisms of epileptogenesis and might ultimately have an impact on treatment. Moreover, our software environment holds promise to be useful in many other neurological disorders, where integration of multimodality data is crucial for a better understanding of the underlying disease mechanisms.

  1. Video genre classification using multimodal features

    Science.gov (United States)

    Jin, Sung Ho; Bae, Tae Meon; Choo, Jin Ho; Ro, Yong Man

    2003-12-01

    We propose a video genre classification method using multimodal features. The proposed method is applied for the preprocessing of automatic video summarization or the retrieval and classification of broadcasting video contents. Through a statistical analysis of low-level and middle-level audio-visual features in video, the proposed method can achieve good performance in classifying several broadcasting genres such as cartoon, drama, music video, news, and sports. In this paper, we adopt MPEG-7 audio-visual descriptors as multimodal features of video contents and evaluate the performance of the classification by feeding the features into a decision tree-based classifier which is trained by CART. The experimental results show that the proposed method can recognize several broadcasting video genres with a high accuracy and the classification performance with multimodal features is superior to the one with unimodal features in the genre classification.

  2. Reference Resolution in Multi-modal Interaction: Position paper

    NARCIS (Netherlands)

    Fernando, T.; Nijholt, Antinus

    2002-01-01

    In this position paper we present our research on multimodal interaction in and with virtual environments. The aim of this presentation is to emphasize the necessity to spend more research on reference resolution in multimodal contexts. In multi-modal interaction the human conversational partner can

  3. Reference resolution in multi-modal interaction: Preliminary observations

    NARCIS (Netherlands)

    González González, G.R.; Nijholt, Antinus

    2002-01-01

    In this paper we present our research on multimodal interaction in and with virtual environments. The aim of this presentation is to emphasize the necessity to spend more research on reference resolution in multimodal contexts. In multi-modal interaction the human conversational partner can apply

  4. Training of Perceptual Motor Skills in Multimodal Virtual Environments

    Directory of Open Access Journals (Sweden)

    Gopher Daniel

    2011-12-01

    Full Text Available Multimodal, immersive, virtual reality (VR techniques open new perspectives for perceptualmotor skill trainers. They also introduce new risks and dangers. This paper describes the benefits and pitfalls of multimodal training and the cognitive building blocks of a multimodal, VR training simulators.

  5. Indocyanine green for intraoperative localization of ureter.

    Science.gov (United States)

    Siddighi, Sam; Yune, Junchan Joshua; Hardesty, Jeffrey

    2014-10-01

    Intraurethral injection of indocyanine green (ICG; Akorn, Lake Forest, IL) and visualization under near-infrared (NIR) light allows for real-time delineation of the ureter. This technology can be helpful to prevent iatrogenic ureteral injury during pelvic surgery. Patients were scheduled to undergo robot-assisted laparoscopic sacrocolpopexy. Before the robotic surgery started, the tip of a 6-F ureteral catheter was inserted into the ureteral orifice. Twenty-five milligrams of ICG was dissolved in 10-mL of sterile water and injected through the open catheter. The same procedure was repeated on the opposite side. The ICG reversibly stained the inside lining of the ureter by binding to proteins on urothelial layer. During the course of robotic surgery, the NIR laser on the da Vinci Si surgical robot (Intuitive Surgical, Inc, Sunnyvale, CA) was used to excite ICG molecules, and infrared emission was captured by the da Vinci filtered lens system and electronically converted to green color. Thus, the ureter fluoresced green, which allowed its definitive identification throughout the entire case. In all cases of >10 patients, we were able to visualize bilateral ureters with this technology, even though there was some variation in brightness that depended on the depth of the ureter from the peritoneal surface. For example, in a morbidly obese patient, the ureters were not as bright green. There were no intraoperative or postoperative adverse effects attributable to ICG administration for up to 2 months of observation. In our experience, this novel method of intraurethral ICG injection was helpful to identify the entire course of ureter and allowed a safe approach to tissues that were adjacent to the urinary tract. The advantage of our technique is that it requires the insertion of just the tip of ureteral catheter. Despite our limited cohort of patients, our findings are consistent with previous reports of the excellent safety profile of intravenous and intrabiliary ICG

  6. The use of intraoperative computed tomography navigation in pituitary surgery promises a better intraoperative orientation in special cases

    Directory of Open Access Journals (Sweden)

    Stefan Linsler

    2016-01-01

    Full Text Available Objective: The safety of endoscopic skull base surgery can be enhanced by accurate navigation in preoperative computed tomography (CT and magnetic resonance imaging (MRI. Here, we report our initial experience of real-time intraoperative CT-guided navigation surgery for pituitary tumors in childhood. Materials and Methods: We report the case of a 15-year-old girl with a huge growth hormone-secreting pituitary adenoma with supra- and perisellar extension. Furthermore, the skull base was infiltrated. In this case, we performed an endonasal transsphenoidal approach for debulking the adenoma and for chiasma decompression. We used an MRI neuronavigation (Medtronic Stealth Air System which was registered via intraoperative CT scan (Siemens CT Somatom. Preexisting MRI studies (navigation protocol were fused with the intraoperative CT scans to enable three-dimensional navigation based on MR and CT imaging data. Intraoperatively, we did a further CT scan for resection control. Results: The intraoperative accuracy of the neuronavigation was excellent. There was an adjustment of <1 mm. The navigation was very helpful for orientation on the destroyed skull base in the sphenoid sinus. After opening the sellar region and tumor debulking, we did a CT scan for resection control because the extent of resection was not credible evaluable in this huge infiltrating adenoma. Thereby, we were able to demonstrate a sufficient decompression of the chiasma and complete resection of the medial part of the adenoma in the intraoperative CT images. Conclusions: The use of intraoperative CT/MRI-guided neuronavigation for transsphenoidal surgery is a time-effective, safe, and technically beneficial technique for special cases.

  7. Intraoperative use of ultrasonography by small subcortical lesions

    International Nuclear Information System (INIS)

    Kondoff, Sl.; Gabrovski, St.; Krustev, E.; Poptodorov, G.; Gabrovski, N.; Uzunov, K.

    2004-01-01

    The aim of this study is to present the possibilities for use of intraoperative ultrasound (US) diagnostics as a method of image guided surgical navigation in neurosurgery. During an US scan of normal and pathologically changed tissues as well as volume taking lesion images are received in real time intraoperative display allowing dynamic control of the surgical radicalism and at the same time minimal invasiveness to the neural structures. Intraoperative ultrasound with real-time display characteristics finds a very wide application: subcortical and deeply localized tumour lesions, haematomas, large and giant aneurysms, arteriovenous (AV) malformations, spinal tumours and cysts. The real time dynamic scan is based on the B-mod. This method is founded on the US characteristic of reflecting in a different manner at the borderline of two mediums with different density as well as tissues with various physical and chemical characteristics. The reflection is partially absorbed depending on the acoustic impedance of the biologic field. We use a LOGIC200PRO unit with two probes I-type and T-type having a 'wedge of space' - 35 mm and working frequencies of 6 MHz and 7 MHz appropriate for visualizing lesions at a depth of 25 to 60 mm.The advantages of the Intraoperative US diagnostics are: non-invasiveness; real time display - i.e. presents the imminent intraoperative changes; it is a good alternative to other image-guided technologies; accessible price of the US unit

  8. Selected versus routine use of intraoperative cholangiography during laparoscopic cholecystectomy.

    Science.gov (United States)

    Pickuth, D

    1995-12-01

    Routine use of intraoperative cholangiography during laparoscopic cholecystectomy is still widely advocated and standard in many departments, however, this is discussed controversially. We have developed a new diagnostic strategy to detect bile duct stones. The concept is based on an ultrasound examination and on a screening for the presence of six risk indicators of choledocholithiasis. 120 consecutive patients undergoing laparoscopic cholecystectomy were prospectively screened for the presence of six risk indicators of choledocholithiasis: history of jaundice; history of pancreatitis; hyperbilirubinemia; hyperamylasemia; dilated bile duct; unclear ultrasound findings. The sensitivity of ultrasound and of intraoperative cholangiography in diagnosing bile duct stones was also evaluated. For the detection of bile duct stones, the sensitivity was 77% for ultrasound and 100% for intraoperative cholangiography. 20% of all patients had at least one risk indicator. The presence of a risk indicator correlated significantly with the presence of choledocholithiasis (p concept, we would have avoided 80% of intraoperative cholangiographies without missing a stone in the bile duct. This study lends further support to the view that the routine use of intraoperative cholangiography in patients undergoing laparoscopic cholecystectomy is not necessary.

  9. Role of scrape cytology in the intraoperative diagnosis of tumor

    Directory of Open Access Journals (Sweden)

    Kolte Sachin

    2010-01-01

    Full Text Available Background : Rapid diagnosis of surgically removed specimens has created many controversies and a single completely reliable method has not yet been developed. Histopathology of a paraffin section remains the ultimate gold standard in tissue diagnosis. Frozen section is routinely used by the surgical pathology laboratories for intraoperative diagnosis. The use of either frozen section or cytological examination alone has an acceptable rate (93-97% of correct diagnosis, with regard to interpretation of benign versus malignant. Aim : To evaluate the utility of scrape cytology for the rapid diagnosis of surgically removed tumors and its utilisation for learning cytopathology. Materials and Methods : 75 surgically removed specimens from various organs and systems were studied. Scrapings were taken from each specimen before formalin fixation and stained by modified rapid Papanicolaou staining. Results : Of the 75 cases studied, 73 could be correctly differentiated into benign and malignant tumors, with an accuracy rate of 97.3%. Conclusions : Intraoperative scrape cytology is useful for intraoperative diagnosis of tumor, where facilities for frozen section are not available. The skill and expertise developed by routinely practicing intraoperative cytology can be applied to the interpretation of fine needle aspirate smears. Thus, apart from its diagnostic role, intraoperative cytology can become a very useful learning tool in the field of cytopathology.

  10. [Factors related to intraoperative retinal breaks in macular hole surgery].

    Science.gov (United States)

    Kumagai, K; Ogino, N; Demizu, S; Atsumi, K; Kurihara, H; Iwaki, M; Ishigooka, H; Tachi, N

    2001-02-01

    To evaluate the factors of intraoperative retinal breaks in macular hole surgery. This study included 558 eyes of 506 patients who underwent idiopathic macular hole surgery by one surgeon. Multiple regression was performed using the variables of gender, age, affected eye, lens status, stage, duration of symptoms, hole size, axial length, and lattice degeneration. The rate of retinal breaks was higher in stage 3 (16.0%) than in stage 4 (8.2%) (p = 0.014). In eyes with lattice degeneration intraoperative retinal breaks occurred in about 40% of the cases. Major factors were as follows: lattice degeneration (r = 0.24, p lattice degeneration, and gender (r = -0.18, p = 0.035) in eyes of stage 4 without lattice degeneration. The factors of intraoperative retinal breaks in macular hole surgery were lattice degeneration in all eyes and stage 3 in eyes without lattice degeneration. The high incidence of intraoperative retinal breaks in stage 3 was mainly due to the occurrence of posterior vitreous detachment. Male gender was a significant factor associated with intraoperative retinal breaks.

  11. Intraoperative parathyroid hormone assay-cutting the Gordian knot

    Directory of Open Access Journals (Sweden)

    Chandralekha Tampi

    2014-01-01

    Full Text Available Background: Hyperparathyroidism is treated by surgical excision of the hyperfunctioning parathyroid gland. In case of adenoma the single abnormal gland is removed, while in hyperplasias, a subtotal excision, that is, three-and-a-half of the four glands are removed. This therapeutic decision is made intraoperatively through frozen section evaluation and is sometimes problematic, due to a histological overlap between hyperplasia and the adenoma. The intraoperative parathyroid hormone (IOPTH assay, propogated in recent years, offers an elegant solution, with a high success rate, due to its ability to identify the removal of all hyperfunctioning parathyroid tissue. Aim: To study the feasibility of using IOPTH in our setting. Materials and Methods: Seven patients undergoing surgery for primary hyperparathyroidism had their IOPTH levels evaluated, along with the routine frozen and paraffin sections. Results: All seven patients showed more than a 50% intraoperative fall in serum PTH after excision of the abnormal gland. This was indicative of an adenoma and was confirmed by histopathological examination and normalization of serum calcium postoperatively. Conclusion: The intraoperative parathyroid hormone is a sensitive and specific guide to a complete removal of the abnormal parathyroid tissue. It can be incorporated without difficulty as an intraoperative guide and is superior to frozen section diagnosis in parathyroid surgery.

  12. Intraoperative adverse events associated with extremely preterm cesarean deliveries.

    Science.gov (United States)

    Bertholdt, Charline; Menard, Sophie; Delorme, Pierre; Lamau, Marie-Charlotte; Goffinet, François; Le Ray, Camille

    2018-05-01

    At the same time as survival is increasing among premature babies born before 26 weeks of gestation, the rates of cesarean deliveries before 26 weeks is also rising. Our purpose was to compare the frequency of intraoperative adverse events during cesarean deliveries in two gestational age groups: 24-25 weeks and 26-27 weeks. This single-center retrospective cohort study included all women with cesarean deliveries performed before 28 +0 weeks from 2007 through 2015. It compared the frequency of intraoperative adverse events between two groups: those at 24-25 weeks of gestation and at 26-27 weeks. Intraoperative adverse events were a classical incision, transplacental incision, difficulty in fetal extraction (explicitly mentioned in the surgical report), postpartum hemorrhage (≥500 mL of blood loss), and injury to internal organs. A composite outcome including at least one of these events enabled us to analyze the risk factors for intraoperative adverse events with univariate and multivariable analysis. Stratified analyses by the indication for the cesarean were performed. We compared 74 cesarean deliveries at 24-25 weeks of gestation and 214 at 26-27 weeks. Intraoperative adverse events occurred at higher rates in the 24-25-week group (63.5 vs. 30.8%, p cesarean. These results should help obstetricians and women making decisions about cesarean deliveries at these extremely low gestational ages. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

  13. Intraoperative and early postoperative complications of manual sutureless cataract extraction.

    Science.gov (United States)

    Iqbal, Yasir; Zia, Sohail; Baig Mirza, Aneeq Ullah

    2014-04-01

    To determine the intraoperative and early postoperative complications of manual sutureless cataract extraction. Case series. Redo Eye Hospital, Rawalpindi, Pakistan, from January 2009 to December 2010. Three hundred patients of cataract through purposive non-probability sampling were selected. The patients underwent manual sutureless cataract surgery (MSCS) by single experienced surgeon and intraoperative complications were documented. The surgical technique was modified to deal with any intraoperative complications accordingly. Patients were examined on the first postoperative day and on the first postoperative week for any postoperative complications. The data was entered in Statistical Package for Social Sciences (SPSS) version 13.0 and the results were calculated in frequencies. Among the 300 cases, 81.3% surgeries went uneventful whereas 18.6% had some complication. The common intraoperative complications were superior button-hole formation in 5%; posterior capsular rent in 5% and premature entry with iris prolapse in 3% cases. Postoperatively, the commonly encountered complications were striate keratopathy in 9.6% and hyphema 9%. At first week follow-up, 4% had striate keratopathy and 0.6% had hyphema. Striate keratopathy resolved with topical medication on subsequent follow-up. A total of 9 cases (3%) underwent second surgery: 2 cases for lens matter wash, 2 cases for hyphema and 5 cases needed suturing of wound for shallow anterior chamber due to wound leak. Superior button-hole formation, posterior capsular rent and premature entry were the common intraoperative complications of MSCS whereas the common early postoperative complications were striate keratopathy and hyphema.

  14. PET-MRI and multimodal cancer imaging

    International Nuclear Information System (INIS)

    Wang Taisong; Zhao Jinhua; Song Jianhua

    2011-01-01

    Multimodality imaging, specifically PET-CT, brought a new perspective into the fields of clinical imaging. Clinical cases have shown that PET-CT has great value in clinical diagnosis and experimental research. But PET-CT still bears some limitations. A major drawback is that CT provides only limited soft tissue contrast and exposes the patient to a significant radiation dose. MRI overcome these limitations, it has excellent soft tissue contrast, high temporal and spatial resolution and no radiation damage. Additionally, since MRI provides also functional information, PET-MRI will show a new direction of multimodality imaging in the future. (authors)

  15. Strategy development management of Multimodal Transport Network

    Directory of Open Access Journals (Sweden)

    Nesterova Natalia S.

    2016-01-01

    Full Text Available The article gives a brief overview of works on the development of transport infrastructure for multimodal transportation and integration of Russian transport system into the international transport corridors. The technology for control of the strategy, that changes shape and capacity of Multi-modal Transport Network (MTN, is considered as part of the methodology for designing and development of MTN. This technology allows to carry out strategic and operational management of the strategy implementation based on the use of the balanced scorecard.

  16. Multimodal surveillance sensors, algorithms, and systems

    CERN Document Server

    Zhu, Zhigang

    2007-01-01

    From front-end sensors to systems and environmental issues, this practical resource guides you through the many facets of multimodal surveillance. The book examines thermal, vibration, video, and audio sensors in a broad context of civilian and military applications. This cutting-edge volume provides an in-depth treatment of data fusion algorithms that takes you to the core of multimodal surveillance, biometrics, and sentient computing. The book discusses such people and activity topics as tracking people and vehicles and identifying individuals by their speech.Systems designers benefit from d

  17. Connecting multimodality in human communication.

    Science.gov (United States)

    Regenbogen, Christina; Habel, Ute; Kellermann, Thilo

    2013-01-01

    DCM analysis instead showed a pronounced top-down control. Remarkably, all connections from the dmPFC to the three other regions were modulated by the experimental conditions. This observation is in line with the presumed role of the dmPFC in the allocation of attention. In contrary, all incoming connections to the AG were modulated, indicating its key role in integrating multimodal information and supporting comprehension. Notably, the input from the FFG to the AG was enhanced when facial expressions conveyed emotional information. These findings serve as preliminary results in understanding network dynamics in human emotional communication and empathy.

  18. Intraoperative monitoring technician: a new member of the surgical team.

    Science.gov (United States)

    Brown, Molly S; Brown, Debra S

    2011-02-01

    As surgery needs have increased, the traditional surgical team has expanded to include personnel from radiology and perfusion services. A new surgical team member, the intraoperative monitoring technician, is needed to perform intraoperative monitoring during procedures that carry a higher risk of central and peripheral nerve injury. Including the intraoperative monitoring technician on the surgical team can create challenges, including surgical delays and anesthesia care considerations. When the surgical team members, including the surgeon, anesthesia care provider, and circulating nurse, understand and facilitate this new staff member's responsibilities, the technician is able to perform monitoring functions that promote the smooth flow of the surgical procedure and positive patient outcomes. Copyright © 2011 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  19. Intraoperative ultrasonography for presumed brain metastases: a case series study

    Directory of Open Access Journals (Sweden)

    Helder Picarelli

    2012-10-01

    Full Text Available Brain metastases (BM are one of the most common intracranial tumors and surgical treatment can improve both the functional outcomes and patient survival, particularly when systemic disease is controlled. Image-guided BM resection using intraoperative exams, such as intraoperative ultrasound (IOUS, can lead to better surgical results. METHODS: To evaluate the use of IOUS for BM resection, 20 consecutives patients were operated using IOUS to locate tumors, identify their anatomical relationships and surgical cavity after resection. Technical difficulties, complications, recurrence and survival rates were noted. RESULTS: IOUS proved effective for locating, determining borders and defining the anatomical relationships of BM, as well as to identify incomplete tumor resection. No complications related to IOUS were seen. CONCLUSION: IOUS is a practical supporting method for the resection of BM, but further studies comparing this method with other intraoperative exams are needed to evaluate its actual contribution and reliability.

  20. Intraoperative magnetic resonance imaging for neurosurgery – An anaesthesiologist's challenge

    Directory of Open Access Journals (Sweden)

    Rajashree U Gandhe

    2018-01-01

    Full Text Available Intraoperative magnetic resonance imaging (MRI-guided neurosurgery has gained popularity over the years globally. These surgeries require a dedicated operating room and MRI-compatible anaesthesia equipment. The anaesthesiologist providing care in this setup needs to be experienced and vigilant to ensure patient safety. Strict adherence to MRI safety checklists and regular personnel training would avoid potential accidents and life-threatening emergencies. Teamwork, good communication, preprocedure planning, and familiarity with the surroundings are very important for safe care and good outcomes. We performed a literature search in Google Scholar, PubMed and Cochrane databases for original and reviewed articles for the origins, development and applications of intraoperative MRI in neurosurgical procedures. Much of the research has emphasised on the surgical indications than the anaesthetic challenges faced during intraoperative MRI guided surgery. The purpose of this review is to discuss the anaesthetic concerns specific to this unique environment.

  1. Intraoperative cyclorotation and pupil centroid shift during LASIK and PRK.

    Science.gov (United States)

    Narváez, Julio; Brucks, Matthew; Zimmerman, Grenith; Bekendam, Peter; Bacon, Gregory; Schmid, Kristin

    2012-05-01

    To determine the degree of cyclorotation and centroid shift in the x and y axis that occurs intraoperatively during LASIK and photorefractive keratectomy (PRK). Intraoperative cyclorotation and centroid shift were measured in 63 eyes from 34 patients with a mean age of 34 years (range: 20 to 56 years) undergoing either LASIK or PRK. Preoperatively, an iris image of each eye was obtained with the VISX WaveScan Wavefront System (Abbott Medical Optics Inc) with iris registration. A VISX Star S4 (Abbott Medical Optics Inc) laser was later used to measure cyclotorsion and pupil centroid shift at the beginning of the refractive procedure and after flap creation or epithelial removal. The mean change in intraoperative cyclorotation was 1.48±1.11° in LASIK eyes and 2.02±2.63° in PRK eyes. Cyclorotation direction changed by >2° in 21% of eyes after flap creation in LASIK and in 32% of eyes after epithelial removal in PRK. The respective mean intraoperative shift in the x axis and y axis was 0.13±0.15 mm and 0.17±0.14 mm, respectively, in LASIK eyes, and 0.09±0.07 mm and 0.10±0.13 mm, respectively, in PRK eyes. Intraoperative centroid shifts >100 μm in either the x axis or y axis occurred in 71% of LASIK eyes and 55% of PRK eyes. Significant changes in cyclotorsion and centroid shifts were noted prior to surgery as well as intraoperatively with both LASIK and PRK. It may be advantageous to engage iris registration immediately prior to ablation to provide a reference point representative of eye position at the initiation of laser delivery. Copyright 2012, SLACK Incorporated.

  2. Glioma surgery using intraoperative tractography and MEP monitoring

    International Nuclear Information System (INIS)

    Maesawa, Satoshi; Nakahara, Norimoto; Watanabe, Tadashi; Fujii, Masazumi; Yoshida, Jun

    2009-01-01

    In surgery of gliomas in motor-eloquent locations, it is essential to maximize resection while minimizing motor deficits. We attempted to identify the cortico-spinal tract (CST) by intraoperative-diffusion tensor imaging (DTI) tractography, combined with electrophysiological mapping using direct subcortical stimulation during tumor resection. Our techniques and preliminary results are reported. Tumors were removed from twelve patients with gliomas in and around the CST using high-field intraoperative MRI and neuronavigation system (BrainSUITE). DTI-based tractography was implemented for navigation of CST pre-and intraoperatively. When the CST was close to the manipulating area, direct subcortical stimulation was performed, and motor evoked potential (MEP)-responses were examined. Locations of CST indicated by pre- and intraoperative tractography (pre- or intra-CST-tractography), and locations identified by subcortical stimulation were recorded, and those correlations were examined. Imaging and functional outcomes were reviewed. Total resections were achieved in 10 patients (83.4%). Two patients developed transient deterioration of motor function (16.6%), and permanent paresis was seen in one (8.3%). The distance from intra-CST-tractography to corresponding sites by subcortical stimulation was 4.5 mm in average (standard deviation (SD)=4.2), and significantly shorter than from pre-CST-tractography. That distance correlated significantly with the intensity of subcortical stimulation. We observed that intraoperative DTI-tractography demonstrated the location of the pyramidal tract more accurately than preoperative one. The combination of intraoperative tractgraphy and MEP monitoring enhanced the quality of surgery for gliomas in motor-eloquent area. (author)

  3. Introduction of a standardized multimodality image protocol for navigation-guided surgery of suspected low-grade gliomas.

    Science.gov (United States)

    Mert, Aygül; Kiesel, Barbara; Wöhrer, Adelheid; Martínez-Moreno, Mauricio; Minchev, Georgi; Furtner, Julia; Knosp, Engelbert; Wolfsberger, Stefan; Widhalm, Georg

    2015-01-01

    OBJECT Surgery of suspected low-grade gliomas (LGGs) poses a special challenge for neurosurgeons due to their diffusely infiltrative growth and histopathological heterogeneity. Consequently, neuronavigation with multimodality imaging data, such as structural and metabolic data, fiber tracking, and 3D brain visualization, has been proposed to optimize surgery. However, currently no standardized protocol has been established for multimodality imaging data in modern glioma surgery. The aim of this study was therefore to define a specific protocol for multimodality imaging and navigation for suspected LGG. METHODS Fifty-one patients who underwent surgery for a diffusely infiltrating glioma with nonsignificant contrast enhancement on MRI and available multimodality imaging data were included. In the first 40 patients with glioma, the authors retrospectively reviewed the imaging data, including structural MRI (contrast-enhanced T1-weighted, T2-weighted, and FLAIR sequences), metabolic images derived from PET, or MR spectroscopy chemical shift imaging, fiber tracking, and 3D brain surface/vessel visualization, to define standardized image settings and specific indications for each imaging modality. The feasibility and surgical relevance of this new protocol was subsequently prospectively investigated during surgery with the assistance of an advanced electromagnetic navigation system in the remaining 11 patients. Furthermore, specific surgical outcome parameters, including the extent of resection, histological analysis of the metabolic hotspot, presence of a new postoperative neurological deficit, and intraoperative accuracy of 3D brain visualization models, were assessed in each of these patients. RESULTS After reviewing these first 40 cases of glioma, the authors defined a specific protocol with standardized image settings and specific indications that allows for optimal and simultaneous visualization of structural and metabolic data, fiber tracking, and 3D brain

  4. Pygopagus Conjoined Twins: A Neurophysiologic Intraoperative Monitoring Schema.

    Science.gov (United States)

    Cromeens, Barrett P; McKinney, Jennifer L; Leonard, Jeffrey R; Governale, Lance S; Brown, Judy L; Henry, Christina M; Levitt, Marc A; Wood, Richard J; Besner, Gail E; Islam, Monica P

    2017-03-01

    Conjoined twins occur in up to 1 in 50,000 live births with approximately 18% joined in a pygopagus configuration at the buttocks. Twins with this configuration display symptoms and carry surgical risks during separation related to the extent of their connection which can include anorectal, genitourinary, vertebral, and neural structures. Neurophysiologic intraoperative monitoring for these cases has been discussed in the literature with variable utility. The authors present a case of pygopagus twins with fused spinal cords and imperforate anus where the use of neurophysiologic intraoperative monitoring significantly impacted surgical decision-making in division of these critical structures.

  5. Intraoperative ultrasound to facilitate removal of a submucosal foreign body.

    Science.gov (United States)

    Smith, Matthew E; Riffat, Faruque; Berman, Laurence H; Jani, Piyush

    2014-01-01

    A 61-year-old man with a history of fish bone ingestion and poorly localized symptoms was seen. His clinical examination was unremarkable, but CT demonstrated a foreign body deeply embedded within his tongue. Intraoperative ultrasound (US) guidance facilitated identification of a bone, allowing a needle to be placed as a guide to dissection. Repeat US scanning through the incision permitted precisely targeted surgery. CT and US are the most effective imaging techniques for localizing fish bones. Intraoperative US can be used to accurately locate a submucosal fish bone in mobile tissue such as the tongue, and focused, image-guided dissection can reduce surgical tissue trauma. © 2014 Wiley Periodicals, Inc.

  6. Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation

    Directory of Open Access Journals (Sweden)

    Terrence T. Kim

    2016-01-01

    Full Text Available We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy.

  7. Reading Multimodal Texts for Learning – a Model for Cultivating Multimodal Literacy

    Directory of Open Access Journals (Sweden)

    Kristina Danielsson

    2016-08-01

    Full Text Available The re-conceptualisation of texts over the last 20 years, as well as the development of a multimodal understanding of communication and representation of knowledge, has profound consequences for the reading and understanding of multimodal texts, not least in educational contexts. However, if teachers and students are given tools to “unwrap” multimodal texts, they can develop a deeper understanding of texts, information structures, and the textual organisation of knowledge. This article presents a model for working with multimodal texts in education with the intention to highlight mutual multimodal text analysis in relation to the subject content. Examples are taken from a Singaporean science textbook as well as a Chilean science textbook, in order to demonstrate that the framework is versatile and applicable across different cultural contexts. The model takes into account the following aspects of texts: the general structure, how different semiotic resources operate, the ways in which different resources are combined (including coherence, the use of figurative language, and explicit/implicit values. Since learning operates on different dimensions – such as social and affective dimensions besides the cognitive ones – our inclusion of figurative language and values as components for textual analysis is a contribution to multimodal text analysis for learning.

  8. Influence of Blood Contamination During Multimode Adhesive ...

    African Journals Online (AJOL)

    Objectives: The present study evaluated the effects of blood contamination performed at different steps of bonding on the microtensile bond strength (μTBS) of multimode adhesives to dentin when using the self-etch approach. Materials and Methods: Seventy-five molars were randomly assigned to three adhesive groups ...

  9. Multimodal representations in collaborative history learning

    NARCIS (Netherlands)

    Prangsma, M.E.

    2007-01-01

    This dissertation focuses on the question: How does making and connecting different types of multimodal representations affect the collaborative learning process and the acquisition of a chronological frame of reference in 12 to 14-year olds in pre vocational education? A chronological frame of

  10. A Multimodal Interaction Framework for Blended Learning

    DEFF Research Database (Denmark)

    Vidakis, Nikolaos; Kalafatis, Konstantinos; Triantafyllidis, Georgios

    2016-01-01

    Humans interact with each other by utilizing the five basic senses as input modalities, whereas sounds, gestures, facial expressions etc. are utilized as output modalities. Multimodal interaction is also used between humans and their surrounding environment, although enhanced with further senses ...... framework enabling deployment of a vast variety of modalities, tailored appropriately for use in blended learning environment....

  11. Multimodal Student Interaction Online: An Ecological Perspective

    Science.gov (United States)

    Berglund, Therese Ornberg

    2009-01-01

    This article describes the influence of tool and task design on student interaction in language learning at a distance. Interaction in a multimodal desktop video conferencing environment, FlashMeeting, is analyzed from an ecological perspective with two main foci: participation rates and conversational feedback strategies. The quantitative…

  12. Multimodal Dialogue Management - State of the art

    NARCIS (Netherlands)

    Bui Huu Trung, B.H.T.

    This report is about the state of the art in dialogue management. We first introduce an overview of a multimodal dialogue system and its components. Second, four main approaches to dialogue management are described (finite-state and frame-based, information-state based and probabilistic, plan-based,

  13. Multimode waveguide speckle patterns for compressive sensing.

    Science.gov (United States)

    Valley, George C; Sefler, George A; Justin Shaw, T

    2016-06-01

    Compressive sensing (CS) of sparse gigahertz-band RF signals using microwave photonics may achieve better performances with smaller size, weight, and power than electronic CS or conventional Nyquist rate sampling. The critical element in a CS system is the device that produces the CS measurement matrix (MM). We show that passive speckle patterns in multimode waveguides potentially provide excellent MMs for CS. We measure and calculate the MM for a multimode fiber and perform simulations using this MM in a CS system. We show that the speckle MM exhibits the sharp phase transition and coherence properties needed for CS and that these properties are similar to those of a sub-Gaussian MM with the same mean and standard deviation. We calculate the MM for a multimode planar waveguide and find dimensions of the planar guide that give a speckle MM with a performance similar to that of the multimode fiber. The CS simulations show that all measured and calculated speckle MMs exhibit a robust performance with equal amplitude signals that are sparse in time, in frequency, and in wavelets (Haar wavelet transform). The planar waveguide results indicate a path to a microwave photonic integrated circuit for measuring sparse gigahertz-band RF signals using CS.

  14. Single versus multimodality training basic laparoscopic skills

    NARCIS (Netherlands)

    Brinkman, W.M.; Havermans, S.Y.; Buzink, S.N.; Botden, S.M.B.I.; Jakimowicz, J.J.; Schoot, B.C.

    2012-01-01

    Introduction - Even though literature provides compelling evidence of the value of simulators for training of basic laparoscopic skills, the best way to incorporate them into a surgical curriculum is unclear. This study compares the training outcome of single modality training with multimodality

  15. New two-port multimode interference reflectors

    NARCIS (Netherlands)

    Kleijn, E.; Smit, M.K.; Wale, M.J.; Leijtens, X.J.M.

    2012-01-01

    Multi-mode interference reflectors (MIRs) are versatile components. Two new MIR designs with a fixed 50/50 reflection to transmission ratio are introduced. Measurements on these new devices and on devices similar to those in [1] are presented and compared to the design values. Measured losses are

  16. Scenemash: multimodal route summarization for city exploration

    NARCIS (Netherlands)

    Berg, J. van den; Rudinac, S.; Worring, M.

    2016-01-01

    The potential of mining tourist information from social multimedia data gives rise to new applications offering much richer impressions of the city. In this paper we propose Scenemash, a system that generates multimodal summaries of multiple alternative routes between locations in a city. To get

  17. Naming Block Structures: A Multimodal Approach

    Science.gov (United States)

    Cohen, Lynn; Uhry, Joanna

    2011-01-01

    This study describes symbolic representation in block play in a culturally diverse suburban preschool classroom. Block play is "multimodal" and can allow children to experiment with materials to represent the world in many forms of literacy. Combined qualitative and quantitative data from seventy-seven block structures were collected and analyzed.…

  18. Academic Knowledge Construction and Multimodal Curriculum Development

    Science.gov (United States)

    Loveless, Douglas J., Ed.; Griffith, Bryant, Ed.; Bérci, Margaret E., Ed.; Ortlieb, Evan, Ed.; Sullivan, Pamela, Ed.

    2014-01-01

    While incorporating digital technologies into the classroom has offered new ways of teaching and learning into educational processes, it is essential to take a look at how the digital shift impacts teachers, school administration, and curriculum development. "Academic Knowledge Construction and Multimodal Curriculum Development" presents…

  19. Perils of intraoperative neurophysiological monitoring: analysis of "false-negative" results in spine surgeries.

    Science.gov (United States)

    Tamkus, Arvydas A; Rice, Kent S; McCaffrey, Michael T

    2018-02-01

    Although some authors have published case reports describing false negatives in intraoperative neurophysiological monitoring (IONM), a systematic review of causes of false-negative IONM results is lacking. The objective of this study was to analyze false-negative IONM findings in spine surgery. This is a retrospective cohort analysis. A cohort of 109 patients with new postoperative neurologic deficits was analyzed for possible false-negative IONM reporting. The causes of false-negative IONM reporting were determined. From a cohort of 62,038 monitored spine surgeries, 109 consecutive patients with new postoperative neurologic deficits were reviewed for IONM alarms. Intraoperative neurophysiological monitoring alarms occurred in 87 of 109 surgeries. Nineteen patients with new postoperative neurologic deficits did not have an IONM alarm and surgeons were not warned. In addition, three patients had no interpretable IONM baseline data and no alarms were possible for the duration of the surgery. Therefore, 22 patients were included in the study. The absence of IONM alarms during these 22 surgeries had different origins: "true" false negatives where no waveform changes meeting the alarm criteria occurred despite the appropriate IONM (7); a postoperative development of a deficit (6); failure to monitor the pathway, which became injured (5); the absence of interpretable IONM baseline data which precluded any alarm (3); and technical IONM application issues (1). Overall, the rate of IONM method failing to predict the patient's outcome was very low (0.04%, 22/62,038). Minimizing false negatives requires the application of a proper IONM technique with the limitations of each modality considered in their selection and interpretation. Multimodality IONM provides the most inclusive information, and although it might be impractical to monitor every neural structure that can be at risk, a thorough preoperative consideration of available IONM modalities is important. Delayed

  20. Intravenous dexmedetomidine infusion in adult patients undergoing open nephrolithotomy: Effects on intraoperative hemodynamics and blood loss; a random

    Directory of Open Access Journals (Sweden)

    Doaa A. Rashwan

    2015-10-01

    Conclusion: Dexmedetomidine infusion in patients undergoing open nephrolithotomy under general anesthesia was associated with intraoperative hemodynamic stability, which decreases intraoperative blood loss and the need for intraoperative blood transfusion.

  1. Facilitating Multiple Intelligences Through Multimodal Learning Analytics

    Directory of Open Access Journals (Sweden)

    Ayesha PERVEEN

    2018-01-01

    Full Text Available This paper develops a theoretical framework for employing learning analytics in online education to trace multiple learning variations of online students by considering their potential of being multiple intelligences based on Howard Gardner’s 1983 theory of multiple intelligences. The study first emphasizes the need to facilitate students as multiple intelligences by online education systems and then suggests a framework of the advanced form of learning analytics i.e., multimodal learning analytics for tracing and facilitating multiple intelligences while they are engaged in online ubiquitous learning. As multimodal learning analytics is still an evolving area, it poses many challenges for technologists, educationists as well as organizational managers. Learning analytics make machines meet humans, therefore, the educationists with an expertise in learning theories can help technologists devise latest technological methods for multimodal learning analytics and organizational managers can implement them for the improvement of online education. Therefore, a careful instructional design based on a deep understanding of students’ learning abilities, is required to develop teaching plans and technological possibilities for monitoring students’ learning paths. This is how learning analytics can help design an adaptive instructional design based on a quick analysis of the data gathered. Based on that analysis, the academicians can critically reflect upon the quick or delayed implementation of the existing instructional design based on students’ cognitive abilities or even about the single or double loop learning design. The researcher concludes that the online education is multimodal in nature, has the capacity to endorse multiliteracies and, therefore, multiple intelligences can be tracked and facilitated through multimodal learning analytics in an online mode. However, online teachers’ training both in technological implementations and

  2. Effects of intraoperative irradiation and intraoperative hyperthermia on canine sciatic nerve: neurologic and electrophysiologic study

    International Nuclear Information System (INIS)

    Vujaskovic, Zeljko; Gillette, Sharon M.; Powers, Barbara E.; Stukel, Therese A.; LaRue, Susan M.; Gillette, Edward L.; Borak, Thomas B.; Scott, Robert J.; Weiss, Julia; Colacchio, Thomas A.

    1996-01-01

    Purpose: Late radiation injury to peripheral nerve may be the limiting factor in the clinical application of intraoperative radiation therapy (IORT). The combination of IORT with intraoperative hyperthermia (IOHT) raises specific concerns regarding the effects on certain normal tissues such as peripheral nerve, which might be included in the treatment field. The objective of this study was to compare the effect of IORT alone to the effect of IORT combined with IOHT on peripheral nerve in normal beagle dogs. Methods and Materials: Young adult beagle dogs were randomized into five groups of three to five dogs each to receive IORT doses of 16, 20, 24, 28, or 32 Gy to 5 cm of surgically exposed right sciatic nerve using 6 MeV electrons and six groups of four to five dogs each received IORT doses of 0, 12, 16, 20, 24, or 28 Gy simultaneously with 44 deg. C of IOHT for 60 min. IOHT was performed using a water circulating hyperthermia device with a multichannel thermometry system on the surgically exposed sciatic nerve. Neurologic and electrophysiologic examinations were done before and monthly after treatment for 24 months. Electrophysiologic studies included electromyographic (EMG) examinations of motor function, as well as motor nerve conduction velocities studies. Results: Two years after treatment, the effective dose for 50% complication (ED 50 ) for limb paresis in dogs exposed to IORT only was 22 Gy. The ED 50 for paresis in dogs exposed to IORT combined with IOHT was 15 Gy. The thermal enhancement ratio (TER) was 1.5. Electrophysiologic studies showed more prominent changes such as EMG abnormalities, decrease in conduction velocity and amplitude of the action potential, and complete conduction block in dogs that received the combination of IORT and IOHT. The latency to development of peripheral neuropathies was shorter for dogs exposed to the combined treatment. Conclusion: The probability of developing peripheral neuropathies in a large animal model was higher

  3. The effect of preoperative Lugol's iodine on intraoperative bleeding in patients with hyperthyroidism

    Directory of Open Access Journals (Sweden)

    Yeliz Yilmaz

    2016-08-01

    Conclusion: Preoperative Lugol solution treatment was found to be a significant independent determinant of intraoperative blood loss. Moreover, preoperative Lugol solution treatment decreased the rate of blood flow, and intraoperative blood loss during thyroidectomy.

  4. INTRAOPERATIVE IRRADIATION OF THE CANINE PANCREAS - SHORT-TERM EFFECTS

    NARCIS (Netherlands)

    HEIJMANS, HJ; MEHTA, DM; KLEIBEUKER, JH; SLUITER, WJ; OLDHOFF, J; HOEKSTRA, HJ

    1993-01-01

    Intraoperative electron beam radiotherapy (IORT) is clinically used as a potential adjunctive treatment to surgery of locally advanced pancreatic and gastric cancer. The tolerance of the pancreas to IORT was studied in 15 adult beagles, divided in 3 groups of 5 beagles in which 25, 30 or 35 Gy IORT

  5. Intraoperative cell salvage in South Africa: Feasible, beneficial and ...

    African Journals Online (AJOL)

    More than one CS blood unit was available for transfusion in 66% of cases. No additional staff were required to operate the Cell Saver, which was successfully used by medical officers. Conclusions. This study showed that intraoperative CS use is feasible, has potential patient benefit by reducing blood bank blood ...

  6. Intraoperative Death During Cervical Spinal Surgery: A Retrospective Multicenter Study.

    Science.gov (United States)

    Wang, Jeffrey C; Buser, Zorica; Fish, David E; Lord, Elizabeth L; Roe, Allison K; Chatterjee, Dhananjay; Gee, Erica L; Mayer, Erik N; Yanez, Marisa Y; McBride, Owen J; Cha, Peter I; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    A retrospective multicenter study. Routine cervical spine surgeries are typically associated with low complication rates, but serious complications can occur. Intraoperative death is a very rare complication and there is no literature on its incidence. The purpose of this study was to determine the intraoperative mortality rates and associated risk factors in patients undergoing cervical spine surgery. Twenty-one surgical centers from the AOSpine North America Clinical Research Network participated in the study. Medical records of patients who received cervical spine surgery from January 1, 2005, to December 31, 2011, were reviewed to identify occurrence of intraoperative death. A total of 258 patients across 21 centers met the inclusion criteria. Most of the surgeries were done using the anterior approach (53.9%), followed by posterior (39.1%) and circumferential (7%). Average patient age was 57.1 ± 13.2 years, and there were more male patients (54.7% male and 45.3% female). There was no case of intraoperative death. Death during cervical spine surgery is a very rare complication. In our multicenter study, there was a 0% mortality rate. Using an adequate surgical approach for patient diagnosis and comorbidities may be the reason how the occurrence of this catastrophic adverse event was prevented in our patient population.

  7. Intraoperative colonic irrigation in the management of left sided ...

    African Journals Online (AJOL)

    Objectives: To evaluate the safety and benefits of antegrade intraoperative colonic irrigation (lavage) and primary anastomosis, after colonic resection, in the treatment of left sided large bowel emergencies. Design: A prospective descriptive study. Setting: Jos University Teaching Hospital, Jos, Nigeria. Participants: Thirty ...

  8. Fusion of intraoperative force sensoring, surface reconstruction and biomechanical modeling

    Science.gov (United States)

    Röhl, S.; Bodenstedt, S.; Küderle, C.; Suwelack, S.; Kenngott, H.; Müller-Stich, B. P.; Dillmann, R.; Speidel, S.

    2012-02-01

    Minimally invasive surgery is medically complex and can heavily benefit from computer assistance. One way to help the surgeon is to integrate preoperative planning data into the surgical workflow. This information can be represented as a customized preoperative model of the surgical site. To use it intraoperatively, it has to be updated during the intervention due to the constantly changing environment. Hence, intraoperative sensor data has to be acquired and registered with the preoperative model. Haptic information which could complement the visual sensor data is still not established. In addition, biomechanical modeling of the surgical site can help in reflecting the changes which cannot be captured by intraoperative sensors. We present a setting where a force sensor is integrated into a laparoscopic instrument. In a test scenario using a silicone liver phantom, we register the measured forces with a reconstructed surface model from stereo endoscopic images and a finite element model. The endoscope, the instrument and the liver phantom are tracked with a Polaris optical tracking system. By fusing this information, we can transfer the deformation onto the finite element model. The purpose of this setting is to demonstrate the principles needed and the methods developed for intraoperative sensor data fusion. One emphasis lies on the calibration of the force sensor with the instrument and first experiments with soft tissue. We also present our solution and first results concerning the integration of the force sensor as well as accuracy to the fusion of force measurements, surface reconstruction and biomechanical modeling.

  9. Pre- and intraoperative volume determination of craniopharyngioma cysts

    Energy Technology Data Exchange (ETDEWEB)

    Georgi, P.; Strauss, L.; Sturm, V.; Ostertag, H.; Sinn, H.; Rommel, T.

    1980-08-01

    Exact cystic volume measurement is a prerequisite to proper /sup 90/Y dosage in the therapy of intracavitary monocystic craniopharyngiomas. The method of intraoperative volume measurement by a radionuclide dilution technique is compared to results abtained by preoperative using computer tomography. Both methods gave congruous results. It is pointed out that gamma camera scintigrams are essential for the early detection of complications.

  10. Appropriateness of Intra-Operative Blood Transfusion In Children at ...

    African Journals Online (AJOL)

    Background: The decision to transfuse intra-operatively is based on preoperative haemoglobin (Hb), estimated blood loss and physiological variables. The visual estimate of blood loss is notoriously unreliable especially with small volumes of blood losses in children. Objectives :We sought therefore to determine the ...

  11. The diagnostic dilemma of intraoperative hyperpyrexia in a malaria ...

    African Journals Online (AJOL)

    Keywords: Intraoperative fever, Malaria, Malignant hyperthermia. ... paludisme devront être examiné et soigné de paludisme s'il est indiqué d'une manière préopératoire même s'il est ... West African Journal of Medicine Vol.22(1) 2003: 98-100 ...

  12. Video-rate optical flow corrected intraoperative functional fluorescence imaging

    NARCIS (Netherlands)

    Koch, Maximilian; Glatz, Juergen; Ermolayev, Vladimir; de Vries, Elisabeth G. E.; van Dam, Gooitzen M.; Englmeier, Karl-Hans; Ntziachristos, Vasilis

    Intraoperative fluorescence molecular imaging based on targeted fluorescence agents is an emerging approach to improve surgical and endoscopic imaging and guidance. Short exposure times per frame and implementation at video rates are necessary to provide continuous feedback to the physician and

  13. Intraoperative seizures and seizures outcome in patients underwent awake craniotomy.

    Science.gov (United States)

    Yuan, Yang; Peizhi, Zhou; Xiang, Wang; Yanhui, Liu; Ruofei, Liang; Shu, Jiang; Qing, Mao

    2016-11-25

    Awake craniotomies (AC) could reduce neurological deficits compared with patients under general anesthesia, however, intraoperative seizure is a major reason causing awake surgery failure. The purpose of the study was to give a comprehensive overview the published articles focused on seizure incidence in awake craniotomy. Bibliographic searches of the EMBASE, MEDLINE,were performed to identify articles and conference abstracts that investigated the intraoperative seizure frequency of patients underwent AC. Twenty-five studies were included in this meta-analysis. Among the 25 included studies, one was randomized controlled trials and 5 of them were comparable studies. The pooled data suggested the general intraoperative seizure(IOS) rate for patients with AC was 8%(fixed effect model), sub-group analysis identified IOS rate for glioma patients was 8% and low grade patients was 10%. The pooled data showed early seizure rates of AC patients was 11% and late seizure rates was 35%. This systematic review and meta-analysis shows that awake craniotomy is a safe technique with relatively low intraoperative seizure occurrence. However, few RCTs were available, and the acquisition of further evidence through high-quality RCTs is highly recommended.

  14. Intraoperative glucose management in children < 1 year or < 10 kg ...

    African Journals Online (AJOL)

    The intraoperative management of intravenous dextrose administration and blood glucose monitoring was at the discretion of the attending anaesthetists. Data collected included patient demographics, period of starvation, dose of dextrose administered and blood glucose measurements taken. Results: Nine infants had at ...

  15. Intraoperative Deaths at Ahmadu Bello University Teaching Hospital ...

    African Journals Online (AJOL)

    Nine cases of intraoperative deaths were recorded. Most of the deaths occurred among the gravely ill, inadequately prepared patients and patients whose operations were done in the late hours of the night. Conclusion: This tragedy is preventable by paying meticulous attention to details and careful patient selection and ...

  16. Comparative Study Of Intra-Operative Pelvimetry With Calipers And ...

    African Journals Online (AJOL)

    The pelvic measurement of patients who have had a caesarean section was done using Pelvic Calipers (intra-operative) and x-ray methods. In the former method, during Caesarean sections and after closure of the lower uterine segment incision, a pair of pelvic calipers was used to measure the true conjugate of the pelvis.

  17. Intra-operative parathyroid hormone measurements – experience of ...

    African Journals Online (AJOL)

    Background. Surgery is the treatment of choice for symptomatic primary hyperparathyroidism. The majority of research concerning intra-operative parathyroid hormone (ioPTH) measurements is conducted in university hospitals. Whether ioPTH measurements are feasible and useful in predicting the presence of remaining ...

  18. Physics-based shape matching for intraoperative image guidance

    Energy Technology Data Exchange (ETDEWEB)

    Suwelack, Stefan, E-mail: suwelack@kit.edu; Röhl, Sebastian; Bodenstedt, Sebastian; Reichard, Daniel; Dillmann, Rüdiger; Speidel, Stefanie [Institute for Anthropomatics and Robotics, Karlsruhe Institute of Technology, Adenauerring 2, Karlsruhe 76131 (Germany); Santos, Thiago dos; Maier-Hein, Lena [Computer-assisted Interventions, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120 (Germany); Wagner, Martin; Wünscher, Josephine; Kenngott, Hannes; Müller, Beat P. [General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, Heidelberg 69120 (Germany)

    2014-11-01

    Purpose: Soft-tissue deformations can severely degrade the validity of preoperative planning data during computer assisted interventions. Intraoperative imaging such as stereo endoscopic, time-of-flight or, laser range scanner data can be used to compensate these movements. In this context, the intraoperative surface has to be matched to the preoperative model. The shape matching is especially challenging in the intraoperative setting due to noisy sensor data, only partially visible surfaces, ambiguous shape descriptors, and real-time requirements. Methods: A novel physics-based shape matching (PBSM) approach to register intraoperatively acquired surface meshes to preoperative planning data is proposed. The key idea of the method is to describe the nonrigid registration process as an electrostatic–elastic problem, where an elastic body (preoperative model) that is electrically charged slides into an oppositely charged rigid shape (intraoperative surface). It is shown that the corresponding energy functional can be efficiently solved using the finite element (FE) method. It is also demonstrated how PBSM can be combined with rigid registration schemes for robust nonrigid registration of arbitrarily aligned surfaces. Furthermore, it is shown how the approach can be combined with landmark based methods and outline its application to image guidance in laparoscopic interventions. Results: A profound analysis of the PBSM scheme based on in silico and phantom data is presented. Simulation studies on several liver models show that the approach is robust to the initial rigid registration and to parameter variations. The studies also reveal that the method achieves submillimeter registration accuracy (mean error between 0.32 and 0.46 mm). An unoptimized, single core implementation of the approach achieves near real-time performance (2 TPS, 7–19 s total registration time). It outperforms established methods in terms of speed and accuracy. Furthermore, it is shown that the

  19. Lumbar Lordosis of Spinal Stenosis Patients during Intraoperative Prone Positioning

    Science.gov (United States)

    Lee, Su-Keon; Song, Kyung-Sub; Park, Byung-Moon; Lim, Sang-Youn; Jang, Geun; Lee, Beom-Seok; Moon, Seong-Hwan; Lee, Hwan-Mo

    2016-01-01

    Background To evaluate the effect of spondylolisthesis on lumbar lordosis on the OSI (Jackson; Orthopaedic Systems Inc.) frame. Restoration of lumbar lordosis is important for maintaining sagittal balance. Physiologic lumbar lordosis has to be gained by intraoperative prone positioning with a hip extension and posterior instrumentation technique. There are some debates about changing lumbar lordosis on the OSI frame after an intraoperative prone position. We evaluated the effect of spondylolisthesis on lumbar lordosis after an intraoperative prone position. Methods Sixty-seven patients, who underwent spinal fusion at the Department of Orthopaedic Surgery of Gwangmyeong Sungae Hospital between May 2007 and February 2012, were included in this study. The study compared lumbar lordosis on preoperative upright, intraoperative prone and postoperative upright lateral X-rays between the simple stenosis (SS) group and spondylolisthesis group. The average age of patients was 67.86 years old. The average preoperative lordosis was 43.5° (± 14.9°), average intraoperative lordosis was 48.8° (± 13.2°), average postoperative lordosis was 46.5° (± 16.1°) and the average change on the frame was 5.3° (± 10.6°). Results Among all patients, 24 patients were diagnosed with simple spinal stenosis, 43 patients with spondylolisthesis (29 degenerative spondylolisthesis and 14 isthmic spondylolisthesis). Between the SS group and spondylolisthesis group, preoperative lordosis, intraoperative lordosis and postoperative lordosis were significantly larger in the spondylolisthesis group. The ratio of patients with increased lordosis on the OSI frame compared to preoperative lordosis was significantly higher in the spondylolisthesis group. The risk of increased lordosis on frame was significantly higher in the spondylolisthesis group (odds ratio, 3.325; 95% confidence interval, 1.101 to 10.039; p = 0.033). Conclusions Intraoperative lumbar lordosis on the OSI frame with a prone

  20. Categorization of intraoperative ureteroscopy complications using modified Satava classification system.

    Science.gov (United States)

    Tepeler, Abdulkadir; Resorlu, Berkan; Sahin, Tolga; Sarikaya, Selcuk; Bayindir, Mirze; Oguz, Ural; Armagan, Abdullah; Unsal, Ali

    2014-02-01

    To review our experience with ureteroscopy (URS) in the treatment of ureteral calculi and stratify intraoperative complications of URS according to the modified Satava classification system. We performed a retrospective analysis of 1,208 patients (672 males and 536 females), with a mean age of 43.1 years (range 1-78), who underwent ureteroscopic procedures for removal of ureteral stones. Intraoperative complications were recorded according to modified Satava classification system. Grade 1 complications included incidents without consequences for the patient; grade 2 complications, which are treated intraoperatively with endoscopic surgery (grade 2a) or required endoscopic re-treatment (grade 2b); and grade 3 complications included incidents requiring open or laparoscopic surgery. The stones were completely removed in 1,067 (88.3%) patients after primary procedure by either simple extraction or after fragmentation. The overall incidence of intraoperative complications was 12.6%. The most common complications were proximal stone migration (3.9%), mucosal injury (2.8%), bleeding (1.9%), inability to reach stone (1.8%), malfunctioning or breakage of instruments (0.8%), ureteral perforation (0.8%) and ureteral avulsion (0.16%). According to modified Satava classification system, there were 4.5% grade 1; 4.4% grade 2a; 3.2% grade 2b; and 0.57% grade 3 complications. We think that modified Satava classification is a quick and simple system for describing the severity of intraoperative URS complications and this grading system will facilitate a better comparison for the surgical outcomes obtained from different centers.

  1. Intraoperative and Early Postoperative Complications of Manual Sutureless Cataract Extraction

    International Nuclear Information System (INIS)

    Iqbal, Y.; Zia, S.; Mirza, A. B.

    2014-01-01

    Objective: To determine the intraoperative and early postoperative complications of manual sutureless cataract extraction. Study Design: Case series. Place and Duration of Study: Redo Eye Hospital, Rawalpindi, Pakistan, from January 2009 to December 2010. Methodology: Three hundred patients of cataract through purposive non-probability sampling were selected. The patients underwent manual sutureless cataract surgery (MSCS) by single experienced surgeon and intraoperative complications were documented. The surgical technique was modified to deal with any intraoperative complications accordingly. Patients were examined on the first postoperative day and on the first postoperative week for any postoperative complications. The data was entered in Statistical Package for Social Sciences (SPSS) version 13.0 and the results were calculated in frequencies. Results: Among the 300 cases, 81.3% surgeries went uneventful whereas 18.6% had some complication. The common intraoperative complications were superior button-hole formation in 5%; posterior capsular rent in 5% and premature entry with iris prolapse in 3% cases. Postoperatively, the commonly encountered complications were striate keratopathy in 9.6% and hyphema 9%. At first week follow-up, 4% had striate keratopathy and 0.6% had hyphema. Striate keratopathy resolved with topical medication on subsequent follow-up. A total of 9 cases (3%) underwent second surgery: 2 cases for lens matter wash, 2 cases for hyphema and 5 cases needed suturing of wound for shallow anterior chamber due to wound leak. Conclusion: Superior button-hole formation, posterior capsular rent and premature entry were the common intraoperative complications of MSCS whereas the common early postoperative complications were striate keratopathy and hyphema. (author)

  2. Effects of intraoperative irradiation (IORT) and intraoperative hyperthermia (IOHT) on canine sciatic nerve : Histopathological and morphometric studies

    NARCIS (Netherlands)

    Vujaskovic, Z; Powers, BE; Paardekoper, G; Gillette, SM; Gillette, EL; Colacchio, TA

    1999-01-01

    Purpose/Objective: Peripheral neuropathies have emerged as the major dose-limiting complication reported after intraoperative radiation therapy (IORT). The combination of IORT with hyperthermia may further increase the risk of peripheral nerve injury. The objective of this study was to evaluate

  3. Multimodal mechanisms of food creaminess sensation.

    Science.gov (United States)

    Chen, Jianshe; Eaton, Louise

    2012-12-01

    In this work, the sensory creaminess of a set of four viscosity-matched fluid foods (single cream, evaporated milk, corn starch solution, and corn starch solution containing long chain free fatty acids) was tested by a panel of 16 assessors via controlled sensation mechanisms of smell only, taste only, taste and tactile, and integrated multimodal. It was found that all sensation channels were able to discriminate between creamy and non-creamy foods, but only the multimodal method gave creaminess ratings in agreement with the samples' fat content. Results from this study show that the presence of long chain free fatty acids has no influence on creaminess perception. It is certain that food creaminess is not a primary sensory property but an integrated sensory perception (or sensory experience) derived from combined sensations of visual, olfactory, gustatory, and tactile cues. Creamy colour, milky flavour, and smooth texture are probably the most important sensory features of food creaminess.

  4. Multimodal location estimation of videos and images

    CERN Document Server

    Friedland, Gerald

    2015-01-01

    This book presents an overview of the field of multimodal location estimation, i.e. using acoustic, visual, and/or textual cues to estimate the shown location of a video recording. The authors' sample research results in this field in a unified way integrating research work on this topic that focuses on different modalities, viewpoints, and applications. The book describes fundamental methods of acoustic, visual, textual, social graph, and metadata processing as well as multimodal integration methods used for location estimation. In addition, the text covers benchmark metrics and explores the limits of the technology based on a human baseline. ·         Discusses localization of multimedia data; ·         Examines fundamental methods of establishing location metadata for images and videos (other than GPS tagging); ·         Covers Data-Driven as well as Semantic Location Estimation.

  5. Multimodality imaging of the postoperative shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Woertler, Klaus [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany)

    2007-12-15

    Multimodality imaging of the postoperative shoulder includes radiography, magnetic resonance (MR) imaging, MR arthrography, computed tomography (CT), CT arthrography, and ultrasound. Target-oriented evaluation of the postoperative shoulder necessitates familiarity with surgical techniques, their typical complications and sources of failure, knowledge of normal and abnormal postoperative findings, awareness of the advantages and weaknesses with the different radiologic techniques, and clinical information on current symptoms and function. This article reviews the most commonly used surgical procedures for treatment of anterior glenohumeral instability, lesions of the labral-bicipital complex, subacromial impingement, and rotator cuff lesions and highlights the significance of imaging findings with a view to detection of recurrent lesions and postoperative complications in a multimodality approach. (orig.)

  6. Multimodal interaction in image and video applications

    CERN Document Server

    Sappa, Angel D

    2013-01-01

    Traditional Pattern Recognition (PR) and Computer Vision (CV) technologies have mainly focused on full automation, even though full automation often proves elusive or unnatural in many applications, where the technology is expected to assist rather than replace the human agents. However, not all the problems can be automatically solved being the human interaction the only way to tackle those applications. Recently, multimodal human interaction has become an important field of increasing interest in the research community. Advanced man-machine interfaces with high cognitive capabilities are a hot research topic that aims at solving challenging problems in image and video applications. Actually, the idea of computer interactive systems was already proposed on the early stages of computer science. Nowadays, the ubiquity of image sensors together with the ever-increasing computing performance has open new and challenging opportunities for research in multimodal human interaction. This book aims to show how existi...

  7. Semiconductor laser using multimode interference principle

    Science.gov (United States)

    Gong, Zisu; Yin, Rui; Ji, Wei; Wu, Chonghao

    2018-01-01

    Multimode interference (MMI) structure is introduced in semiconductor laser used in optical communication system to realize higher power and better temperature tolerance. Using beam propagation method (BPM), Multimode interference laser diode (MMI-LD) is designed and fabricated in InGaAsP/InP based material. As a comparison, conventional semiconductor laser using straight single-mode waveguide is also fabricated in the same wafer. With a low injection current (about 230 mA), the output power of the implemented MMI-LD is up to 2.296 mW which is about four times higher than the output power of the conventional semiconductor laser. The implemented MMI-LD exhibits stable output operating at the wavelength of 1.52 μm and better temperature tolerance when the temperature varies from 283.15 K to 293.15 K.

  8. Multimodality therapy of local regional esophageal cancer.

    Science.gov (United States)

    Kelsen, David P

    2005-12-01

    Recent trials regarding the use of multimodality therapy for patients with cancers of the esophagus and gastroesophageal junction have not conclusively shown benefit. Regimens containing cisplatin and fluorouracil administered preoperatively appear to be tolerable and do not increase operative morbidity or mortality when compared with surgery alone. Yet clinical trials have not clearly shown that such regimens improve outcome as measured by survival. Likewise, trials of postoperative chemoradiation have not reported a significant improvement in median or overall survival. The reasons for the lack of clinical benefit from multimodality therapy are not completely understood, but improvements in systemic therapy will probably be necessary before disease-free or overall survival improves substantially. Some new single agents such as the taxanes (docetaxel or paclitaxel) and the camptothecan analog irinotecan have shown modest activity for palliative therapy.

  9. Pattern recognition of neurotransmitters using multimode sensing.

    Science.gov (United States)

    Stefan-van Staden, Raluca-Ioana; Moldoveanu, Iuliana; van Staden, Jacobus Frederick

    2014-05-30

    Pattern recognition is essential in chemical analysis of biological fluids. Reliable and sensitive methods for neurotransmitters analysis are needed. Therefore, we developed for pattern recognition of neurotransmitters: dopamine, epinephrine, norepinephrine a method based on multimode sensing. Multimode sensing was performed using microsensors based on diamond paste modified with 5,10,15,20-tetraphenyl-21H,23H-porphyrine, hemin and protoporphyrin IX in stochastic and differential pulse voltammetry modes. Optimized working conditions: phosphate buffer solution of pH 3.01 and KCl 0.1mol/L (as electrolyte support), were determined using cyclic voltammetry and used in all measurements. The lowest limits of quantification were: 10(-10)mol/L for dopamine and epinephrine, and 10(-11)mol/L for norepinephrine. The multimode microsensors were selective over ascorbic and uric acids and the method facilitated reliable assay of neurotransmitters in urine samples, and therefore, the pattern recognition showed high reliability (RSDneurotransmitters on biological fluids at a lower determination level than chromatographic methods. The sampling of the biological fluids referees only to the buffering (1:1, v/v) with a phosphate buffer pH 3.01, while for chromatographic methods the sampling is laborious. Accordingly with the statistic evaluation of the results at 99.00% confidence level, both modes can be used for pattern recognition and quantification of neurotransmitters with high reliability. The best multimode microsensor was the one based on diamond paste modified with protoporphyrin IX. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. The multimodal treatment of eating disorders

    OpenAIRE

    HALMI, KATHERINE A.

    2005-01-01

    The treatment of eating disorders is based on a multimodal model, recognizing that these disorders do not have a single cause or a predictable course. The treatment strategy is determined by the severity of illness and the specific eating disorder diagnosis. For the treatment of anorexia nervosa, the key elements are medical management, behavioral therapy, cognitive therapy and family therapy, while pharmacotherapy is at best an adjunct to other therapies. In bulimia nervosa...

  11. A Multimodal Robot Game for Seniors

    DEFF Research Database (Denmark)

    Hansen, Søren Tranberg; Krogsager, Anders; Fredslund, Jakob

    2017-01-01

    This paper describes the initial findings of a multimodal game which has been implemented on a humanoid robot platform and tested with seniors suffering from dementia. Physical and cognitive activities can improve the overall wellbeing of seniors, but it is often difficult to motivate seniors...... feedback and includes animated gestures and sounds. The game has been tested in a nursing home with four seniors suffering from moderate to severe dementia....

  12. Speech Perception as a Multimodal Phenomenon

    OpenAIRE

    Rosenblum, Lawrence D.

    2008-01-01

    Speech perception is inherently multimodal. Visual speech (lip-reading) information is used by all perceivers and readily integrates with auditory speech. Imaging research suggests that the brain treats auditory and visual speech similarly. These findings have led some researchers to consider that speech perception works by extracting amodal information that takes the same form across modalities. From this perspective, speech integration is a property of the input information itself. Amodal s...

  13. Learning new skills in Multimodal Enactive Environments

    Directory of Open Access Journals (Sweden)

    Bardy Benoît G.

    2011-12-01

    Full Text Available A European consortium of researchers in movement and cognitive sciences, robotics, and interaction design developed multimodal technologies to accelerate and transfer the (relearning of complex skills from virtual to real environments. The decomposition of skill into functional elements — the subskills — and the enactment of informational variables used as accelerators are here described. One illustration of accelerator using virtual reality in team rowing is described.

  14. Frequency tripling with multimode-lasers

    International Nuclear Information System (INIS)

    Langer, H.; Roehr, H.; Wrobel, W.G.

    1978-10-01

    The presence of different modes with random phases in a laser beam leads to fluctuations in nonlinear optical interactions. This paper describes the influence of the linewidth of a dye laser on the generation of intensive Lyman-alpha radiation by frequency tripling. Using this Lyman-alpha source for resonance scattering on strongly doppler-broadened lines in fusion plasmas the detection limit of neutral hydrogen is nearly two orders higher with the multimode than the singlemode dye laser. (orig.) [de

  15. Digital Storytelling and Multimodal Literacy in Education

    OpenAIRE

    Gregori-Signes, Carmen

    2014-01-01

    This article argues in favour of using digital storytelling to encourage a critical socio-educational focus in education and include multimodal explicit teaching in the curriculum.The analysis of fifty digital stories indicates that the students developed a certain awareness of the issue chosen for their story (e.g. violence, racism, war) since the final product transmits a critical perspective on the topic itself. Further work, however, needs to be invested in the development of the digital ...

  16. Intraoperative and external beam radiotherapy for pancreatic carcinoma; Intraoperative und perkutane Radiotherapie des Pankreaskarzinoms

    Energy Technology Data Exchange (ETDEWEB)

    Eble, M.J. [Abt. Klinische Radiologie, Radiologische Universitaetsklinik Heidelberg (Germany); Maurer, U. [Klinikum der Stadt Mannheim (Germany). Inst. fuer Radiologie

    1996-05-01

    Therapeutic strategies in the treatment of pancreatic carcinoma are based on the high number of non-resectable cancers, the high relative radioresistance and the high distant metastases rate. Even in curatively resected carcinomas, a locally effective treatment modality is needed because of the risk of microscopical residual disease in the peripancreatic tissue. The efficacy of radiotherapy is dose dependent. Based on an analysis of published data a dose of more than 50 Gy is recommended, resulting in a high morbidity rate with external beam radiotherapy alone. The use of intraoperative radiotherapy allows locally restricted dose escalation without increased perioperative morbidity. In adjuvant and in primary treatment, local tumor control was improved (70-90%). With palliative intent, pain relief was obtained rapidly in over 60% of patients and led to improved patient performance. As a result of the high distant metastases rate, even in curatively resected carcinomas, the overall prognosis could not be significantly improved. Further dose escalation is limited by the increasing incidence of upper gastrointestinal bleeding (20-30%). (orig.) [Deutsch] Therapiestrategien beim Pankreaskarzinom werden bestimmt durch den hohen Anteil primaer nicht resektabler Karzinome, der hohen relativen Strahlenresistenz und der hohen Fernmetastasierungsrate. Selbst kurativ resezierte Karzinome erfordern durch ihre hohe lokale Tumorzellpersistenz eine lokal effektive adjuvante Behandlungsmassnahme. Die Effektivitaet einer Radiotherapie ist dosisabhaengig. Aus der Analyse publizierter Daten wird eine Dosis von >50 Gy, welche bei der alleinigen perkutanen Bestrahlung mit einer hohen Morbiditaet verbunden ist, empfohlen. Mit der intraoperativen Radiotherapie ist eine lokal begrenzte Dosiseskalation ohne erhoehte perioperative Morbiditaet moeglich. Sowohl in der adjuvanten als auch in der primaeren Behandlung kann die lokale Tumorkontrolle deutlich verbessert werden (70-90%). Unter

  17. Intraoperative /sup 99m/Tc bone imaging in the treatment of benign osteoblastic tumors

    International Nuclear Information System (INIS)

    Sty, J.; Simons, G.

    1982-01-01

    Benign bone tumors can be successfully treated by local resection with the use of intraoperative bone imaging. Intraoperative bone imaging provided accurate localization of an osteoid osteoma in a patella of a 16-year-old girl when standard radiographs failed to demonstrate the lesion. In a case of osteoblastoma of the sacrum in a 12-year old girl, intraoperative scanning was used repeatedly to guide completeness of resection. In these cases in which routine intraoperative radiographs would have failed, intraoperative scanning proved to be essential for success

  18. Optimal Face-Iris Multimodal Fusion Scheme

    Directory of Open Access Journals (Sweden)

    Omid Sharifi

    2016-06-01

    Full Text Available Multimodal biometric systems are considered a way to minimize the limitations raised by single traits. This paper proposes new schemes based on score level, feature level and decision level fusion to efficiently fuse face and iris modalities. Log-Gabor transformation is applied as the feature extraction method on face and iris modalities. At each level of fusion, different schemes are proposed to improve the recognition performance and, finally, a combination of schemes at different fusion levels constructs an optimized and robust scheme. In this study, CASIA Iris Distance database is used to examine the robustness of all unimodal and multimodal schemes. In addition, Backtracking Search Algorithm (BSA, a novel population-based iterative evolutionary algorithm, is applied to improve the recognition accuracy of schemes by reducing the number of features and selecting the optimized weights for feature level and score level fusion, respectively. Experimental results on verification rates demonstrate a significant improvement of proposed fusion schemes over unimodal and multimodal fusion methods.

  19. Intraoperative language localization in multilingual patients with gliomas.

    Science.gov (United States)

    Bello, Lorenzo; Acerbi, Francesco; Giussani, Carlo; Baratta, Pietro; Taccone, Paolo; Songa, Valeria; Fava, Marica; Stocchetti, Nino; Papagno, Costanza; Gaini, Sergio M

    2006-07-01

    Intraoperative localization of speech is problematic in patients who are fluent in different languages. Previous studies have generated various results depending on the series of patients studied, the type of language, and the sensitivity of the tasks applied. It is not clear whether languages are mediated by multiple and separate cortical areas or shared by common areas. Globally considered, previous studies recommended performing a multiple intraoperative mapping for all the languages in which the patient is fluent. The aim of this work was to study the feasibility of performing an intraoperative multiple language mapping in a group of multilingual patients with a glioma undergoing awake craniotomy for tumor removal and to describe the intraoperative cortical and subcortical findings in the area of craniotomy, with the final goal to maximally preserve patients' functional language. Seven late, highly proficient multilingual patients with a left frontal glioma were submitted preoperatively to a battery of tests to evaluate oral language production, comprehension, and repetition. Each language was tested serially starting from the first acquired language. Items that were correctly named during these tests were used to build personalized blocks to be used intraoperatively. Language mapping was undertaken during awake craniotomies by the use of an Ojemann cortical stimulator during counting and oral naming tasks. Subcortical stimulation by using the same current threshold was applied during tumor resection, in a back and forth fashion, and the same tests. Cortical sites essential for oral naming were found in 87.5% of patients, those for the first acquired language in one to four sites, those for the other languages in one to three sites. Sites for each language were distinct and separate. Number and location of sites were not predictable, being randomly and widely distributed in the cortex around or less frequently over the tumor area. Subcortical stimulations found

  20. Multimodal integration of anatomy and physiology classes: How instructors utilize multimodal teaching in their classrooms

    Science.gov (United States)

    McGraw, Gerald M., Jr.

    Multimodality is the theory of communication as it applies to social and educational semiotics (making meaning through the use of multiple signs and symbols). The term multimodality describes a communication methodology that includes multiple textual, aural, and visual applications (modes) that are woven together to create what is referred to as an artifact. Multimodal teaching methodology attempts to create a deeper meaning to course content by activating the higher cognitive areas of the student's brain, creating a more sustained retention of the information (Murray, 2009). The introduction of multimodality educational methodologies as a means to more optimally engage students has been documented within educational literature. However, studies analyzing the distribution and penetration into basic sciences, more specifically anatomy and physiology, have not been forthcoming. This study used a quantitative survey design to determine the degree to which instructors integrated multimodality teaching practices into their course curricula. The instrument used for the study was designed by the researcher based on evidence found in the literature and sent to members of three associations/societies for anatomy and physiology instructors: the Human Anatomy and Physiology Society; the iTeach Anatomy & Physiology Collaborate; and the American Physiology Society. Respondents totaled 182 instructor members of two- and four-year, private and public higher learning colleges collected from the three organizations collectively with over 13,500 members in over 925 higher learning institutions nationwide. The study concluded that the expansion of multimodal methodologies into anatomy and physiology classrooms is at the beginning of the process and that there is ample opportunity for expansion. Instructors continue to use lecture as their primary means of interaction with students. Email is still the major form of out-of-class communication for full-time instructors. Instructors with

  1. Transversus abdominis plane block as a component of multimodal analgesia for laparoscopic cholecystectomy.

    Science.gov (United States)

    Oksar, Menekse; Koyuncu, Onur; Turhanoglu, Selim; Temiz, Muhyittin; Oran, Mustafa Cemil

    2016-11-01

    To evaluate and compare intercostal-iliac transversus abdominis plane (TAP) and oblique subcostal TAP (OSTAP) blocks for multimodal analgesia in patients receiving laparoscopic cholecystectomy. A prospective, randomized, double-blinded clinical study. Operating room, postoperative recovery area, and ward. In total, 60 laparoscopic cholecystectomy patients (43 women, 17 men, American Society of Anesthesiologists grades I-II) were enrolled from the general surgery department of our tertiary care center. The patients were assigned to 1 of the 3 groups. Group 1 received TAP blocks (n=20), group 2 received OSTAP blocks (n=20), and group 3 patients were used as controls and received patient-controlled analgesia (PCA) only (n=20). After the induction of anesthesia, blocks were performed bilaterally in study groups 1 and 2, using 20mL of lidocaine (5mg/mL). PCA with intravenous tramadol was routinely provided for all patients during the first 24hours. The intraoperative use of remifentanil, postoperative visual analog scale (VAS) scores, demand for PCA, and total analgesic consumption were recorded. The patients in the control group had greater analgesic demands and analgesic consumption than did those in groups 1 and 2. However, patients in the OSTAP group had lower VAS scores than did those in groups 1 and 3. The demand for analgesia was greater in the control group than in groups 1 and 2. Moreover, lower VAS scores were recorded in the OSTAP group than in groups 1 and 3 and were positively correlated with total PCA consumption among all patients. However, postoperative VAS scores were negatively correlated with the total intraoperative consumption of remifentanil at 24hours. TAP and OSTAP blocks improved postoperative analgesia in patients receiving laparoscopic cholecystectomy, which resulted in lower VAS scores and reduction in total analgesic consumption. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Newer techniques for intravascular and intraoperative neurointerventional procedures

    International Nuclear Information System (INIS)

    Higashida, R.T.; Halbach, V.V.; Hieshima, G.B.; Yang, P.

    1987-01-01

    A videotape demonstrating newer techniques used in intravascular and intraoperative embolization procedures will be presented. The authors discuss the use of some of the newer embolic agents, real-time digital subtraction angiography, roadmapping techniques, and the use of microcatheters and steerable micro guide wires, which has greatly facilitated neurovascullar embolization procedures and enhanced patient safety. A number of actual intraoperative and intravascular cases will be shown demonstrating treatment of vascular malformations of the brain and spinal cord, carotid cavernous sinus fistulas, aneurysms and dural arteriovenous malformations. The indications for treatment, patient selection, technical preparation and newer methodologies and approaches to complex vascular lesions of the brain and spinal cord are discussed in detail

  3. Principles for Management of Intraoperative Acute Type A Aortic Dissection.

    Science.gov (United States)

    Gukop, Philemon; Chandrasekaran, Vankatachalam

    2015-12-01

    Intraoperative Type A aortic dissection is a rare pathology with incidence of 0.06-0.32%. It is associated with a high mortality between 30-50%. Some associated risk factors, including hypertension, enlarged aorta, peripheral vascular disease, advanced age, atheroma, and high arterial pressure on cardiopulmonary bypass, have been identified. Modification of these risk factors could reduce the incidence of this event. Prompt diagnosis and management, with the aid of intraoperative trans-esophageal echocardiography and/or epi-aortic ultrasound has been shown to reduce the mortality to 17%. We illustrate the principles of management of this pathology with the case of a 62-year-old female who developed acute Type A aortic dissection while undergoing minimally invasive mitral valve repair.

  4. Transsphenoidal pituitary resection with intraoperative MR guidance: preliminary results

    Science.gov (United States)

    Pergolizzi, Richard S., Jr.; Schwartz, Richard B.; Hsu, Liangge; Wong, Terence Z.; Black, Peter M.; Martin, Claudia; Jolesz, Ferenc A.

    1999-05-01

    The use of intraoperative MR image guidance has the potential to improve the precision, extent and safety of transsphenoidal pituitary resections. At Brigham and Women's Hospital, an open-bore configuration 0.5T MR system (SIGNA SP, GE Medical Systems, Milwaukee, WI) has been used to provide image guidance for nine transsphenoidal pituitary adenoma resections. The intraoperative MR system allowed the radiologist to direct the surgeon toward the sella turcica successfully while avoiding the cavernous sinus, optic chiasm and other sensitive structures. Imaging performed during the surgery monitored the extent of resection and allowed for removal of tumor beyond the surgeon's view in five cases. Dynamic MR imaging was used to distinguish residual tumor from normal gland and postoperative changes permitting more precise tumor localization. A heme-sensitive long TE gradient echo sequence was used to evaluate for the presence of hemorrhagic debris. All patients tolerated the procedure well without significant complications.

  5. Intraoperative Functional Mapping and Monitoring during Glioma Surgery

    Science.gov (United States)

    SAITO, Taiichi; MURAGAKI, Yoshihiro; MARUYAMA, Takashi; TAMURA, Manabu; NITTA, Masayuki; OKADA, Yoshikazu

    2015-01-01

    Glioma surgery represents a significant advance with respect to improving resection rates using new surgical techniques, including intraoperative functional mapping, monitoring, and imaging. Functional mapping under awake craniotomy can be used to detect individual eloquent tissues of speech and/or motor functions in order to prevent unexpected deficits and promote extensive resection. In addition, monitoring the patient’s neurological findings during resection is also very useful for maximizing the removal rate and minimizing deficits by alarming that the touched area is close to eloquent regions and fibers. Assessing several types of evoked potentials, including motor evoked potentials (MEPs), sensory evoked potentials (SEPs) and visual evoked potentials (VEPs), is also helpful for performing surgical monitoring in patients under general anesthesia (GA). We herein review the utility of intraoperative mapping and monitoring the assessment of neurological findings, with a particular focus on speech and the motor function, in patients undergoing glioma surgery. PMID:25744346

  6. A meta-analysis of intraoperative factors associated with ...

    African Journals Online (AJOL)

    ... 95% 1.9-26), new onset atrial fibrillation (OR 6.6, 95% CI 2.5-20), hypothermia (OR 2.2, 95% CI 1.1-5) and remote ischaemic preconditioning (OR 0.22, 95% CI 0.07-0.67). None of these studies controlled for blood transfusion. Conclusion: Both surgical and haemodynamic intraoperative events significantly increased the ...

  7. Intraoperative Assessment of Tricuspid Valve Function After Conservative Repair

    OpenAIRE

    Revuelta, J.M.; Gomez-Duran, C.; Garcia-Rinaldi, R.; Gallagher, M.W.

    1982-01-01

    It is desirable to repair coexistent tricuspid valve pathology at the time of mitral valve corrections. Conservative tricuspid repair may consist of commissurotomy, annuloplasty, or both. It is important that the repair be appropriate or tricuspid valve replacement may be necessary. A simple reproducible method of intraoperative testing for tricuspid valve insufficiency has been developed and used in 25 patients. Fifteen patients have been recatheterized, and the correlation between the intra...

  8. Recurrent intraoperative silent ST depression responding to phenylephrine

    Directory of Open Access Journals (Sweden)

    P M Singh

    2012-01-01

    Full Text Available Intraoperative myocardial ischemia is attributed to decreased myocardial oxygen supply. We present an unusual case of recurrent, symptomless inferior wall ischemia in an apparently healthy male with no history of coronary artery disease after a spinal block. The recurring episodes were linked to tachycardia and presented with significant ST depression in Lead II with reciprocal elevation in lead aVL. The episodes responded to phenylephrine and subsided without residual sequelae.

  9. Premedication with oral Dextromethorphan reduces intra-operative Morphine requirement

    Directory of Open Access Journals (Sweden)

    R Talakoub

    2005-09-01

    Full Text Available Background: Intra-operative pain has adverse effects on hemodynamic parameters. Due to complications of opioids for pain relief, using non-opioids medication is preferred. The purpose of this study was to investigate the effect of oral dextrometorphan premedication on intra-operative Morphine requirement. Methods: After approval of the Ethics committee and informed consent, 40 adult patients who stand in American Society of Anesthesiologists Physical Status I and II, under general anesthesia for elective laparatomy were selected and classified in two equal groups randomly. In group A, oral dextromethorphan (60mg was administered at 10 PM and 6 AM preoperatively. In group B, placebo (dextrose was administered. After induction of general anesthesia and before skin incision, intravenous morphine (0.01 mg/kg was administered. During surgery, when systolic blood pressure or heart rate was increased more than 20% of the preoperative baseline, 0.01 mg/kg morphine was administered. At the end of surgery, the totally prescribed morphine (mg/kg and maximal increase in systolic, diastolic, mean arterial blood pressure and heart rate relative to the baseline values were calculated and statistically compared with student’s t-test. Results: The mean dose of administered morphine during surgery was significantly less in group A than group B (P<0.0001. Also, Maximal increase in systolic, diastolic and mean arterial blood pressure was significantly less in group A (p<0.003, p<0.004, p<0.0001, respectively. There was no significant difference in maximal heart rate increase between two groups (p<0.114. Conclusion: Oral dextromethorphan premedication may decrease intra-operative morphine requirement and reduce maximal increase in systolic and mean arterial blood pressure during surgery. Key words: Dextromethorphan, Morphine, Intra-operative, Premedication Hemodynamic

  10. Intraoperative tractography and neuronavigation of the pyramidal tract

    International Nuclear Information System (INIS)

    Nimsky, C.; Ganslandt, O.; Weigel, D.; Keller, B. von; Stadlbauer, A.; Akutsu, H.; Hammen, T.; Buchfelder, M.

    2008-01-01

    Diffusion tensor imaging (DTI) based fiber tracking was applied to visualize the course of the pyramidal tract in the surgical field by microscope-based navigation. In 70 patients with lesions adjacent to the pyramidal tract, DTI data were integrated in a navigational setup. Diffusion data (b=0) were rigidly registered with standard T1-weighted 3-D images. Fiber tracking was performed applying a tensor-deflection algorithm using a multiple volume of interest approach as seed regions for tracking. fMRI data identifying the motor gyrus were applied as selection criteria to define the fibers of interest. After tracking, a 3-D object was generated representing the pyramidal tract. In selected cases, the intraoperative image data (1.5 T intraoperative MRI) were used to update the navigation system. In all patients the pyramidal tract could be visualized in the operative field applying the heads-up display of the operating microscope. In 8 patients (11%) a new or aggravated postoperative paresis could be observed, which was transient in 5 of them; thus, only in 3 patients (4.2%) was there a new permanent neurological deficit. Intraoperative imaging depicted a shifting of the pyramidal tract which amounted up to 15 mm; even the direction of shifting was variable and could not be predicted before surgery, so that mathematical models trying to predict brain shift behaviour are of restricted value only. DTI fiber tracking data can be reliably integrated into navigational systems providing intraoperative visualization of the pyramidal tract. This technique allowed the resection of lesions adjacent to the pyramidal tract with low morbidity. (author)

  11. Dapsone Induced Methaemoglobinemia: Early Intraoperative Detection by Pulse Oximeter Desaturation

    Directory of Open Access Journals (Sweden)

    Mahmood Rafiq

    2008-01-01

    Case signifies the importance of knowledge of any preoperative drug intake and its anaesthetic implications. Also patients on dapsone therapy especially children should be monitored for methaemoglobin levels. Since children with immune thrombocy-topenic purpura are being treated with dapsone these days and many of these patients would be planned for splenectomy, monitoring of preoperative methaemoglobin levels and methaemoglobinemia as a cause of intraoperative pulse oximeter desaturation should be kept in mind.

  12. Intraoperative radionuclide study and colonoscopy in gastrointestinal hemorrhage

    International Nuclear Information System (INIS)

    Navab, F.; Westbrook, K.C.; Slaton, G.; Boyd, C.M.

    1985-01-01

    Tc-99m labeled red cell imaging is used in the diagnosis and localization of gastrointestinal hemorrhage. A patient in whom a preoperative scan was positive in the right paraumbilical region is discussed. Intraoperative Tc-99m labeled red cell imaging was used in conjunction with colonoscopy, and the site of active bleeding was found in the proximal transverse colon, which had been displaced downward because of adhesions

  13. Intraoperative perception and sensation in laser in situ keratomileusis (LASIK).

    Science.gov (United States)

    Srivannaboon, Sabong; Chansue, Ekktet

    2004-04-01

    To investigate intraoperative perception and sensation during Laser in situ Keratomileusis (LASIK). Sixty patients with uneventful LASIK were included. All procedures were performed by one surgeon with one technique. Any patient with intra-operative complications was excluded. The patients were asked to fill in the subjective evaluation form regarding their perception and sensation during the operation. Twenty-nine patients (48%) reported no pain and twenty-six patients (43%) reported no burning sensation during the surgery. Nineteen patients (32%) reported no light perception during the suction period of microkeratome. There was no correlation between duration of the suction and no light perception (R2 0.01). Thirty-four patients (56%) reported no trouble in maintaining visual fixation at the red light during the laser treatment. Ten patients (16%) reported they could clearly see the movement during the surgery and 5 out of 10 patients (50% of 16%) reported visual frightening. Fifty cases (84%) reported no visual frightening during the surgery after reassurance of the visual experience by the surgeon before the surgery. Patients undergoing LASIK may experience different visual perceptions. Reassurance of the intraoperative perception and sensation before the surgery can reduce the visual frightening.

  14. Intraoperative Cerebral Glioma Characterization with Contrast Enhanced Ultrasound

    Directory of Open Access Journals (Sweden)

    Francesco Prada

    2014-01-01

    Full Text Available Background. Contrast enhanced ultrasound (CEUS is a dynamic and continuous modality providing real-time view of vascularization and flow distribution patterns of different organs and tumors. Nevertheless its intraoperative use for brain tumors visualization has been performed few times, and a thorough characterization of cerebral glioma had never been performed before. Aim. To perform the first characterization of cerebral glioma using CEUS and to possibly achieve an intraoperative differentiation of different gliomas. Methods. We performed CEUS in an off-label setting in 69 patients undergoing surgery for cerebral glioma. An intraoperative qualitative analysis was performed comparing iCEUS with B-mode imaging. A postprocedural semiquantitative analysis was then performed for each case, according to EFSUMB criteria. Results were related to histopathology. Results. We observed different CE patterns: LGG show a mild, dotted CE with diffuse appearance and slower, delayed arterial and venous phase. HGG have a high CE with a more nodular, nonhomogeneous appearance and fast perfusion patterns. Conclusion. Our study characterizes for the first time human brain glioma with CEUS, providing further insight regarding these tumors’ biology. CEUS is a fast, safe, dynamic, real-time, and economic tool that might be helpful during surgery in differentiating malignant and benign gliomas and refining surgical strategy.

  15. SEP Montage Variability Comparison during Intraoperative Neurophysiologic Monitoring.

    Science.gov (United States)

    Hanson, Christine; Lolis, Athena Maria; Beric, Aleksandar

    2016-01-01

    Intraoperative monitoring is performed to provide real-time assessment of the neural structures that can be at risk during spinal surgery. Somatosensory evoked potentials (SEPs) are the most commonly used modality for intraoperative monitoring. SEP stability can be affected by many factors during the surgery. This study is a prospective review of SEP recordings obtained during intraoperative monitoring of instrumented spinal surgeries that were performed for chronic underlying neurologic and neuromuscular conditions, such as scoliosis, myelopathy, and spinal stenosis. We analyzed multiple montages at the baseline, and then followed their development throughout the procedure. Our intention was to examine the stability of the SEP recordings throughout the surgical procedure on multiple montages of cortical SEP recordings, with the goal of identifying the appropriate combination of the least number of montages that gives the highest yield of monitorable surgeries. Our study shows that it is necessary to have multiple montages for SEP recordings, as it reduces the number of non-monitorable cases, improves IOM reliability, and therefore could reduce false positives warnings to the surgeons. Out of all the typical montages available for use, our study has shown that the recording montage Cz-C4/Cz-C3 (Cz-Cc) is the most reliable and stable throughout the procedure and should be the preferred montage followed throughout the surgery.

  16. Intraoperative Hypoglossal Nerve Mapping During Carotid Endarterectomy: Technical Note.

    Science.gov (United States)

    Kojima, Atsuhiro; Saga, Isako; Ishikawa, Mami

    2018-05-01

    Hypoglossal nerve deficit is a possible complication caused by carotid endarterectomy (CEA). The accidental injury of the hypoglossal nerve during surgery is one of the major reasons for permanent hypoglossal nerve palsy. In this study, we investigated the usefulness of intraoperative mapping of the hypoglossal nerve to identify this nerve during CEA. Five consecutive patients who underwent CEA for the treatment of symptomatic or asymptomatic carotid artery stenosis were studied. A hand-held probe was used to detect the hypoglossal nerve in the operative field, and the tongue motor evoked potentials (MEPs) were recorded. The tongue MEPs were obtained in all the patients. The invisible hypoglossal nerve was successfully identified without any difficulty when the internal carotid artery was exposed. Intraoperative mapping was particularly useful for identifying the hypoglossal nerve when the hypoglossal nerve passed beneath the posterior belly of the digastric muscle. In 1 of 2 cases, MEP was also elicited when the ansa cervicalis was stimulated, although the resulting amplitude was much smaller than that obtained by direct stimulation of the hypoglossal nerve. Postoperatively, none of the patients presented with hypoglossal nerve palsy. Intraoperative hypoglossal nerve mapping enabled us to locate the invisible hypoglossal nerve during the exposure of the internal carotid artery accurately without retracting the posterior belly of the digastric muscle and other tissues in the vicinity of the internal carotid artery. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. Hydrodynamic study of syringomyelia by MRI and intraoperative ultrasonography

    International Nuclear Information System (INIS)

    Moritake, Kouzo; Takaya, Mikio; Minamikawa, Jun; Ishikawa, Masatsune; Kikuchi, Haruhiko; Minami, Shunsuke

    1989-01-01

    Syringomyelic cavities were studied with magnetic resonance imaging (MRI) in eleven patients with special reference to the hemodynamic contribution to the pathogenesis of syringomyelia. They were also studied intraoperatively with ultrasonography (USG) in five patients. Syrinx cavities combined with lumbosacral lipomyelomeningocele or with spinal stenosis did not present a flow-void phenomenon reflecting pulsatile movements of syrinx fluid. On serial MRI study in those the patients, enlargement of the syrinx cavity was not observed. Syrinx cavities occupying the caudal part of the spinal cord did not develop either. These cases were not treated surgically but followed conservatively. On the other hand, the flow-void sign in the syrinx cavities was present on MRI in patients who also had Chiari type I or type II malformations. They were treated with a syringo-subarachnoid shunt. In these cases, intraoperative USG disclosed marked fluctuation of syrinx cavity size synchronous with the motions of pulmonary ventilation. In all of them, clinical signs and symptoms improved postoperatively to various degrees. These results suggest that both the flow-void sign in the syrinx cavity on MRI and marked fluctaution of cavity size on intraoperative USG are indications for the shunt operation and support William's revised theory (1987). Fluctuation of cystic cavity size synchronous with ventilation suggests that venous pressure in the spinal subarachnoid space contributes to the pathogenesis of syringomyelic cavities. Further analysis of the fluctuation of cystic cavities by video monitoring will provide further information on the etiology and other clinical problems of syringomyelia. (author)

  18. Intraoperative radiotherapy in combined treatment of sinonasal malignant tumors

    Science.gov (United States)

    Novikov, V. A.; Gribova, O. V.; Vasiljev, R. V.; Choynzonov, E. L.; Shtin, V. I.; Shiianova, A. A.; Surkova, P. V.; Starceva, Zh. A.; Shilova, O. G.

    2017-09-01

    Obvious advantage of IORT (intraoperative radiotherapy) is that the radiation source is delivered directly to the bed of the tumor during surgery, thus avoiding the negative impact on the skin, subcutaneous tissue and reducing the risk of fibrosis. Sinonasal tumors—a convenient object for intraoperative radiotherapy application (surface location, relatively small size tumors, good operational access). The surface location and comparatively small size of neoplasms, good operational access provide an efficient and accurate transfer of the electron beam to the postoperative cavity to increase the irradiation dose in the areas of the most probable recurrence, which makes the tumors of this localization a convenient object for the use of the intraoperative radiation therapy. The treatment was conducted using a mobile compact betatron (MIB-6E), 10-12 Gy single dose. IORT session extends surgery period by 30 min. There were no pathological clinical and laboratory reactions on IORT in the early postoperative period. Carrying out the procedure is possible in various standard operating rooms. It does not require special security measures for the patients and the staff. IORT with the help of electron beam allows avoiding post-radiation reactions and achieving a 5-year—disease-free survival of 66% of the patients. IORT session is possible through a minimal incision during organ preservation surgeries. Evident economic feasibility provides the prospects of applying IORT in the clinical practice.

  19. Intraoperative ultrasonography of liver, bile ducts and pancreas

    Directory of Open Access Journals (Sweden)

    Luciana Mendes de Oliveira Cerri

    Full Text Available The use of intraoperative ultrasonography (IOUS to evaluate liver, bile ducts and pancreatic disease, as compared to the results of preoperative ultrasonography and CT, is discussed. Forty-two patients who underwent abdominal surgery for suspected hepatobiliary and/or pancreatic disease were studied. The intraoperative study was carried out with a portable apparatus (Aloka 500, Japan, using 5.0 MHz and 7.5 MHz linear sterile transducers. The main indications for IOUS were the search for and/or evaluation of primary hepatic masses,hepatic abscesses or metastases, obstructive jaundice, or neuroendocrine tumors. In 15 cases (38.5 percent from the hepatobiliary group and in 7 cases (58.3 percent from the pancreatic group, a difference between preoperative and intraoperative findings was observed. The main difference was observed in relation to the number and size of hepatic and pancreatic lesions. The relationship between the lesions and the vascular structures was evaluated through IOUS. The method was also used to guide surgical procedures such as biopsies, the alcoholization of nodules, and the drainage of abscesses. IOUS plays an important role in detecting small hepatic and pancreatic nodules, in the assessment of anatomical relationships between the lesions and the vascular structures, and in the performance of interventionist procedures.

  20. Dacryocystorhinostomy without intubation with intraoperative mitomycin-c

    International Nuclear Information System (INIS)

    Rahman, A.; Channa, S.; Memon, M.S.; Niazi, J.H.

    2006-01-01

    To evaluate the success rate and complications of intraoperative Mitomycin-C in dacryocystorhinostomy surgery. This study included total 90 eyes of 90 patients fulfilling the inclusion criteria.The surgical procedure of external DCR done with intraoperative Mitomycin-C with a neurosurgical cottonoid soaked with 0.2mg/ml. Mitomycin C was applied to the anastomosed flaps and osteotomy site for 10 minutes, without Silicon tube intubation. Surgery was done under local as well as general anesthesia. Patients were followed for 6 months. Out of 90 patients included in this study, only 2 patients complained of persistent epiphora after 6 months follow-up and were labeled as failed DCR. Remaining 88 had either no tearing or significant improvement of tearing after 6 months follow up and patent lacrimal system by syringing without pressure. Success rate in this procedure was 97.77% (p-value< 0.001). This study showed very high rate of success. Only complication noted was excessive nasal bleeding which was easily controlled. Intraoperative Mitomycin-C application in external DCR is safe, effective, cheap adjunct that helps to achieve good results of DCR surgery. (author)

  1. Intraoperative panoramic image using alignment grid, is it accurate?

    Science.gov (United States)

    Apivatthakakul, T; Duanghakrung, M; Luevitoonvechkit, S; Patumasutra, S

    2013-07-01

    Minimally invasive orthopedic trauma surgery relies heavily on intraoperative fluoroscopic images to evaluate the quality of fracture reduction and fixation. However, fluoroscopic images have a narrow field of view and often cannot visualize the entire long bone axis. To compare the coronal femoral alignment between conventional X-rays to that achieved with a new method of acquiring a panoramic intraoperative image. Twenty-four cadaveric femurs with simple diaphyseal fractures were fixed with an angulated broad DCP to create coronal plane malalignment. An intraoperative alignment grid was used to help stitch different fluoroscopic images together to produce a panoramic image. A conventional X-ray of the entire femur was then performed. The coronal plane angulation in the panoramic images was then compared to the conventional X-rays using a Wilcoxon signed rank test. The mean angle measured from the panoramic view was 173.9° (range 169.3°-178.0°) with median of 173.2°. The mean angle measured from the conventional X-ray was 173.4° (range 167.7°-178.7°) with a median angle of 173.5°. There was no significant difference between both methods of measurement (P = 0.48). Panoramic images produced by stitching fluoroscopic images together with help of an alignment grid demonstrated the same accuracy at evaluating the coronal plane alignment of femur fractures as conventional X-rays.

  2. Incidence of intraoperative hypothermia: adopting protocol for its prevention

    International Nuclear Information System (INIS)

    Al-Qahtani, Ali S.; Messahel, Farouk M.

    2003-01-01

    To determine the incidence of hypothermia during surgical procedures when adequate methods of preserving normothermia are applied .For this was a study in which patients ASA I-IV presented for surgery at the Armed Forces Hospital, Wadi Al- Dawasir, kingdom of Saudi Arabia ,during the period from July 2000 to February 2003 in whom body core temprature was between 35-37C ,were included. Ambient temperature of the operating room was thermostatically adjusted to record 26C and 24C if patents were < 10 year-old or above .Depending on type of surgery ;the patients were provided with space blankents and were lying on warm mattresses. Fluid or blood warmers and forced-air surface were used when needed for this. = Aggressive measures must be adopted to preserve normothermia as prevention of intraoperative hypothermia improves patients outcome .All patients shoud have their body temprature monitored during surgery .However application of available methods of keeping normothermia reduces the the incidence of intraoperative hypothermia but does not abolish it completely . Hypothermia patients should be closely moniterd during gradual rewarming preferably in the intensive care setting. A protocol for prevention of intraoperative hypothermia must be adopted by all operating theatres. (author)

  3. Intraoperative radiotherapy for the treatment of gastric cancer

    Energy Technology Data Exchange (ETDEWEB)

    Satomura, Kisaku; Inamoto, Shun; Honda, Kazuo; Takahashi, Masaji [Kyoto Univ. (Japan). Faculty of Medicine

    1982-12-01

    Clinical results of intraoperative radiotherapy for gastric cancer were reported. One hundred and five cases of gastric cancer were treated by intraoperative radiotherapy. Whatever the stage of the patient was, 3-year survival rate was found to be better in the radiotherapy group than that of the control group (treated surgical resection only). Five year survival rate of the stages III and IV in the radiotherapy group was better than the control group. Unfavorable side effects were observed in 4 cases out of 105 cases. In one case, penetration of postoperative peptic ulcer into the irradiated aortic wall was found by autopsy. Two cases of bile duct stenosis and one case of ileus due to acutely developed peritonitis carcinomatosa were experienced. In conclusion, intraoperative radiotherapy immediately after surgical resection for the treatment of gastric cancer was found to be an effective method. The most effective application of the method appears to be to cases of stage II and III without liver metastasis and peritoneal disseminations (H/sub 0/P/sub 0/, M, A).

  4. Intraoperative CT with integrated navigation system in spinal neurosurgery

    International Nuclear Information System (INIS)

    Zausinger, S.; Heigl, T.; Scheder, B.; Schnell, O.; Tonn, J.C.; Uhl, E.; Morhard, D.

    2007-01-01

    For spinal surgery navigational system images are usually acquired before surgery with patients positioned supine. The aim of this study was to evaluate prospectively navigated procedures in spinal surgery with data acquisition by intraoperative computed tomography (iCT). CT data of 38 patients [thoracolumbar instability (n = 24), C1/2 instability (n = 6), cervicothoracic stabilization (n = 7), disk herniation (n = 1)] were acquired after positioning the patient in prone position. A sliding gantry 24 detector row CT was used for image acquisition. Data were imported to the frameless infrared-based neuronavigation station. A postprocedural CT was obtained to assess the extent of decompression and the accuracy of instrumentation. Intraoperative registration revealed computed accuracy 2 mm in 9/158 screws (5.6%), allowing immediate correction in five screws without any damage to vessels or nerves. There were three transient complications with clinical improvement in all patients. Intraoperative CT in combination with neuronavigation provides high accuracy of screw placement and thus safety for patients undergoing spinal stabilization. The procedure is rapid and easy to perform and - by replacing pre- and postoperative imaging-is not associated with additional exposure to radiation. (orig.)

  5. Can we trust intraoperative culture results in nonunions?

    Science.gov (United States)

    Palmer, Michael P; Altman, Daniel T; Altman, Gregory T; Sewecke, Jeffrey J; Ehrlich, Garth D; Hu, Fen Z; Nistico, Laura; Melton-Kreft, Rachel; Gause, Trent M; Costerton, John W

    2014-07-01

    To identify the presence of bacterial biofilms in nonunions comparing molecular techniques (multiplex polymerase chain reaction and mass spectrometry, fluorescent in situ hybridization) with routine intraoperative cultures. Thirty-four patients with nonunions were scheduled for surgery and enrolled in this ongoing prospective study. Intraoperative specimens were collected from removed implants, surrounding tissue membrane, and local soft tissue followed by standard culture analysis, Ibis's second generation molecular diagnostics (Ibis Biosystems), and bacterial 16S rRNA-based fluorescence in situ hybridization (FISH). Confocal microscopy was used to visualize the tissue specimens reacted with the FISH probes, which were chosen based on the Ibis analysis. Thirty-four patient encounters were analyzed. Eight were diagnosed as infected nonunions by positive intraoperative culture results. Ibis confirmed the presence of bacteria in all 8 samples. Ibis identified bacteria in a total of 30 of 34 encounters, and these data were confirmed by FISH. Twenty-two of 30 Ibis-positive samples were culture-negative. Four samples were negative by all methods of analysis. No samples were positive by culture, but negative by molecular techniques. Our preliminary data indicate that molecular diagnostics are more sensitive for identifying bacteria than cultures in cases of bony nonunion. This is likely because of the inability of cultures to detect biofilms and bacteria previously exposed to antibiotic therapy. Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.

  6. An audit of intraoperative frozen section in Johor.

    Science.gov (United States)

    Khoo, J J

    2004-03-01

    A 4-year-review was carried out on intraoperative frozen section consultations in Sultanah Aminah Hospital, Johor Bahru. Two hundred and fifteen specimens were received from 79 patients in the period between January 1999 and December 2002. An average of 2.72 specimens per patient was received. The overall diagnostic accuracy was high, 97.56%. The diagnoses were deferred in 4.65% of the specimens. False positive diagnoses were made in 3 specimens (1.46%) and false negative diagnoses in 2 specimens (0.98%). This gave an error rate of 2.44%. The main cause of error was incorrect interpretation of the pathologic findings. In the present study, frozen sections showed good sensitivity (97.98%) and specificity (97.16%). Despite its limitations, frozen section is still generally considered to be an accurate mode of intraoperative consultation to assist the surgeon in deciding the best therapeutic approach for his patient at the operating table. The use of frozen section with proper indications was cost-effective as it helped lower the number of reoperations. An audit of intraoperative frozen section from time to time serves as part of an ongoing quality assurance program and should be recommended where the service is available.

  7. Multimodal follow-up questions to multimodal answers in a QA system

    NARCIS (Netherlands)

    van Schooten, B.W.; op den Akker, Hendrikus J.A.

    2007-01-01

    We are developing a dialogue manager (DM) for a multimodal interactive Question Answering (QA) system. Our QA system presents answers using text and pictures, and the user may pose follow-up questions using text or speech, while indicating screen elements with the mouse. We developed a corpus of

  8. A new method for intraoperative localization of epilepsy focus by means of a gamma probe; Um novo metodo para a localizacao intraoperatoria de foco de epilepsia mediante utilizacao de gamaprobe

    Energy Technology Data Exchange (ETDEWEB)

    Carneiro Filho, Omar, E-mail: dromarcarneiro@gmail.com [Centro Brasileiro de Medicina Nuclear e Imagem Molecular (CEBRAMEN), Goiania, GO (Brazil); Instituto de Medicina Nuclear, Goiania, GO (Brazil); Vilela Filho, Osvaldo [Universidade Federal de Goias (UFG), Goiania, GO (Brazil). Hospital das Clinicas. Servico de Neurocirurgia; Ragazzo, Paulo Cesar [Instituto de Neurologia de Goiania, GO (Brazil). Servico de Eplepsia e Neurofisiologia; Fonseca, Lea Mirian Barbosa da [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Dept. de Radiologia

    2014-01-15

    Objective: to evaluate the utility of a new multimodal image-guided intervention technique to detect epileptogenic areas with a gamma probe as compared with intraoperative electrocorticography. Materials and methods: two symptomatic patients with refractory epilepsy underwent magnetic resonance imaging, videoelectroencephalography, brain SPECT scan, neuropsychological evaluation and were submitted to gamma probe-assisted surgery. Results: in patient 1, maximum radioactive count was initially observed on the temporal gyrus at about 3.5 cm posteriorly to the tip of the left temporal lobe. After corticotomy, the gamma probe indicated maximum count at the head of the hippocampus, in agreement with the findings of intraoperative electrocorticography. In patient 2, maximum count was observed in the occipital region at the transition between the temporal and parietal lobes (right hemisphere). During the surgery, the area of epileptogenic activity mapped at electrocorticography was also delimited, demarcated, and compared with the gamma probe findings. After lesionectomy, new radioactive counts were performed both in the patients and on the surgical specimens (ex-vivo). Conclusion: the comparison between intraoperative electrocorticography and gamma probe-assisted surgery showed similarity of both methods. The advantages of gamma probe include: noninvasiveness, low cost and capacity to demonstrate decrease in the radioactive activity at the site of excision after lesionectomy. (author)

  9. Advanced Multimodal Solutions for Information Presentation

    Science.gov (United States)

    Wenzel, Elizabeth M.; Godfroy-Cooper, Martine

    2018-01-01

    High-workload, fast-paced, and degraded sensory environments are the likeliest candidates to benefit from multimodal information presentation. For example, during EVA (Extra-Vehicular Activity) and telerobotic operations, the sensory restrictions associated with a space environment provide a major challenge to maintaining the situation awareness (SA) required for safe operations. Multimodal displays hold promise to enhance situation awareness and task performance by utilizing different sensory modalities and maximizing their effectiveness based on appropriate interaction between modalities. During EVA, the visual and auditory channels are likely to be the most utilized with tasks such as monitoring the visual environment, attending visual and auditory displays, and maintaining multichannel auditory communications. Previous studies have shown that compared to unimodal displays (spatial auditory or 2D visual), bimodal presentation of information can improve operator performance during simulated extravehicular activity on planetary surfaces for tasks as diverse as orientation, localization or docking, particularly when the visual environment is degraded or workload is increased. Tactile displays offer a third sensory channel that may both offload information processing effort and provide a means to capture attention when urgently required. For example, recent studies suggest that including tactile cues may result in increased orientation and alerting accuracy, improved task response time and decreased workload, as well as provide self-orientation cues in microgravity on the ISS (International Space Station). An important overall issue is that context-dependent factors like task complexity, sensory degradation, peripersonal vs. extrapersonal space operations, workload, experience level, and operator fatigue tend to vary greatly in complex real-world environments and it will be difficult to design a multimodal interface that performs well under all conditions. As a

  10. The semiotics of typography in literary texts. A multimodal approach

    DEFF Research Database (Denmark)

    Nørgaard, Nina

    2009-01-01

    to multimodal discourse proposed, for instance, by Kress & Van Leeuwen (2001) and Baldry & Thibault (2006), and, more specifically, the multimodal approach to typography suggested by Van Leeuwen (2005b; 2006), in order to sketch out a methodological framework applicable to the description and analysis...... of the semiotic potential of typography in literary texts....

  11. Validation of a multimodal travel simulator with travel information provision

    NARCIS (Netherlands)

    Chorus, C.G.; Molin, E.J.E.; Arentze, T.A.; Hoogendoorn, S.P.; Timmermans, H.J.P.; Wee, van G.P.

    2007-01-01

    This paper presents a computer based travel simulator for collecting data concerning the use of next-generation ATIS and their effects on traveler decision making in a multimodal travel environment. The tool distinguishes itself by presenting a completely abstract multimodal transport network, where

  12. A Multimodal Discourse Analysis of Tmall's Double Eleven Advertisement

    Science.gov (United States)

    Hu, Chunyu; Luo, Mengxi

    2016-01-01

    From the 1990s, the multimodal turn in discourse studies makes multimodal discourse analysis a popular topic in linguistics and communication studies. An important approach to applying Systemic Functional Linguistics to non-verbal modes is Visual Grammar initially proposed by Kress and van Leeuwen (1996). Considering that commercial advertisement…

  13. Deterministic multimode photonic device for quantum-information processing

    DEFF Research Database (Denmark)

    Nielsen, Anne E. B.; Mølmer, Klaus

    2010-01-01

    We propose the implementation of a light source that can deterministically generate a rich variety of multimode quantum states. The desired states are encoded in the collective population of different ground hyperfine states of an atomic ensemble and converted to multimode photonic states by exci...

  14. Interactivity in Educational Apps for Young Children: A Multimodal Analysis

    Science.gov (United States)

    Blitz-Raith, Alexandra H.; Liu, Jianxin

    2017-01-01

    Interactivity is an important indicator of an educational app's reception. Since most educational apps are multimodal, it justifies a methodological initiative to understand meaningful involvement of multimodality in enacting and even amplifying interactivity in an educational app. Yet research so far has largely concentrated on algorithm…

  15. Cultural Shifts, Multimodal Representations, and Assessment Practices: A Case Study

    Science.gov (United States)

    Curwood, Jen Scott

    2012-01-01

    Multimodal texts involve the presence, absence, and co-occurrence of alphabetic text with visual, audio, tactile, gestural, and spatial representations. This article explores how teachers' evaluation of students' multimodal work can be understood in terms of cognition and culture. When teachers apply a paradigm of assessment rooted in print-based…

  16. Multimodal versus Unimodal Instruction in a Complex Learning Context.

    Science.gov (United States)

    Gellevij, Mark; van der Meij, Hans; de Jong, Ton; Pieters, Jules

    2002-01-01

    Compared multimodal instruction with text and pictures with unimodal text-only instruction as 44 college students used a visual or textual manual to learn a complex software application. Results initially support dual coding theory and indicate that multimodal instruction led to better performance than unimodal instruction. (SLD)

  17. Multimodal warnings to enhance risk communication and safety

    NARCIS (Netherlands)

    Haas, E.C.; Erp, J.B.F. van

    2014-01-01

    Multimodal warnings incorporate audio and/or skin-based (tactile) cues to supplement or replace visual cues in environments where the user’s visual perception is busy, impaired, or nonexistent. This paper describes characteristics of audio, tactile, and multimodal warning displays and their role in

  18. Adaptive multimodal interaction in mobile augmented reality: A conceptual framework

    Science.gov (United States)

    Abidin, Rimaniza Zainal; Arshad, Haslina; Shukri, Saidatul A'isyah Ahmad

    2017-10-01

    Recently, Augmented Reality (AR) is an emerging technology in many mobile applications. Mobile AR was defined as a medium for displaying information merged with the real world environment mapped with augmented reality surrounding in a single view. There are four main types of mobile augmented reality interfaces and one of them are multimodal interfaces. Multimodal interface processes two or more combined user input modes (such as speech, pen, touch, manual gesture, gaze, and head and body movements) in a coordinated manner with multimedia system output. In multimodal interface, many frameworks have been proposed to guide the designer to develop a multimodal applications including in augmented reality environment but there has been little work reviewing the framework of adaptive multimodal interface in mobile augmented reality. The main goal of this study is to propose a conceptual framework to illustrate the adaptive multimodal interface in mobile augmented reality. We reviewed several frameworks that have been proposed in the field of multimodal interfaces, adaptive interface and augmented reality. We analyzed the components in the previous frameworks and measure which can be applied in mobile devices. Our framework can be used as a guide for designers and developer to develop a mobile AR application with an adaptive multimodal interfaces.

  19. Player/Avatar Body Relations in Multimodal Augmented Reality Games

    NARCIS (Netherlands)

    Rosa, N.E.

    2016-01-01

    Augmented reality research is finally moving towards multimodal experiences: more and more applications do not only include visuals, but also audio and even haptics. The purpose of multimodality in these applications can be to increase realism or to increase the amount or quality of communicated

  20. Multimodal network design for sustainable household plastic recycling

    NARCIS (Netherlands)

    Bing Xiaoyun, Xiaoyun; Groot, J.J.; Bloemhof, J.M.; Vorst, van der J.G.A.J.

    2013-01-01

    Purpose – This research studies a plastic recycling system from a reverse logistics angle and investigates the potential benefits of a multimodality strategy to the network design of plastic recycling. This research aims to quantify the impact of multimodality on the network, to provide decision

  1. A Multimodal Database for Affect Recognition and Implicit Tagging

    NARCIS (Netherlands)

    Soleymani, Mohammad; Lichtenauer, Jeroen; Pun, Thierry; Pantic, Maja

    MAHNOB-HCI is a multimodal database recorded in response to affective stimuli with the goal of emotion recognition and implicit tagging research. A multimodal setup was arranged for synchronized recording of face videos, audio signals, eye gaze data, and peripheral/central nervous system

  2. The Big Five: Addressing Recurrent Multimodal Learning Data Challenges

    NARCIS (Netherlands)

    Di Mitri, Daniele; Schneider, Jan; Specht, Marcus; Drachsler, Hendrik

    2018-01-01

    The analysis of multimodal data in learning is a growing field of research, which has led to the development of different analytics solutions. However, there is no standardised approach to handle multimodal data. In this paper, we describe and outline a solution for five recurrent challenges in

  3. Composition at Washington State University: Building a Multimodal Bricolage

    Science.gov (United States)

    Ericsson, Patricia; Hunter, Leeann Downing; Macklin, Tialitha Michelle; Edwards, Elizabeth Sue

    2016-01-01

    Multimodal pedagogy is increasingly accepted among composition scholars. However, putting such pedagogy into practice presents significant challenges. In this profile of Washington State University's first-year composition program, we suggest a multi-vocal and multi-theoretical approach to addressing the challenges of multimodal pedagogy. Patricia…

  4. Multimodal Scaffolding in the Secondary English Classroom Curriculum

    Science.gov (United States)

    Boche, Benjamin; Henning, Megan

    2015-01-01

    This article examines the topic of multimodal scaffolding in the secondary English classroom curriculum through the viewpoint of one teacher's experiences. With technology becoming more commonplace and readily available in the English classroom, we must pinpoint specific and tangible ways to help teachers use and teach multimodalities in their…

  5. MULTIMODAL ANALGESIA AFTER TOTAL HIP ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    I. G. Mukutsa

    2012-01-01

    Full Text Available Purpose - to assess the effect of multimodal analgesia in the early rehabilitation of patients after hip replacement. Materials and methods. A prospective single-centre randomized research, which included 32 patients. Patients of the 1st group received paracetamol, ketorolac and tramadol, the 2nd group of patients - ketorolac intravenously and the 3rd group of patients - etoricoxib and gabapentin. Patients of the 2nd and the 3rd groups underwent epidural analgesia with ropivacaine. Multimodal analgesia was carried out for 48 hours after the surgery. Assessment of pain intensity was performed by the VAS (visual analogue scale, a neuropathic pain component - on the DN4 questionnaire . Time was recorded during the first and second verticalization of patients, using the distance walkers and by fixing the distance covered with in 2 minutes. Results. The intensity of pain for more than 50 mm on VAS at movement at least once every 48 hours after the surgery was occurred among 9% of the 1st group, 22% of patients from the 2nd group and 8% of patients of the 3rd group. Number of patients with neuropathic pain component decreased from 25% to 3% (p ≤ 0.05. The first verticalization was performed 10 ± 8 hours after the surgery, the second - 21 ± 8 hours later. Two-minute walk distance was 5 ± 3 and 8 ± 4 m, respectively. It is noted more frequent adverse events in patients of the 1st group was noted compared to patients of the 2nd and the 3rd groups during first (91%, 33% and 25%, p ≤ 0.05 and the second verticalization (70%, 25% and 17%, p ≤ 0.05. Multimodal analgesia allows to proceed with the successful activation of patients after hip replacement with in the first day after the surgery. The 3rd group patients are noted with a tendency for the optimal combination of efficient and safe of analgetic therapy.

  6. New developments in multimodal clinical multiphoton tomography

    Science.gov (United States)

    König, Karsten

    2011-03-01

    80 years ago, the PhD student Maria Goeppert predicted in her thesis in Goettingen, Germany, two-photon effects. It took 30 years to prove her theory, and another three decades to realize the first two-photon microscope. With the beginning of this millennium, first clinical multiphoton tomographs started operation in research institutions, hospitals, and in the cosmetic industry. The multiphoton tomograph MPTflexTM with its miniaturized flexible scan head became the Prism-Award 2010 winner in the category Life Sciences. Multiphoton tomographs with its superior submicron spatial resolution can be upgraded to 5D imaging tools by adding spectral time-correlated single photon counting units. Furthermore, multimodal hybrid tomographs provide chemical fingerprinting and fast wide-field imaging. The world's first clinical CARS studies have been performed with a hybrid multimodal multiphoton tomograph in spring 2010. In particular, nonfluorescent lipids and water as well as mitochondrial fluorescent NAD(P)H, fluorescent elastin, keratin, and melanin as well as SHG-active collagen have been imaged in patients with dermatological disorders. Further multimodal approaches include the combination of multiphoton tomographs with low-resolution imaging tools such as ultrasound, optoacoustic, OCT, and dermoscopy systems. Multiphoton tomographs are currently employed in Australia, Japan, the US, and in several European countries for early diagnosis of skin cancer (malignant melanoma), optimization of treatment strategies (wound healing, dermatitis), and cosmetic research including long-term biosafety tests of ZnO sunscreen nanoparticles and the measurement of the stimulated biosynthesis of collagen by anti-ageing products.

  7. Invariant measures on multimode quantum Gaussian states

    Science.gov (United States)

    Lupo, C.; Mancini, S.; De Pasquale, A.; Facchi, P.; Florio, G.; Pascazio, S.

    2012-12-01

    We derive the invariant measure on the manifold of multimode quantum Gaussian states, induced by the Haar measure on the group of Gaussian unitary transformations. To this end, by introducing a bipartition of the system in two disjoint subsystems, we use a parameterization highlighting the role of nonlocal degrees of freedom—the symplectic eigenvalues—which characterize quantum entanglement across the given bipartition. A finite measure is then obtained by imposing a physically motivated energy constraint. By averaging over the local degrees of freedom we finally derive the invariant distribution of the symplectic eigenvalues in some cases of particular interest for applications in quantum optics and quantum information.

  8. Invariant measures on multimode quantum Gaussian states

    International Nuclear Information System (INIS)

    Lupo, C.; Mancini, S.; De Pasquale, A.; Facchi, P.; Florio, G.; Pascazio, S.

    2012-01-01

    We derive the invariant measure on the manifold of multimode quantum Gaussian states, induced by the Haar measure on the group of Gaussian unitary transformations. To this end, by introducing a bipartition of the system in two disjoint subsystems, we use a parameterization highlighting the role of nonlocal degrees of freedom—the symplectic eigenvalues—which characterize quantum entanglement across the given bipartition. A finite measure is then obtained by imposing a physically motivated energy constraint. By averaging over the local degrees of freedom we finally derive the invariant distribution of the symplectic eigenvalues in some cases of particular interest for applications in quantum optics and quantum information.

  9. Invariant measures on multimode quantum Gaussian states

    Energy Technology Data Exchange (ETDEWEB)

    Lupo, C. [School of Science and Technology, Universita di Camerino, I-62032 Camerino (Italy); Mancini, S. [School of Science and Technology, Universita di Camerino, I-62032 Camerino (Italy); Istituto Nazionale di Fisica Nucleare, Sezione di Perugia, I-06123 Perugia (Italy); De Pasquale, A. [NEST, Scuola Normale Superiore and Istituto Nanoscienze-CNR, I-56126 Pisa (Italy); Facchi, P. [Dipartimento di Matematica and MECENAS, Universita di Bari, I-70125 Bari (Italy); Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari (Italy); Florio, G. [Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari (Italy); Museo Storico della Fisica e Centro Studi e Ricerche Enrico Fermi, Piazza del Viminale 1, I-00184 Roma (Italy); Dipartimento di Fisica and MECENAS, Universita di Bari, I-70126 Bari (Italy); Pascazio, S. [Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70126 Bari (Italy); Dipartimento di Fisica and MECENAS, Universita di Bari, I-70126 Bari (Italy)

    2012-12-15

    We derive the invariant measure on the manifold of multimode quantum Gaussian states, induced by the Haar measure on the group of Gaussian unitary transformations. To this end, by introducing a bipartition of the system in two disjoint subsystems, we use a parameterization highlighting the role of nonlocal degrees of freedom-the symplectic eigenvalues-which characterize quantum entanglement across the given bipartition. A finite measure is then obtained by imposing a physically motivated energy constraint. By averaging over the local degrees of freedom we finally derive the invariant distribution of the symplectic eigenvalues in some cases of particular interest for applications in quantum optics and quantum information.

  10. Sensory Substitution and Multimodal Mental Imagery.

    Science.gov (United States)

    Nanay, Bence

    2017-09-01

    Many philosophers use findings about sensory substitution devices in the grand debate about how we should individuate the senses. The big question is this: Is "vision" assisted by (tactile) sensory substitution really vision? Or is it tactile perception? Or some sui generis novel form of perception? My claim is that sensory substitution assisted "vision" is neither vision nor tactile perception, because it is not perception at all. It is mental imagery: visual mental imagery triggered by tactile sensory stimulation. But it is a special form of mental imagery that is triggered by corresponding sensory stimulation in a different sense modality, which I call "multimodal mental imagery."

  11. Multimodal Landscaping in Higher Education Research

    DEFF Research Database (Denmark)

    Lueg, Klarissa

    2018-01-01

    The purpose of this paper is to introduce Multimodal Landscaping (ML) as a conceptual framework, and to illustrate how this approach can be applied within the field of higher education research. It is argued that ML is a suitable tool, especially, in studies investigating university...... internationalization, and in studies focusing on the agent level of higher education organizations. ML is argued to add to the diversity of methods within a social constructivist methodology. The author illustrates how ML is connected and/or different from kindred approaches. Pathways are proposed as to how...

  12. Multimodality Imaging of Heart Valve Disease

    International Nuclear Information System (INIS)

    Rajani, Ronak; Khattar, Rajdeep; Chiribiri, Amedeo; Victor, Kelly; Chambers, John

    2014-01-01

    Unidentified heart valve disease is associated with a significant morbidity and mortality. It has therefore become important to accurately identify, assess and monitor patients with this condition in order that appropriate and timely intervention can occur. Although echocardiography has emerged as the predominant imaging modality for this purpose, recent advances in cardiac magnetic resonance and cardiac computed tomography indicate that they may have an important contribution to make. The current review describes the assessment of regurgitant and stenotic heart valves by multimodality imaging (echocardiography, cardiac computed tomography and cardiac magnetic resonance) and discusses their relative strengths and weaknesses

  13. Multimodality Imaging of Heart Valve Disease

    Energy Technology Data Exchange (ETDEWEB)

    Rajani, Ronak, E-mail: Dr.R.Rajani@gmail.com [Department of Cardiology, St. Thomas’ Hospital, London (United Kingdom); Khattar, Rajdeep [Department of Cardiology, Royal Brompton Hospital, London (United Kingdom); Chiribiri, Amedeo [Divisions of Imaging Sciences, The Rayne Institute, St. Thomas' Hospital, London (United Kingdom); Victor, Kelly; Chambers, John [Department of Cardiology, St. Thomas’ Hospital, London (United Kingdom)

    2014-09-15

    Unidentified heart valve disease is associated with a significant morbidity and mortality. It has therefore become important to accurately identify, assess and monitor patients with this condition in order that appropriate and timely intervention can occur. Although echocardiography has emerged as the predominant imaging modality for this purpose, recent advances in cardiac magnetic resonance and cardiac computed tomography indicate that they may have an important contribution to make. The current review describes the assessment of regurgitant and stenotic heart valves by multimodality imaging (echocardiography, cardiac computed tomography and cardiac magnetic resonance) and discusses their relative strengths and weaknesses.

  14. Multimodal Imaging Brain Connectivity Analysis (MIBCA toolbox

    Directory of Open Access Journals (Sweden)

    Andre Santos Ribeiro

    2015-07-01

    Full Text Available Aim. In recent years, connectivity studies using neuroimaging data have increased the understanding of the organization of large-scale structural and functional brain networks. However, data analysis is time consuming as rigorous procedures must be assured, from structuring data and pre-processing to modality specific data procedures. Until now, no single toolbox was able to perform such investigations on truly multimodal image data from beginning to end, including the combination of different connectivity analyses. Thus, we have developed the Multimodal Imaging Brain Connectivity Analysis (MIBCA toolbox with the goal of diminishing time waste in data processing and to allow an innovative and comprehensive approach to brain connectivity.Materials and Methods. The MIBCA toolbox is a fully automated all-in-one connectivity toolbox that offers pre-processing, connectivity and graph theoretical analyses of multimodal image data such as diffusion-weighted imaging, functional magnetic resonance imaging (fMRI and positron emission tomography (PET. It was developed in MATLAB environment and pipelines well-known neuroimaging softwares such as Freesurfer, SPM, FSL, and Diffusion Toolkit. It further implements routines for the construction of structural, functional and effective or combined connectivity matrices, as well as, routines for the extraction and calculation of imaging and graph-theory metrics, the latter using also functions from the Brain Connectivity Toolbox. Finally, the toolbox performs group statistical analysis and enables data visualization in the form of matrices, 3D brain graphs and connectograms. In this paper the MIBCA toolbox is presented by illustrating its capabilities using multimodal image data from a group of 35 healthy subjects (19–73 years old with volumetric T1-weighted, diffusion tensor imaging, and resting state fMRI data, and 10 subjets with 18F-Altanserin PET data also.Results. It was observed both a high inter

  15. Registration of deformed multimodality medical images

    International Nuclear Information System (INIS)

    Moshfeghi, M.; Naidich, D.

    1989-01-01

    The registration and combination of images from different modalities have several potential applications, such as functional and anatomic studies, 3D radiation treatment planning, surgical planning, and retrospective studies. Image registration algorithms should correct for any local deformations caused by respiration, heart beat, imaging device distortions, and so forth. This paper reports on an elastic matching technique for registering deformed multimodality images. Correspondences between contours in the two images are used to stretch the deformed image toward its goal image. This process is repeated a number of times, with decreasing image stiffness. As the iterations continue, the stretched image better approximates its goal image

  16. Development of Multimodal Human Interface Technology

    Science.gov (United States)

    Hirose, Michitaka

    About 20 years have passed since the word “Virtual Reality” became popular. During these two decades, novel human interface technology so called “multimodal interface technology” has been formed. In this paper, firstly, recent progress in realtime CG, BCI and five senses IT is quickly reviewed. Since the life cycle of the information technology is said to be 20 years or so, novel directions and paradigms of VR technology can be found in conjunction with the technologies forementioned. At the end of the paper, these futuristic directions such as ultra-realistic media are briefly introduced.

  17. Multimodal approach to the international transit transport

    Directory of Open Access Journals (Sweden)

    D. Bazaras

    2003-12-01

    Full Text Available In the article not only the problems of multi-modal and inter-modal conveyances in Lithuania and the concept of transit and the transit system stimulating factors are analysed, but also the modelling of transit transport and the flows of the loads are given. The main part of the article comes to the analysis of resent situation of Lithuania. In this part the place of transport sector in the market of transit services is analysed and the transit profit for Lithuanian economy is evaluated. The conclusions and proposals are given at the end of the article.

  18. Percorsi linguistici e semiotici: Critical Multimodal Analysis of Digital Discourse

    Directory of Open Access Journals (Sweden)

    edited by Ilaria Moschini

    2014-12-01

    Full Text Available The language section of LEA - edited by Ilaria Moschini - is dedicated to the Critical Multimodal Analysis of Digital Discourse, an approach that encompasses the linguistic and semiotic detailed investigation of texts within a socio-cultural perspective. It features an interview with Professor Theo van Leeuwen by Ilaria Moschini and four essays: “Retwitting, reposting, repinning; reshaping identities online: Towards a social semiotic multimodal analysis of digital remediation” by Elisabetta Adami; “Multimodal aspects of corporate social responsibility communication” by Carmen Daniela Maier; “Pervasive Technologies and the Paradoxes of Multimodal Digital Communication” by Sandra Petroni and “Can the powerless speak? Linguistic and multimodal corporate media manipulation in digital environments: the case of Malala Yousafzai” by Maria Grazia Sindoni. 

  19. Multimodality 3D Superposition and Automated Whole Brain Tractography: Comprehensive Printing of the Functional Brain.

    Science.gov (United States)

    Konakondla, Sanjay; Brimley, Cameron J; Sublett, Jesna Mathew; Stefanowicz, Edward; Flora, Sarah; Mongelluzzo, Gino; Schirmer, Clemens M

    2017-09-29

    Whole brain tractography using diffusion tensor imaging (DTI) sequences can be used to map cerebral connectivity; however, this can be time-consuming due to the manual component of image manipulation required, calling for the need for a standardized, automated, and accurate fiber tracking protocol with automatic whole brain tractography (AWBT). Interpreting conventional two-dimensional (2D) images, such as computed tomography (CT) and magnetic resonance imaging (MRI), as an intraoperative three-dimensional (3D) environment is a difficult task with recognized inter-operator variability. Three-dimensional printing in neurosurgery has gained significant traction in the past decade, and as software, equipment, and practices become more refined, trainee education, surgical skills, research endeavors, innovation, patient education, and outcomes via valued care is projected to improve. We describe a novel multimodality 3D superposition (MMTS) technique, which fuses multiple imaging sequences alongside cerebral tractography into one patient-specific 3D printed model. Inferences on cost and improved outcomes fueled by encouraging patient engagement are explored.

  20. [Radiofrequency ablation in the multimodal treatment of liver metastases--preliminary report].

    Science.gov (United States)

    Burcoveanu, C; Dogaru, C; Diaconu, C; Grecu, F; Dragomir, Cr; Pricop, Adriana; Balan, G; Drug, V L

    2007-01-01

    Although the "gold standard" in the multimodal treatment of liver primary and secondary tumors is the surgical ablation, the rate of resection, despite the last decades advances, remains still low (10 - 20%). In addition, the interest for non-surgical ablation therapies is increasing. Among them, regional or systemic chemotherapy, intra-arterial radiotherapy as well as locally targeted therapies--cryotherapy, alcohol instillation and radiofrequency (RF) are the most valuable options as alternative to the surgical approach. Between February 2005 - January 2007, 9 patients with liver metastases underwent open RF ablation of their secondaries in the III-rd Surgical Unit, "St. Spiridon" Hospital. An Elektrotom 106 HiTT Berchtold device with a 60W power generator and a 15 mm monopolar active electrode was used. Destruction of the tumors was certified with intraoperative ultrasound examination. Pre- and postoperative CarcinoEmbryonic Antigen (CEA) together with imaging follow-up was carried out, in order to determine local or systemic recurrencies. Six patients died between 6 month - 4 years after the RF ablation. Median survival is 29.2 months. RF ablation is a challenge alternative in non-resectable liver tumors.

  1. Development of a precision multimodal surgical navigation system for lung robotic segmentectomy.

    Science.gov (United States)

    Baste, Jean Marc; Soldea, Valentin; Lachkar, Samy; Rinieri, Philippe; Sarsam, Mathieu; Bottet, Benjamin; Peillon, Christophe

    2018-04-01

    Minimally invasive sublobar anatomical resection is becoming more and more popular to manage early lung lesions. Robotic-assisted thoracic surgery (RATS) is unique in comparison with other minimally invasive techniques. Indeed, RATS is able to better integrate multiple streams of information including advanced imaging techniques, in an immersive experience at the level of the robotic console. Our aim was to describe three-dimensional (3D) imaging throughout the surgical procedure from preoperative planning to intraoperative assistance and complementary investigations such as radial endobronchial ultrasound (R-EBUS) and virtual bronchoscopy for pleural dye marking. All cases were operated using the DaVinci System TM . Modelisation was provided by Visible Patient™ (Strasbourg, France). Image integration in the operative field was achieved using the Tile Pro multi display input of the DaVinci console. Our experience was based on 114 robotic segmentectomies performed between January 2012 and October 2017. The clinical value of 3D imaging integration was evaluated in 2014 in a pilot study. Progressively, we have reached the conclusion that the use of such an anatomic model improves the safety and reliability of procedures. The multimodal system including 3D imaging has been used in more than 40 patients so far and demonstrated a perfect operative anatomic accuracy. Currently, we are developing an original virtual reality experience by exploring 3D imaging models at the robotic console level. The act of operating is being transformed and the surgeon now oversees a complex system that improves decision making.

  2. Multimodal EEG Recordings, Psychometrics and Behavioural Analysis.

    Science.gov (United States)

    Boeijinga, Peter H

    2015-01-01

    High spatial and temporal resolution measurements of neuronal activity are preferably combined. In an overview on how this approach can take shape, multimodal electroencephalography (EEG) is treated in 2 main parts: by experiments without a task and in the experimentally cued working brain. It concentrates first on the alpha rhythm properties and next on data-driven search for patterns such as the default mode network. The high-resolution volumic distributions of neuronal metabolic indices result in distributed cortical regions and possibly relate to numerous nuclei, observable in a non-invasive manner in the central nervous system of humans. The second part deals with paradigms in which nowadays assessment of target-related networks can align level-dependent blood oxygenation, electrical responses and behaviour, taking the temporal resolution advantages of event-related potentials. Evidence-based electrical propagation in serial tasks during performance is now to a large extent attributed to interconnected pathways, particularly chronometry-dependent ones, throughout a chain including a dorsal stream, next ventral cortical areas taking the flow of information towards inferior temporal domains. The influence of aging is documented, and results of the first multimodal studies in neuropharmacology are consistent. Finally a scope on implementation of advanced clinical applications and personalized marker strategies in neuropsychiatry is indicated. © 2016 S. Karger AG, Basel.

  3. Fiber Optic Pressure Sensor using Multimode Interference

    International Nuclear Information System (INIS)

    Ruiz-Perez, V I; Sanchez-Mondragon, J J; Basurto-Pensado, M A; LiKamWa, P; May-Arrioja, D A

    2011-01-01

    Based on the theory of multimode interference (MMI) and self-image formation, we developed a novel intrinsic optical fiber pressure sensor. The sensing element consists of a section of multimode fiber (MMF) without cladding spliced between two single mode fibers (SMF). The MMI pressure sensor is based on the intensity changes that occur in the transmitted light when the effective refractive index of the MMF is changed. Basically, a thick layer of Polydimethylsiloxane (PDMS) is placed in direct contact with the MMF section, such that the contact area between the PDMS and the fiber will change proportionally with the applied pressure, which results in a variation of the transmitted light intensity. Using this configuration, a good correlation between the measured intensity variations and the applied pressure is obtained. The sensitivity of the sensor is 3 μV/psi, for a range of 0-60 psi, and the maximum resolution of our system is 0.25 psi. Good repeatability is also observed with a standard deviation of 0.0019. The key feature of the proposed pressure sensor is its low fabrication cost, since the cost of the MMF is minimal.

  4. Fiber Optic Pressure Sensor using Multimode Interference

    Energy Technology Data Exchange (ETDEWEB)

    Ruiz-Perez, V I; Sanchez-Mondragon, J J [INAOE, Apartado Postal 51 y 216, Puebla 72000 (Mexico); Basurto-Pensado, M A [CIICAp, Universidad Autonoma del Estado de Morelos (Mexico); LiKamWa, P [CREOL, University of Central Florida, Orlando, FL 32816 (United States); May-Arrioja, D A, E-mail: iruiz@inaoep.mx, E-mail: mbasurto@uaem.mx, E-mail: delta_dirac@hotmail.com, E-mail: daniel_may_arrioja@hotmail.com [UAT Reynosa Rodhe, Universidad Autonoma de Tamaulipas (Mexico)

    2011-01-01

    Based on the theory of multimode interference (MMI) and self-image formation, we developed a novel intrinsic optical fiber pressure sensor. The sensing element consists of a section of multimode fiber (MMF) without cladding spliced between two single mode fibers (SMF). The MMI pressure sensor is based on the intensity changes that occur in the transmitted light when the effective refractive index of the MMF is changed. Basically, a thick layer of Polydimethylsiloxane (PDMS) is placed in direct contact with the MMF section, such that the contact area between the PDMS and the fiber will change proportionally with the applied pressure, which results in a variation of the transmitted light intensity. Using this configuration, a good correlation between the measured intensity variations and the applied pressure is obtained. The sensitivity of the sensor is 3 {mu}V/psi, for a range of 0-60 psi, and the maximum resolution of our system is 0.25 psi. Good repeatability is also observed with a standard deviation of 0.0019. The key feature of the proposed pressure sensor is its low fabrication cost, since the cost of the MMF is minimal.

  5. ASIC3 channels in multimodal sensory perception.

    Science.gov (United States)

    Li, Wei-Guang; Xu, Tian-Le

    2011-01-19

    Acid-sensing ion channels (ASICs), which are members of the sodium-selective cation channels belonging to the epithelial sodium channel/degenerin (ENaC/DEG) family, act as membrane-bound receptors for extracellular protons as well as nonproton ligands. At least five ASIC subunits have been identified in mammalian neurons, which form both homotrimeric and heterotrimeric channels. The highly proton sensitive ASIC3 channels are predominantly distributed in peripheral sensory neurons, correlating with their roles in multimodal sensory perception, including nociception, mechanosensation, and chemosensation. Different from other ASIC subunit composing ion channels, ASIC3 channels can mediate a sustained window current in response to mild extracellular acidosis (pH 7.3-6.7), which often occurs accompanied by many sensory stimuli. Furthermore, recent evidence indicates that the sustained component of ASIC3 currents can be enhanced by nonproton ligands including the endogenous metabolite agmatine. In this review, we first summarize the growing body of evidence for the involvement of ASIC3 channels in multimodal sensory perception and then discuss the potential mechanisms underlying ASIC3 activation and mediation of sensory perception, with a special emphasis on its role in nociception. We conclude that ASIC3 activation and modulation by diverse sensory stimuli represent a new avenue for understanding the role of ASIC3 channels in sensory perception. Furthermore, the emerging implications of ASIC3 channels in multiple sensory dysfunctions including nociception allow the development of new pharmacotherapy.

  6. Multimodal 2D Brain Computer Interface.

    Science.gov (United States)

    Almajidy, Rand K; Boudria, Yacine; Hofmann, Ulrich G; Besio, Walter; Mankodiya, Kunal

    2015-08-01

    In this work we used multimodal, non-invasive brain signal recording systems, namely Near Infrared Spectroscopy (NIRS), disc electrode electroencephalography (EEG) and tripolar concentric ring electrodes (TCRE) electroencephalography (tEEG). 7 healthy subjects participated in our experiments to control a 2-D Brain Computer Interface (BCI). Four motor imagery task were performed, imagery motion of the left hand, the right hand, both hands and both feet. The signal slope (SS) of the change in oxygenated hemoglobin concentration measured by NIRS was used for feature extraction while the power spectrum density (PSD) of both EEG and tEEG in the frequency band 8-30Hz was used for feature extraction. Linear Discriminant Analysis (LDA) was used to classify different combinations of the aforementioned features. The highest classification accuracy (85.2%) was achieved by using features from all the three brain signals recording modules. The improvement in classification accuracy was highly significant (p = 0.0033) when using the multimodal signals features as compared to pure EEG features.

  7. Photonic lantern with multimode fibers embedded

    Science.gov (United States)

    Yu, Hai-Jiao; Yan, Qi; Huang, Zong-Jun; Tian, He; Jiang, Yu; Liu, Yong-Jun; Zhang, Jian-Zhong; Sun, Wei-Min

    2014-08-01

    A photonic lantern is studied which is formed by seven multimode fibers inserted into a pure silica capillary tube. The core of the tapered end has a uniform refractive index because the polymer claddings are removed before the fibers are inserted. Consequently, the light distribution is also uniform. Two theories describing a slowly varying waveguide and multimode coupling are used to analyze the photonic lantern. The transmission loss decreases as the length of the tapered part increases. For a device with a taper length of 3.4 cm, the loss is about 1.06 dB on average for light propagating through the taper from an inserted fiber to the tapered end and 0.99 dB in the reverse direction. For a device with a taper length of 0.7 cm, the two loss values are 2.63 dB and 2.53 dB, respectively. The results show that it is possible to achieve a uniform light distribution with the tapered end and a low-loss transmission in the device if parameters related to the lantern are reasonably defined.

  8. Photonic lantern with multimode fibers embedded

    International Nuclear Information System (INIS)

    Yu Hai-Jiao; Yan Qi; Huang Zong-Jun; Tian He; Jiang Yu; Liu Yong-Jun; Zhang Jian-Zhong; Sun Wei-Min

    2014-01-01

    A photonic lantern is studied which is formed by seven multimode fibers inserted into a pure silica capillary tube. The core of the tapered end has a uniform refractive index because the polymer claddings are removed before the fibers are inserted. Consequently, the light distribution is also uniform. Two theories describing a slowly varying waveguide and multimode coupling are used to analyze the photonic lantern. The transmission loss decreases as the length of the tapered part increases. For a device with a taper length of 3.4 cm, the loss is about 1.06 dB on average for light propagating through the taper from an inserted fiber to the tapered end and 0.99 dB in the reverse direction. For a device with a taper length of 0.7 cm, the two loss values are 2.63 dB and 2.53 dB, respectively. The results show that it is possible to achieve a uniform light distribution with the tapered end and a low-loss transmission in the device if parameters related to the lantern are reasonably defined. (research papers)

  9. Quantitative multi-modal NDT data analysis

    International Nuclear Information System (INIS)

    Heideklang, René; Shokouhi, Parisa

    2014-01-01

    A single NDT technique is often not adequate to provide assessments about the integrity of test objects with the required coverage or accuracy. In such situations, it is often resorted to multi-modal testing, where complementary and overlapping information from different NDT techniques are combined for a more comprehensive evaluation. Multi-modal material and defect characterization is an interesting task which involves several diverse fields of research, including signal and image processing, statistics and data mining. The fusion of different modalities may improve quantitative nondestructive evaluation by effectively exploiting the augmented set of multi-sensor information about the material. It is the redundant information in particular, whose quantification is expected to lead to increased reliability and robustness of the inspection results. There are different systematic approaches to data fusion, each with its specific advantages and drawbacks. In our contribution, these will be discussed in the context of nondestructive materials testing. A practical study adopting a high-level scheme for the fusion of Eddy Current, GMR and Thermography measurements on a reference metallic specimen with built-in grooves will be presented. Results show that fusion is able to outperform the best single sensor regarding detection specificity, while retaining the same level of sensitivity

  10. Multimodal Network Equilibrium with Stochastic Travel Times

    Directory of Open Access Journals (Sweden)

    M. Meng

    2014-01-01

    Full Text Available The private car, unlike public traffic modes (e.g., subway, trolley running along dedicated track-ways, is invariably subject to various uncertainties resulting in travel time variation. A multimodal network equilibrium model is formulated that explicitly considers stochastic link capacity variability in the road network. The travel time of combined-mode trips is accumulated based on the concept of the mean excess travel time (METT which is a summation of estimated buffer time and tardy time. The problem is characterized by an equivalent VI (variational inequality formulation where the mode choice is expressed in a hierarchical logit structure. Specifically, the supernetwork theory and expansion technique are used herein to represent the multimodal transportation network, which completely represents the combined-mode trips as constituting multiple modes within a trip. The method of successive weighted average is adopted for problem solutions. The model and solution method are further applied to study the trip distribution and METT variations caused by the different levels of the road conditions. Results of numerical examples show that travelers prefer to choose the combined travel mode as road capacity decreases. Travelers with different attitudes towards risk are shown to exhibit significant differences when making travel choice decisions.

  11. Intraoperative Recurrent Laryngeal Nerve Monitoring in a Patient with Contralateral Vocal Fold Palsy

    Directory of Open Access Journals (Sweden)

    Bub-Se Na

    2017-10-01

    Full Text Available Recurrent laryngeal nerve injury can develop following cervical or thoracic surgery; however, few reports have described intraoperative recurrent laryngeal nerve monitoring. Consensus regarding the use of this technique during thoracic surgery is lacking. We used intraoperative recurrent laryngeal nerve monitoring in a patient with contralateral vocal cord paralysis who was scheduled for completion pneumonectomy. This case serves as an example of intraoperative recurrent laryngeal nerve monitoring during thoracic surgery and supports this indication for its use.

  12. Diagnosing periprosthetic infection: false-positive intraoperative Gram stains.

    Science.gov (United States)

    Oethinger, Margret; Warner, Debra K; Schindler, Susan A; Kobayashi, Hideo; Bauer, Thomas W

    2011-04-01

    Intraoperative Gram stains have a reported low sensitivity but high specificity when used to help diagnose periprosthetic infections. In early 2008, we recognized an unexpectedly high frequency of apparent false-positive Gram stains from revision arthroplasties. The purpose of this report is to describe the cause of these false-positive test results. We calculated the sensitivity and specificity of all intraoperative Gram stains submitted from revision arthroplasty cases during a 3-month interval using microbiologic cultures of the same samples as the gold standard. Methods of specimen harvesting, handling, transport, distribution, specimen processing including tissue grinding/macerating, Gram staining, and interpretation were studied. After a test modification, results of specimens were prospectively collected for a second 3-month interval, and the sensitivity and specificity of intraoperative Gram stains were calculated. The retrospective review of 269 Gram stains submitted from revision arthroplasties indicated historic sensitivity and specificity values of 23% and 92%, respectively. Systematic analysis of all steps of the procedure identified Gram-stained but nonviable bacteria in commercial broth reagents used as diluents for maceration of periprosthetic membranes before Gram staining and culture. Polymerase chain reaction and sequencing showed mixed bacterial DNA. Evaluation of 390 specimens after initiating standardized Millipore filtering of diluent fluid revealed a reduced number of positive Gram stains, yielding 9% sensitivity and 99% specificity. Clusters of false-positive Gram stains have been reported in other clinical conditions. They are apparently rare related to diagnosing periprosthetic infections but have severe consequences if used to guide treatment. Even occasional false-positive Gram stains should prompt review of laboratory methods. Our observations implicate dead bacteria in microbiologic reagents as potential sources of false-positive Gram

  13. Intraoperative HDR implant boost for breast cancer (preliminary results)

    International Nuclear Information System (INIS)

    Rodriguez, I.; Torre, M. de la; Gonzalez, E.; Bourel, V.

    1996-01-01

    Introduction: In spite of the fact that it is been discussed whether or not a boost is necessary for all conservative treated breast cancer patients, it is a generalized radiotherapy practice. Since september 1993 we developed a breast conservative protocol for early stage breast cancer (T1-T2) with intraoperative HDR implant boost. Side effects, cosmetic results and recurrence rates are reviewed. Method and Material: From September 1993 we treated 55 patients with intraoperative HDR implant boost to the lumpectomy site for clinical T1 or T2 invasive breast cancer, followed by external megavoltage radiotherapy to the entire breast. We used the Nucletron microselectron HDR remote afterloading system with flexible implant tubes. The geometric distribution of the tubes was performed according to the 'Paris' configuration. Each implant was evaluated by calculating the dose-volume natural histograms. The HDR fractionation schedule consists of three fractions of 4.5Gy each given at least 48 hs apart, and starting between 48-72hs from surgical procedure. The external radiotherapy to the entire breast started one week after the completion of brachytherapy, using conventional fractionation of 5 fractions per week, 1,8Gy per fraction up to 45-50Gy. Results: So far there is not any local recurrence, but medium follow up is only 18 months. We did not observe any acute damage and the cosmetic outcome was 60% excellent, 30% good and 10% acceptable. Two patients developed localized fibrosis, in both the implant involved the submamary fold. Conclusion: The intraoperative implant is the most accurate way to localize the lumpectomy site, to define the target volume, decrease the total treatment time and avoid a second anesthetic procedure without delaying the inpatient time or the initial wound healing process

  14. [Intraoperative choledochoscopy usefulness in the treatment of difficult biliary stones].

    Science.gov (United States)

    Cuendis-Velázquez, A; Rojano-Rodríguez, M E; Morales-Chávez, C E; González Angulo-Rocha, A; Fernández-Castro, E; Aguirre-Olmedo, I; Torres-Ruiz, M F; Orellana-Parra, J C; Cárdenas-Lailson, L E

    2014-01-01

    Choledocholithiasis presents in 5-10% of the patients with biliary lithiasis. Numerous treatment algorithms have been considered for this disease, however, up to 10% of these therapeutic procedures may fail. Intraoperative choledochoscopy has become a useful tool in the treatment of patients with difficult-to-manage choledocholithiasis. To determine the usefulness of intraoperative choledochoscopy in the laparoendoscopic treatment of difficult stones that was carried out in our service. A cross-sectional study was conducted. The case records were reviewed of the patients that underwent intraoperative choledochoscopy during biliary tree exploration plus laparoscopic choledochoduodenal anastomosis within the time frame of March 1, 2011 and May 31, 2012, at the Hospital General Dr. Manuel Gea González. Transabdominal choledochoscopies were performed with active stone extraction when necessary, followed by peroral choledochoscopies through the recently formed bilioenteric anastomosis. The data were analyzed with descriptive statistics and measures of central tendency. The mean age was 71 years, 57% of the patients were women, and the ASA III score predominated. Active extraction of stones with 7 to 35mm diameters was carried out in 4 of the cases and the absence of stones in the biliary tract was corroborated in all the patients. The mean surgery duration was 18 minutes (range: 4 to 45min). Choledochoscopy is a safe and effective minimally invasive procedure for the definitive treatment of difficult stones. Copyright © 2013 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

  15. Pediatric awake craniotomy and intra-operative stimulation mapping.

    Science.gov (United States)

    Balogun, James A; Khan, Osaama H; Taylor, Michael; Dirks, Peter; Der, Tara; Carter Snead Iii, O; Weiss, Shelly; Ochi, Ayako; Drake, James; Rutka, James T

    2014-11-01

    The indications for operating on lesions in or near areas of cortical eloquence balance the benefit of resection with the risk of permanent neurological deficit. In adults, awake craniotomy has become a versatile tool in tumor, epilepsy and functional neurosurgery, permitting intra-operative stimulation mapping particularly for language, sensory and motor cortical pathways. This allows for maximal tumor resection with considerable reduction in the risk of post-operative speech and motor deficits. We report our experience of awake craniotomy and cortical stimulation for epilepsy and supratentorial tumors located in and around eloquent areas in a pediatric population (n=10, five females). The presenting symptom was mainly seizures and all children had normal neurological examinations. Neuroimaging showed lesions in the left opercular (n=4) and precentral or peri-sylvian regions (n=6). Three right-sided and seven left-sided awake craniotomies were performed. Two patients had a history of prior craniotomy. All patients had intra-operative mapping for either speech or motor or both using cortical stimulation. The surgical goal for tumor patients was gross total resection, while for all epilepsy procedures, focal cortical resections were completed without any difficulty. None of the patients had permanent post-operative neurologic deficits. The patient with an epileptic focus over the speech area in the left frontal lobe had a mild word finding difficulty post-operatively but this improved progressively. Follow-up ranged from 6 to 27 months. Pediatric awake craniotomy with intra-operative mapping is a precise, safe and reliable method allowing for resection of lesions in eloquent areas. Further validations on larger number of patients will be needed to verify the utility of this technique in the pediatric population. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Alpha antagonists and intraoperative floppy iris syndrome: A spectrum

    Directory of Open Access Journals (Sweden)

    Sharif A Issa

    2008-07-01

    Full Text Available Sharif A Issa, Omar H Hadid, Oliver Baylis, Margaret DayanDepartment of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UKBackground: To determine occurrence of features of intraoperative floppy iris syndrome (IFIS during cataract surgery in patients taking systemic alpha-antagonists (AA.Methods: We prospectively studied patients on AA and who underwent phacoemulsification. The following were recorded: pupil diameter preoperatively, iris flaccidity, iris prolapse and peroperative miosis.Results: We studied 40 eyes of 31 subjects. Mean age was 78 years. Overall, 14 eyes (13 patients showed signs of IFIS: 9/13 (69% eyes of patients on tamsulosin, 1/18 (6% eyes in the doxazosin group, 2/2 prazosin patients, 1/4 eyes in the indoramin group, and 1/2 eyes in two patients on a combination of doxazosin and tamsulosin. Most cases (92% had only one or two signs of IFIS. Bilateral cataract surgery was undertaken in 9 patients but only one patient (on tamsulosin had features of IFIS in both eyes, while 4 patients (2 on tamsulosin and 2 on other AA showed signs of IFIS in one eye only, and 4 patients did not show IFIS in either eye.Conclusion: Most AA were associated with IFIS, but it tends to present as a spectrum of signs rather than full triad originally described. Tamsulosin was most likely to be associated with IFIS; however, its intake does not necessarily mean that IFIS will occur. For patients on AA, the behavior of the iris intraoperatively in one eye is a poor predictor of the other eye. Surgeons should anticipate the occurrence of IFIS in any patient on AA.Keywords: alpha blocker, alpha antagonist, cataract surgery, intraoperative floppy iris syndrome, tamsulosin.

  17. Microdebrider tonsillectomy associated with more intraoperative blood loss than electrocautery.

    Science.gov (United States)

    Stansifer, Kyle J; Szramowski, Molly G; Barazsu, Lindsay; Buchinsky, Farrel J

    2012-10-01

    To describe and compare the intraoperative blood loss in children who underwent tonsillectomy and/or adenoidectomy during a transition from using electrocautery to a microdebrider. Retrospective case series of a single pediatric otolaryngologist at an urban general hospital. Patients aged 2-20 years who had tonsillectomy, adenoidectomy, or adenotonsillectomy over a 12 month period were included. Tonsillectomy was performed by microdebrider or electrocautery and adenoidectomy was performed by microdebrider, curette, or suction electrocautery. Total intraoperative blood loss was measured and compared between surgical techniques. Of the 148 patients, 109 had tonsillectomy with or without adenoidectomy and 39 had adenoidectomy alone. The mean blood loss was 47 ml or 1.8 ± 1.6 ml/kg and the maximum blood loss was 11 ml/kg. Adenoid curette and adenoid microdebrider yielded similar blood loss but were associated with more bleeding than suction electrocautery (Pelectrocautery tonsillectomy (mean of 2.6 ± 2.2 ml/kg versus 1.2 ± 1.2 ml/kg, P=0.0002). Eighteen percent of adenotonsillectomy patients lost greater than 5% of calculated circulating blood volume (95% CI, 9.8-26). Linear regression models did not show an association between the amount of blood loss and patient age, clinical indication, or the surgeon's experience with the microdebrider (P>0.05). Microdebrider tonsillectomy is associated with more intraoperative bleeding than electrocautery tonsillectomy. Approximately twice as much blood was lost with the microdebrider, but the absolute increase was insignificant from a hemodynamic perspective. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  18. Intraoperative neurophysiology of the conus medullaris and cauda equina.

    Science.gov (United States)

    Kothbauer, Karl F; Deletis, Vedran

    2010-02-01

    Intraoperative neurophysiological techniques are becoming routine tools for neurosurgical practice. Procedures affecting the lumbosacral nervous system are frequent in adult and pediatric neurosurgery. This review provides an overview of the techniques utilized in cauda and conus operations. Two basic methodologies of intraoperative neurophysiological testing are utilized during surgery in the lumbosacral spinal canal. Mapping techniques help identify functional neural structures, namely, nerve roots and their respective spinal levels. Monitoring is referred to as the technology to continuously assess the functional integrity of pathways and reflex circuits. For mapping direct electrical stimulation of a structure within the surgical field and recording at a distant site, usually a muscle is the most commonly used setup. Sensory nerve roots or spinal cord areas can be mapped by stimulation of a distant sensory nerve or skin area and recording from a structure within the surgical field. Continuous monitoring of the motor system is done with motor evoked potentials. These are evoked by transcranial electrical stimulation and recorded from lower extremity and sphincter muscles. Presence or absence of muscle responses are the monitored parameters. To monitor the sensory pathways, sensory potentials evoked by tibial, peroneal, or pudendal nerve stimulation and recorded from the dorsal columns with a spinal electrode or as cortical responses from scalp electrodes are used. Amplitudes and latencies of these responses are measured for interpretation. The bulbocavernosus reflex, with stimulation of the pudendal nerve and recording from the external anal sphincter, is used for continuous monitoring of the reflex circuitry. The presence of absence of this response is the pertinent parameter monitored. Stimulation of individual dorsal nerve roots is used to identify those segments that generate spastic activity and which may be cut during selective dorsal rhizotomy

  19. Prevention of intraoperative cerebrospinal fluid leaks by lumbar cerebrospinal fluid drainage during surgery for pituitary macroadenomas.

    Science.gov (United States)

    Mehta, Gautam U; Oldfield, Edward H

    2012-06-01

    Cerebrospinal fluid leakage is a major complication of transsphenoidal surgery. An intraoperative CSF leak, which occurs in up to 50% of pituitary tumor cases, is the only modifiable risk factor for postoperative leaks. Although several techniques have been described for surgical repair when an intraoperative leak is noted, none has been proposed to prevent an intraoperative CSF leak. The authors postulated that intraoperative CSF drainage would diminish tension on the arachnoid, decrease the rate of intraoperative CSF leakage during surgery for larger tumors, and reduce the need for surgical repair of CSF leaks. The results of 114 transsphenoidal operations for pituitary macroadenoma performed without intraoperative CSF drainage were compared with the findings from 44 cases in which a lumbar subarachnoid catheter was placed before surgery to drain CSF at the time of dural exposure and tumor removal. Cerebrospinal fluid drainage reduced the rate of intraoperative CSF leakage from 41% to 5% (p drainage reduced the need for operative repair (from 32% to 5%, p drainage during transsphenoidal surgery for macroadenomas reduces the rate of intraoperative CSF leaks. This preventative measure obviated the need for surgical repair of intraoperative CSF leaks using autologous fat graft placement, other operative techniques, postoperative lumbar drainage, and/or reoperation in most patients and is associated with minimal risks.

  20. Intraoperative computed tomography with integrated navigation system in spinal stabilizations.

    Science.gov (United States)

    Zausinger, Stefan; Scheder, Ben; Uhl, Eberhard; Heigl, Thomas; Morhard, Dominik; Tonn, Joerg-Christian

    2009-12-15

    STUDY DESIGN.: A prospective interventional case-series study plus a retrospective analysis of historical patients for comparison of data. OBJECTIVE.: To evaluate workflow, feasibility, and clinical outcome of navigated stabilization procedures with data acquisition by intraoperative computed tomography. SUMMARY OF BACKGROUND DATA.: Routine fluoroscopy to assess pedicle screw placement is not consistently reliable. Our hypothesis was that image-guided spinal navigation using an intraoperative CT-scanner can improve the safety and precision of spinal stabilization surgery. METHODS.: CT data of 94 patients (thoracolumbar [n = 66], C1/2 [n = 12], cervicothoracic instability [n = 16]) were acquired after positioning the patient in the final surgical position. A sliding gantry 40-slice CT was used for image acquisition. Data were imported to a frameless infrared-based neuronavigation workstation. Intraoperative CT was obtained to assess the accuracy of instrumentation and, if necessary, the extent of decompression. All patients were clinically evaluated by Odom-criteria after surgery and after 3 months. RESULTS.: Computed accuracy of the navigation system reached /=2 mm without persistent neurologic or vascular damage in 20/414 screws (4.8%) leading to immediate correction of 10 screws (2.4%). Control-iCT changed the course of surgery in 8 cases (8.5% of all patients). The overall revision rate was 8.5% (4 wound revisions, 2 CSF fistulas, and 2 epidural hematomas). There was no reoperation due to implant malposition. According to Odom-criteria all patients experienced a clinical improvement. A retrospective analysis of 182 patients with navigated thoracolumbar transpedicular stabilizations in the preiCT era revealed an overall revision rate of 10.4% with 4.4% of patients requiring screw revision. CONCLUSION.: Intraoperative CT in combination with neuronavigation provides high accuracy of screw placement and thus safety for patients undergoing spinal stabilization

  1. Visualization strategies for major white matter tracts for intraoperative use

    Energy Technology Data Exchange (ETDEWEB)

    Nimsky, C.; Ganslandt, O.; Buchfelder, M. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Neurosurgery; Erlangen-Nuernberg Univ., Erlangen (Germany). Neurocenter; Enders, F.; Merhof, D. [Erlangen-Nuernberg Univ., Erlangen (Germany). Neurocenter; Hammen, T. [Erlangen-Nuernberg Univ., Erlangen (Germany). Neurocenter; Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Neurology

    2006-03-15

    Streamline representation of major fiber tract systems along with high-resolution anatomical data provides a reliable orientation for the neurosurgeon. For intraoperative visualization of these data either on navigation screens near the surgical field or directly in the surgical field applying heads-up displays of operating microscopes, wrapping of all streamlines of interest to render an individual object representing the whole fiber bundle is the most suitable representation. Integration of fiber tract data into a neuronavigation setup allows removal of tumors adjacent to eloquent brain areas with low morbidity. (orig.)

  2. Visualization strategies for major white matter tracts for intraoperative use

    International Nuclear Information System (INIS)

    Nimsky, C.; Ganslandt, O.; Buchfelder, M.; Erlangen-Nuernberg Univ., Erlangen; Enders, F.; Merhof, D.; Hammen, T.; Erlangen-Nuernberg Univ., Erlangen

    2006-01-01

    Streamline representation of major fiber tract systems along with high-resolution anatomical data provides a reliable orientation for the neurosurgeon. For intraoperative visualization of these data either on navigation screens near the surgical field or directly in the surgical field applying heads-up displays of operating microscopes, wrapping of all streamlines of interest to render an individual object representing the whole fiber bundle is the most suitable representation. Integration of fiber tract data into a neuronavigation setup allows removal of tumors adjacent to eloquent brain areas with low morbidity. (orig.)

  3. Non-radiographic intraoperative fluorescent cholangiography is feasible

    DEFF Research Database (Denmark)

    Larsen, Søren Schytt; Schulze, Svend; Bisgaard, Thue

    2014-01-01

    INTRODUCTION: Intraoperative fluorescent cholangiography (IFC) with concomitant fluorescent angiography was recently developed for non-invasive identification of the anatomy during laparoscopic cholecystectomy. The objective of this study was to assess the time required for routine-use of IFC...... hepatic duct was identified by IFC in all patients. In 29 of the 35 patients (83%; 95% confidence interval: 71-96%), the cystic artery was visualised by fluorescent angiography. No adverse effects or complications were recorded. CONCLUSION: Routine-use of IFC with fluorescent angiography during...

  4. A CASE OF GRANISETRON ASSOCIATED INTRAOPERATIVE CARDIAC ARREST.

    Science.gov (United States)

    Al Harbi, Mohammed; Al Rifai, Derar; Al Habeeb, Hassan; Wambi, Freddie; Geldhof, Georges; Dimitriou, Vassilios

    2016-02-01

    We report a case of intraoperative severe bradycardia that resulted in asystole and cardiac arrest shortly after (granisetron 1mg for postoperative nausea and vomiting prophylaxis, that occurred in a female patient who underwent an elective total thyroidectomy. After two cycles of cardiopulmonary resuscitation and defibrillation, spontaneous circulation and sinus rhythm returned successfully. Postoperatively, the patient was diagnosed with a drug-induced long QT syndrome. At the time of the event, granisetron was the only medication administered. Furthermore, there was no reason to suspect electrolyte abnormalities. We explore the association of the onset of severe sinus bradycardia with the intravenous administration of granisetron.

  5. Intraoperative radiotherapy of malignant pancreatic tumors - first results

    Energy Technology Data Exchange (ETDEWEB)

    Thurnher, S.; Glaser, K.; Url, M.; Frommhold, H.; Bodner, E.

    1987-02-01

    Thirteen patients suffering from adenocarcinomas of the pancreas were submitted to an intraoperative fast electron 'boost' therapy with or without percutaneous photon irradiation. A duodeno-cephalo-pancreatectomy with subsequent irradiation of the tumor bed could be performed in three patients. Ten patients were inoperable because of advanced tumors and formation of metastases. The average survival is 6.5 months, at present six patients are alive without major troubles. An analgetic effect was obtained in ten patients. The first results are encouraging with respect to local control, the little acute and chronic morbidity, and palliation achieved in advances stages.

  6. Intraoperative radiotherapy of malignant pancreatic tumors - first results

    International Nuclear Information System (INIS)

    Thurnher, S.; Glaser, K.; Url, M.; Frommhold, H.; Bodner, E.; Innsbruck Univ.

    1987-01-01

    Thirteen patients suffering from adenocarcinomas of the pancreas were submitted to an intraoperative fast electron 'boost' therapy with or without percutaneous photon irradiation. A duodeno-cephalo-pancreatectomy with subsequent irradiation of the tumor bed could be performed in three patients. Ten patients were inoperable because of advanced tumors and formation of metastases. The average survival is 6.5 months, at present six patients are alive without major troubles. An analgetic effect was obtained in ten patients. The first results are encouraging with respect to local control, the little acute and chronic morbidity, and palliation achieved in advances stages. (orig.) [de

  7. Intraoperative neuropathology of glioma recurrence: cell detection and classification

    Science.gov (United States)

    Abas, Fazly S.; Gokozan, Hamza N.; Goksel, Behiye; Otero, Jose J.; Gurcan, Metin N.

    2016-03-01

    Intraoperative neuropathology of glioma recurrence represents significant visual challenges to pathologists as they carry significant clinical implications. For example, rendering a diagnosis of recurrent glioma can help the surgeon decide to perform more aggressive resection if surgically appropriate. In addition, the success of recent clinical trials for intraoperative administration of therapies, such as inoculation with oncolytic viruses, may suggest that refinement of the intraoperative diagnosis during neurosurgery is an emerging need for pathologists. Typically, these diagnoses require rapid/STAT processing lasting only 20-30 minutes after receipt from neurosurgery. In this relatively short time frame, only dyes, such as hematoxylin and eosin (H and E), can be implemented. The visual challenge lies in the fact that these patients have undergone chemotherapy and radiation, both of which induce cytological atypia in astrocytes, and pathologists are unable to implement helpful biomarkers in their diagnoses. Therefore, there is a need to help pathologists differentiate between astrocytes that are cytologically atypical due to treatment versus infiltrating, recurrent, neoplastic astrocytes. This study focuses on classification of neoplastic versus non-neoplastic astrocytes with the long term goal of providing a better neuropathological computer-aided consultation via classification of cells into reactive gliosis versus recurrent glioma. We present a method to detect cells in H and E stained digitized slides of intraoperative cytologic preparations. The method uses a combination of the `value' component of the HSV color space and `b*' component of the CIE L*a*b* color space to create an enhanced image that suppresses the background while revealing cells on an image. A composite image is formed based on the morphological closing of the hue-luminance combined image. Geometrical and textural features extracted from Discrete Wavelet Frames and combined to classify

  8. Clinical experience with intraoperative radiotherapy for locally advanced colorectal cancer

    International Nuclear Information System (INIS)

    Shibamoto, Yuta; Takahashi, Masaharu; Abe, Mitsuyuki

    1988-01-01

    Intraoperative radiotherapy (IORT) was performed on 20 patients with colorectal cancer. IORT with a single dose of 20 to 40 Gy was delivered to the residual tumor, tumor bed, and/or lymphnode regions. Although most of the patients had advanced lesions, local control was achieved in 67 % of the patients when IORT was combined with tumor resection, and 4 patients survived more than 5 years. There were no serious complications, except for contracture or atrophy of the psoas muscle seen in 2 patients. IORT combined with external beam radiotherapy should be a useful adjuvant therapy to surgery for locally advanced colorectal cancer. (author)

  9. Intraoperative Anaphylaxis to Inj Ceftriaxone: Here We Go Again

    Directory of Open Access Journals (Sweden)

    Amit G Bhagwat

    2008-01-01

    Full Text Available Anaphylactic reactions to intraoperative antibiotics are rare events and reactions after a negative intradermal skin testing are even rarer. We are reporting a case of grade V anaphylactic reaction to ceftriaxone, which occurred inspite of a negative skin testing preoperatively. Despite of the treatment along the established guidelines, patient suffered hypoxic brain damage ultimately having a fatal outcome 7 days later. This case highlights the limits of the screening test done preoperatively for antibiotic sensitivity and also the difficulty in resuscitating anaphylactic reac-tions when patient is on B blocker and under spinal anaesthesia.

  10. Towards an intelligent framework for multimodal affective data analysis.

    Science.gov (United States)

    Poria, Soujanya; Cambria, Erik; Hussain, Amir; Huang, Guang-Bin

    2015-03-01

    An increasingly large amount of multimodal content is posted on social media websites such as YouTube and Facebook everyday. In order to cope with the growth of such so much multimodal data, there is an urgent need to develop an intelligent multi-modal analysis framework that can effectively extract information from multiple modalities. In this paper, we propose a novel multimodal information extraction agent, which infers and aggregates the semantic and affective information associated with user-generated multimodal data in contexts such as e-learning, e-health, automatic video content tagging and human-computer interaction. In particular, the developed intelligent agent adopts an ensemble feature extraction approach by exploiting the joint use of tri-modal (text, audio and video) features to enhance the multimodal information extraction process. In preliminary experiments using the eNTERFACE dataset, our proposed multi-modal system is shown to achieve an accuracy of 87.95%, outperforming the best state-of-the-art system by more than 10%, or in relative terms, a 56% reduction in error rate. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Performance Evaluation of Multimodal Multifeature Authentication System Using KNN Classification

    Directory of Open Access Journals (Sweden)

    Gayathri Rajagopal

    2015-01-01

    Full Text Available This research proposes a multimodal multifeature biometric system for human recognition using two traits, that is, palmprint and iris. The purpose of this research is to analyse integration of multimodal and multifeature biometric system using feature level fusion to achieve better performance. The main aim of the proposed system is to increase the recognition accuracy using feature level fusion. The features at the feature level fusion are raw biometric data which contains rich information when compared to decision and matching score level fusion. Hence information fused at the feature level is expected to obtain improved recognition accuracy. However, information fused at feature level has the problem of curse in dimensionality; here PCA (principal component analysis is used to diminish the dimensionality of the feature sets as they are high dimensional. The proposed multimodal results were compared with other multimodal and monomodal approaches. Out of these comparisons, the multimodal multifeature palmprint iris fusion offers significant improvements in the accuracy of the suggested multimodal biometric system. The proposed algorithm is tested using created virtual multimodal database using UPOL iris database and PolyU palmprint database.

  12. Intraoperative radiotherapy in the management of esophageal and gastro-esophageal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Suh, David; Ahmad, Neelofur; Huq, M Saiful; Mohiuddin, Mohammed; Cohn, Herbert; Barbot, Donna; Rosato, Francis

    1995-07-01

    Purpose: Patients with esophageal and gastro-esophageal junction (GEJ) carcinomas suffer a high rates of local regional failure following conventional therapies. This report describes a unique institutional experience with the use of intraoperative radiation therapy (IORT) in the multimodality management of these tumors. Methods and Materials: From January, 1989 through August, 1994, 22 patients with distal esophageal(n=8) or GEJ junction carcinomas (n=14) underwent surgery followed by IORT to the tumor bed. Two patients died perioperatively of complications unrelated to the IORT and were excluded from the study. In the remaining 20 patients, IORT doses ranged from 12 to 20 Gy (median 15 Gy). The electron energies ranged from 4 to 22 MeV (median 6 MeV). Ten patients received no further radiation therapy (IORT only group), and ten patients received adjuvant external beam radiation (IORT + EB group) ranging from 39.6 to 60.8 Gy (median 45.0 Gy) in standard fractionation. 5-FU-based chemotherapy was administered to 15 patients either pre- or postoperatively. Follow-up ranged from 4 to 62 months (median 10 months). Results: The overall median survival time (MST) was 10 months. The overall 2-year actuarial survival rate was 25%. Distant metastasis developed in (9(20)) patients. The results by treatment subgroups are listed below. There was 1 local failure each in the IORT only group and the IORT+EB group. There were no perioperative complications related to IORT. The average length of hospital stay did not appear different than that of patients not receiving IORT. Conclusions: This is the first North American series describing the use of IORT after resection of esophageal/GEJ carcinomas. The use of IORT in our study did not increase perioperative morbidity over that reported for patients undergoing surgery alone. The addition of EBRT was associated with a longer median survival time although not with improved long-term survival when compared to the outcome of patients

  13. Improving treatment planning accuracy through multimodality imaging

    International Nuclear Information System (INIS)

    Sailer, Scott L.; Rosenman, Julian G.; Soltys, Mitchel; Cullip, Tim J.; Chen, Jun

    1996-01-01

    Purpose: In clinical practice, physicians are constantly comparing multiple images taken at various times during the patient's treatment course. One goal of such a comparison is to accurately define the gross tumor volume (GTV). The introduction of three-dimensional treatment planning has greatly enhanced the ability to define the GTV, but there are times when the GTV is not visible on the treatment-planning computed tomography (CT) scan. We have modified our treatment-planning software to allow for interactive display of multiple, registered images that enhance the physician's ability to accurately determine the GTV. Methods and Materials: Images are registered using interactive tools developed at the University of North Carolina at Chapel Hill (UNC). Automated methods are also available. Images registered with the treatment-planning CT scan are digitized from film. After a physician has approved the registration, the registered images are made available to the treatment-planning software. Structures and volumes of interest are contoured on all images. In the beam's eye view, wire loop representations of these structures can be visualized from all image types simultaneously. Each registered image can be seamlessly viewed during the treatment-planning process, and all contours from all image types can be seen on any registered image. A beam may, therefore, be designed based on any contour. Results: Nineteen patients have been planned and treated using multimodality imaging from November 1993 through August 1994. All registered images were digitized from film, and many were from outside institutions. Brain has been the most common site (12), but the techniques of registration and image display have also been used for the thorax (4), abdomen (2), and extremity (1). The registered image has been an magnetic resonance (MR) scan in 15 cases and a diagnostic CT scan in 5 cases. In one case, sequential MRs, one before treatment and another after 30 Gy, were used to plan

  14. Acoustic multimode interference and self-imaging phenomena realized in multimodal phononic crystal waveguides

    International Nuclear Information System (INIS)

    Zou, Qiushun; Yu, Tianbao; Liu, Jiangtao; Wang, Tongbiao; Liao, Qinghua; Liu, Nianhua

    2015-01-01

    We report an acoustic multimode interference effect and self-imaging phenomena in an acoustic multimode waveguide system which consists of M parallel phononic crystal waveguides (M-PnCWs). Results show that the self-imaging principle remains applicable for acoustic waveguides just as it does for optical multimode waveguides. To achieve the dispersions and replicas of the input acoustic waves produced along the propagation direction, we performed the finite element method on M-PnCWs, which support M guided modes within the target frequency range. The simulation results show that single images (including direct and mirrored images) and N-fold images (N is an integer) are identified along the propagation direction with asymmetric and symmetric incidence discussed separately. The simulated positions of the replicas agree well with the calculated values that are theoretically decided by self-imaging conditions based on the guided mode propagation analysis. Moreover, the potential applications based on this self-imaging effect for acoustic wavelength de-multiplexing and beam splitting in the acoustic field are also presented. (paper)

  15. Improvement of limb salvage procedure using intraoperative radiotherapy for osteosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Hirano, Toru; Iwasaki, Katsuo; Kamishiro,; Toshiyuki,; Hayashi, Yasuyuki [Nagasaki Univ. (Japan). School of Medicine

    1992-10-01

    Clinical outcome of limb salvage procedure combined with intraoperative irradiation was investigated in 6 patients with osteosarcoma in the distal part of femur (n=4) and proximal part of tibia (n=2). They ranged in age from 12 to 54 years, with a mean of 22.5. First, a lesion was separated from the surrounding soft tissue with curatively wide margin. Osteotomy was performed at the portion of diaphysis. After irradiation field was setted up by lifting the lesion, and was exposed to doses ranging from 60 Gy to 85 Gy of intraoperative irradiation, soft tissue and fragile tumor tissue, excluding joint capsule and ligament, were removed as soon as possible. Finally, bone was jointed by means of inner fixation or bone grafting. They had a median follow-up of one year and four months after surgery. Although superficial wound infection and delayed wound adhesion were encountered as postoperative complications in one and two patients, respectively, these were all healed. None of the patients had local recurrence. The ability of salvaged limb was excellent in one, good in 3, and fair in 2 patients. Because both of the two patients with sarcoma in the proximal part of tibia had excellent and good limb ability, this procedure was considered useful especially for sarcoma in the proximal part of tibia. (N.K.).

  16. A case of lumbar pain after intraoperative radiotherapy

    International Nuclear Information System (INIS)

    Shimizu, Wakako; Ogino, Takashi; Murakami, Koji; Nawano, Shigeru; Moriyama, Noriyuki; Ryu, Munemasa; Kawano, Nariaki

    1996-01-01

    We report a case of abnormal magnetic resonance imaging (MRI) findings after intraoperative radiotherapy. A 53-year-old woman with cancer of the papilla of Vater was treated with pancreatoduodenectomy and 20 Gy of intraoperative radiotherapy by electron beam to the tumor bed. Three months later the patient complained of lumbar pain. A change of signal intensity on MRI was detected in the anterior half of the vertebral body within the irradiated field. The signal was of high intensity but was not enhanced by Gd-DTPA on T1-weighted images, was isointense on T2-weighted images and of low intensity with the fat-suppression method. The radiation dose to the lumbar spine and the surrounding soft tissue was calculated to be 16 Gy. Histologic changes in bone after irradiation may include depletion of bone marrow cells and fat degeneration. The MRI findings were compatible with these changes. The radiation dose that can be tolerated by soft tissue is lower than that tolerated by bone. Therefore, late radiation injury of the soft tissue might have been the cause of the patient's lumbar pain. (author)

  17. Improvement of limb salvage procedure using intraoperative radiotherapy for osteosarcoma

    International Nuclear Information System (INIS)

    Hirano, Toru; Iwasaki, Katsuo; Kamishiro; Toshiyuki; Hayashi, Yasuyuki

    1992-01-01

    Clinical outcome of limb salvage procedure combined with intraoperative irradiation was investigated in 6 patients with osteosarcoma in the distal part of femur (n=4) and proximal part of tibia (n=2). They ranged in age from 12 to 54 years, with a mean of 22.5. First, a lesion was separated from the surrounding soft tissue with curatively wide margin. Osteotomy was performed at the portion of diaphysis. After irradiation field was setted up by lifting the lesion, and was exposed to doses ranging from 60 Gy to 85 Gy of intraoperative irradiation, soft tissue and fragile tumor tissue, excluding joint capsule and ligament, were removed as soon as possible. Finally, bone was jointed by means of inner fixation or bone grafting. They had a median follow-up of one year and four months after surgery. Although superficial wound infection and delayed wound adhesion were encountered as postoperative complications in one and two patients, respectively, these were all healed. None of the patients had local recurrence. The ability of salvaged limb was excellent in one, good in 3, and fair in 2 patients. Because both of the two patients with sarcoma in the proximal part of tibia had excellent and good limb ability, this procedure was considered useful especially for sarcoma in the proximal part of tibia. (N.K.)

  18. Tumors in dogs exposed to experimental intraoperative radiotherapy

    International Nuclear Information System (INIS)

    Johnstone, Peter A.S.; Laskin, William B.; De Luca, Anne Marie; Barnes, Margaret; Kinsella, Timothy J.; Sindelar, William F.

    1996-01-01

    Purpose: The frequency of radiation-induced neoplasms was determined in dogs enrolled in the National Cancer Institute canine trials of intraoperative radiotherapy (IORT). Methods and Materials: Twelve protocols assessing normal tissue response to IORT involved 238 dogs in a 15-year trial. Eighty-one dogs were followed for > 24 months postoperatively and were assessed for tumor development; 59 of these animals received IORT. Results: Twelve tumors occurred in the 59 dogs receiving IORT. Nine were in the IORT portals and were considered to be radiation induced. No tumors occurred in 13 sham animals or in 9 animals treated with external beam radiotherapy alone. The frequency of radiation-induced malignancies in dogs receiving IORT was 15%, and was 25% in animals receiving ≥ 25 Gy IORT. Frequency of all tumors, including spontaneous lesions, was 20%. Conclusions: Intraoperative radiotherapy contributed to a high frequency of sarcoma induction in these dogs. Unknown to date in humans involved in clinical trials of IORT, this potential complication should be looked for as long-term survivors are followed

  19. Neurophysiological intraoperative monitoring during an optic nerve schwannoma removal.

    Science.gov (United States)

    San-Juan, Daniel; Escanio Cortés, Manuel; Tena-Suck, Martha; Orozco Garduño, Adolfo Josué; López Pizano, Jesús Alejandro; Villanueva Domínguez, Jonathan; Fernández Gónzalez-Aragón, Maricarmen; Gómez-Amador, Juan Luis

    2017-10-01

    This paper reports the case of a patient with optic nerve schwannoma and the first use of neurophysiological intraoperative monitoring of visual evoked potentials during the removal of such tumor with no postoperative visual damage. Schwannomas are benign neoplasms of the peripheral nervous system arising from the neural crest-derived Schwann cells, these tumors are rarely located in the optic nerve and the treatment consists on surgical removal leading to high risk of damage to the visual pathway. Case report of a thirty-year-old woman with an optic nerve schwannoma. The patient underwent surgery for tumor removal on the left optic nerve through a left orbitozygomatic approach with intraoperative monitoring of left II and III cranial nerves. We used Nicolet Endeavour CR IOM (Carefusion, Middleton WI, USA) to performed visual evoked potentials stimulating binocularly with LED flash goggles with the patient´s eyes closed and direct epidural optic nerve stimulation delivering rostral to the tumor a rectangular current pulse. At follow up examinations 7 months later, the left eye visual acuity was 20/60; Ishihara score was 8/8 in both eyes; the right eye photomotor reflex was normal and left eye was mydriatic and arreflectic; optokinetic reflex and ocular conjugate movements were normal. In this case, the epidural direct electrical stimulation of optic nerve provided stable waveforms during optic nerve schwannoma resection without visual loss.

  20. Compact Intraoperative MRI: Stereotactic Accuracy and Future Directions.

    Science.gov (United States)

    Markowitz, Daniel; Lin, Dishen; Salas, Sussan; Kohn, Nina; Schulder, Michael

    2017-01-01

    Intraoperative imaging must supply data that can be used for accurate stereotactic navigation. This information should be at least as accurate as that acquired from diagnostic imagers. The aim of this study was to compare the stereotactic accuracy of an updated compact intraoperative MRI (iMRI) device based on a 0.15-T magnet to standard surgical navigation on a 1.5-T diagnostic scan MRI and to navigation with an earlier model of the same system. The accuracy of each system was assessed using a water-filled phantom model of the brain. Data collected with the new system were compared to those obtained in a previous study assessing the older system. The accuracy of the new iMRI was measured against standard surgical navigation on a 1.5-T MRI using T1-weighted (W) images. The mean error with the iMRI using T1W images was lower than that based on images from the 1.5-T scan (1.24 vs. 2.43 mm). T2W images from the newer iMRI yielded a lower navigation error than those acquired with the prior model (1.28 vs. 3.15 mm). Improvements in magnet design can yield progressive increases in accuracy, validating the concept of compact, low-field iMRI. Avoiding the need for registration between image and surgical space increases navigation accuracy. © 2017 S. Karger AG, Basel.

  1. Investigating multimodal communication in virtual meetings

    DEFF Research Database (Denmark)

    Persson, John Stouby; Mathiassen, Lars

    2014-01-01

    recordings of their oral exchanges and video recordings of their shared dynamic representation of the project’s status and plans, our analysis reveals how their interrelating of visual and verbal communication acts enabled effective communication and coordination. In conclusion, we offer theoretical......To manage distributed work, organizations increasingly rely on virtual meetings based on multimodal, synchronous communication technologies. However, despite technological advances, it is still challenging to coordinate knowledge through these meetings with spatial and cultural separation. Against...... propositions that explain how interrelating of verbal and visual acts based on shared dynamic representations enable communication repairs during virtual meetings. We argue the proposed framework provides researchers with a novel and practical approach to investigate the complex data involved in virtual...

  2. Testing Two Tools for Multimodal Navigation

    Directory of Open Access Journals (Sweden)

    Mats Liljedahl

    2012-01-01

    Full Text Available The latest smartphones with GPS, electronic compasses, directional audio, touch screens, and so forth, hold a potential for location-based services that are easier to use and that let users focus on their activities and the environment around them. Rather than interpreting maps, users can search for information by pointing in a direction and database queries can be created from GPS location and compass data. Users can also get guidance to locations through point and sweep gestures, spatial sound, and simple graphics. This paper describes two studies testing two applications with multimodal user interfaces for navigation and information retrieval. The applications allow users to search for information and get navigation support using combinations of point and sweep gestures, nonspeech audio, graphics, and text. Tests show that users appreciated both applications for their ease of use and for allowing users to interact directly with the surrounding environment.

  3. Automatic processing of multimodal tomography datasets.

    Science.gov (United States)

    Parsons, Aaron D; Price, Stephen W T; Wadeson, Nicola; Basham, Mark; Beale, Andrew M; Ashton, Alun W; Mosselmans, J Frederick W; Quinn, Paul D

    2017-01-01

    With the development of fourth-generation high-brightness synchrotrons on the horizon, the already large volume of data that will be collected on imaging and mapping beamlines is set to increase by orders of magnitude. As such, an easy and accessible way of dealing with such large datasets as quickly as possible is required in order to be able to address the core scientific problems during the experimental data collection. Savu is an accessible and flexible big data processing framework that is able to deal with both the variety and the volume of data of multimodal and multidimensional scientific datasets output such as those from chemical tomography experiments on the I18 microfocus scanning beamline at Diamond Light Source.

  4. Multimodal Feature Learning for Video Captioning

    Directory of Open Access Journals (Sweden)

    Sujin Lee

    2018-01-01

    Full Text Available Video captioning refers to the task of generating a natural language sentence that explains the content of the input video clips. This study proposes a deep neural network model for effective video captioning. Apart from visual features, the proposed model learns additionally semantic features that describe the video content effectively. In our model, visual features of the input video are extracted using convolutional neural networks such as C3D and ResNet, while semantic features are obtained using recurrent neural networks such as LSTM. In addition, our model includes an attention-based caption generation network to generate the correct natural language captions based on the multimodal video feature sequences. Various experiments, conducted with the two large benchmark datasets, Microsoft Video Description (MSVD and Microsoft Research Video-to-Text (MSR-VTT, demonstrate the performance of the proposed model.

  5. Multimodal event streams for virtual reality

    Science.gov (United States)

    von Spiczak, J.; Samset, E.; DiMaio, S.; Reitmayr, G.; Schmalstieg, D.; Burghart, C.; Kikinis, R.

    2007-01-01

    Applications in the fields of virtual and augmented reality as well as image-guided medical applications make use of a wide variety of hardware devices. Existing frameworks for interconnecting low-level devices and high-level application programs do not exploit the full potential for processing events coming from arbitrary sources and are not easily generalizable. In this paper, we will introduce a new multi-modal event processing methodology using dynamically-typed event attributes for event passing between multiple devices and systems. The existing OpenTracker framework was modified to incorporate a highly flexible and extensible event model, which can store data that is dynamically created and arbitrarily typed at runtime. The main factors impacting the library's throughput were determined and the performance was shown to be sufficient for most typical applications. Several sample applications were developed to take advantage of the new dynamic event model provided by the library, thereby demonstrating its flexibility and expressive power.

  6. Multimodal strategies to improve surgical outcome

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Wilmore, Douglas W

    2002-01-01

    OBJECTIVE: To evaluate the effect of modifying perioperative care in noncardiac surgical patients on morbidity, mortality, and other outcome measures. BACKGROUND: New approaches in pain control, introduction of techniques that reduce the perioperative stress response, and the more frequent use...... anesthesia in elective operations, and pilot studies of fast track surgical procedures using the multimodality approach. RESULTS: The introduction of newer approaches to perioperative care has reduced both morbidity and mortality in surgical patients. In the future, most elective operations will become day...... surgical procedures or require only 1 to 2 days of postoperative hospitalization. Reorganization of the perioperative team (anesthesiologists, surgeons, nurses, and physical therapists) will be essential to achieve successful fast track surgical programs. CONCLUSIONS: Understanding perioperative...

  7. User habits and multimodal route planning

    Directory of Open Access Journals (Sweden)

    Géza Katona

    2017-10-01

    Full Text Available The results of route planning researches are monitored by logistic and automotive industries. The economic aspects of the cost saving are in the focus of the attention. An optimal route could cause time or fuel savings. An effective driving or an optimal route is a good basis to achieve an economical aim. Moreover the spread of new automotive solutions especially in case of electric cars the optimisation has particular significance regarding the limited battery storage. Additionally the autonomous car development could not be neglected. As a result the society could expect safer roads, better space usage and effective resource management. Nevertheless the requirements of users are extremely diverse, which is not negligible. Supporting these aims, in this paper the connection between the multimodal route planning and the user requirements are investigated. The examination is focused to a sensitivity analysis and a survey to evaluate the data and support the settings of a user habit effect to the final route.

  8. Compressive multi-mode superresolution display

    KAUST Repository

    Heide, Felix

    2014-01-01

    Compressive displays are an emerging technology exploring the co-design of new optical device configurations and compressive computation. Previously, research has shown how to improve the dynamic range of displays and facilitate high-quality light field or glasses-free 3D image synthesis. In this paper, we introduce a new multi-mode compressive display architecture that supports switching between 3D and high dynamic range (HDR) modes as well as a new super-resolution mode. The proposed hardware consists of readily-available components and is driven by a novel splitting algorithm that computes the pixel states from a target high-resolution image. In effect, the display pixels present a compressed representation of the target image that is perceived as a single, high resolution image. © 2014 Optical Society of America.

  9. Multimodal distribution of human cold pain thresholds.

    Science.gov (United States)

    Lötsch, Jörn; Dimova, Violeta; Lieb, Isabel; Zimmermann, Michael; Oertel, Bruno G; Ultsch, Alfred

    2015-01-01

    It is assumed that different pain phenotypes are based on varying molecular pathomechanisms. Distinct ion channels seem to be associated with the perception of cold pain, in particular TRPM8 and TRPA1 have been highlighted previously. The present study analyzed the distribution of cold pain thresholds with focus at describing the multimodality based on the hypothesis that it reflects a contribution of distinct ion channels. Cold pain thresholds (CPT) were available from 329 healthy volunteers (aged 18 - 37 years; 159 men) enrolled in previous studies. The distribution of the pooled and log-transformed threshold data was described using a kernel density estimation (Pareto Density Estimation (PDE)) and subsequently, the log data was modeled as a mixture of Gaussian distributions using the expectation maximization (EM) algorithm to optimize the fit. CPTs were clearly multi-modally distributed. Fitting a Gaussian Mixture Model (GMM) to the log-transformed threshold data revealed that the best fit is obtained when applying a three-model distribution pattern. The modes of the identified three Gaussian distributions, retransformed from the log domain to the mean stimulation temperatures at which the subjects had indicated pain thresholds, were obtained at 23.7 °C, 13.2 °C and 1.5 °C for Gaussian #1, #2 and #3, respectively. The localization of the first and second Gaussians was interpreted as reflecting the contribution of two different cold sensors. From the calculated localization of the modes of the first two Gaussians, the hypothesis of an involvement of TRPM8, sensing temperatures from 25 - 24 °C, and TRPA1, sensing cold from 17 °C can be derived. In that case, subjects belonging to either Gaussian would possess a dominance of the one or the other receptor at the skin area where the cold stimuli had been applied. The findings therefore support a suitability of complex analytical approaches to detect mechanistically determined patterns from pain phenotype data.

  10. Preterm EEG: a multimodal neurophysiological protocol.

    Science.gov (United States)

    Stjerna, Susanna; Voipio, Juha; Metsäranta, Marjo; Kaila, Kai; Vanhatalo, Sampsa

    2012-02-18

    Since its introduction in early 1950s, electroencephalography (EEG) has been widely used in the neonatal intensive care units (NICU) for assessment and monitoring of brain function in preterm and term babies. Most common indications are the diagnosis of epileptic seizures, assessment of brain maturity, and recovery from hypoxic-ischemic events. EEG recording techniques and the understanding of neonatal EEG signals have dramatically improved, but these advances have been slow to penetrate through the clinical traditions. The aim of this presentation is to bring theory and practice of advanced EEG recording available for neonatal units. In the theoretical part, we will present animations to illustrate how a preterm brain gives rise to spontaneous and evoked EEG activities, both of which are unique to this developmental phase, as well as crucial for a proper brain maturation. Recent animal work has shown that the structural brain development is clearly reflected in early EEG activity. Most important structures in this regard are the growing long range connections and the transient cortical structure, subplate. Sensory stimuli in a preterm baby will generate responses that are seen at a single trial level, and they have underpinnings in the subplate-cortex interaction. This brings neonatal EEG readily into a multimodal study, where EEG is not only recording cortical function, but it also tests subplate function via different sensory modalities. Finally, introduction of clinically suitable dense array EEG caps, as well as amplifiers capable of recording low frequencies, have disclosed multitude of brain activities that have as yet been overlooked. In the practical part of this video, we show how a multimodal, dense array EEG study is performed in neonatal intensive care unit from a preterm baby in the incubator. The video demonstrates preparation of the baby and incubator, application of the EEG cap, and performance of the sensory stimulations.

  11. Multimodal nanoparticle imaging agents: design and applications

    Science.gov (United States)

    Burke, Benjamin P.; Cawthorne, Christopher; Archibald, Stephen J.

    2017-10-01

    Molecular imaging, where the location of molecules or nanoscale constructs can be tracked in the body to report on disease or biochemical processes, is rapidly expanding to include combined modality or multimodal imaging. No single imaging technique can offer the optimum combination of properties (e.g. resolution, sensitivity, cost, availability). The rapid technological advances in hardware to scan patients, and software to process and fuse images, are pushing the boundaries of novel medical imaging approaches, and hand-in-hand with this is the requirement for advanced and specific multimodal imaging agents. These agents can be detected using a selection from radioisotope, magnetic resonance and optical imaging, among others. Nanoparticles offer great scope in this area as they lend themselves, via facile modification procedures, to act as multifunctional constructs. They have relevance as therapeutics and drug delivery agents that can be tracked by molecular imaging techniques with the particular development of applications in optically guided surgery and as radiosensitizers. There has been a huge amount of research work to produce nanoconstructs for imaging, and the parameters for successful clinical translation and validation of therapeutic applications are now becoming much better understood. It is an exciting time of progress for these agents as their potential is closer to being realized with translation into the clinic. The coming 5-10 years will be critical, as we will see if the predicted improvement in clinical outcomes becomes a reality. Some of the latest advances in combination modality agents are selected and the progression pathway to clinical trials analysed. This article is part of the themed issue 'Challenges for chemistry in molecular imaging'.

  12. Intraoperative three-dimensional fluoroscopy after transpedicular positioning of Kirschner-wire versus conventional intraoperative biplanar fluoroscopic control: A retrospective study of 345 patients and 1880 pedicle screws

    Directory of Open Access Journals (Sweden)

    Ghassan Kerry

    2014-01-01

    Full Text Available Study Design: Retrospective study. Objective: The aim was to find out whether intraoperative three-dimensional imaging after transpedicular positioning of Kirschner wire (K-wire in lumbar and thoracic posterior instrumentation procedures is of benefit to the patients and if this technique is accurately enough to make a postoperative screw position control through computer tomography (CT dispensable. Patients and Methods: Lumbar and thoracic posterior instrumentation procedures conducted at our department between 2002 and 2012 were retrospectively reviewed. The patients were divided into two groups: group A, including patients who underwent intraoperative three-dimensional scan after transpedicular positioning of the K-wire and group B, including patients who underwent only intraoperative biplanar fluoroscopy. An early postoperative CT of the instrumented section was done in all cases to assess the screw position. The rate of immediate intraoperative correction of the K-wires in cases of mal-positioning, as well as the rate of postoperative screw revisions, was measured. Results: In general, 345 patients (1880 screws were reviewed and divided into two groups; group A with 225 patients (1218 screws and group B with 120 patients (662 screws. One patient (0.44% (one screw [0.082%] of group A underwent postoperative screw correction while screw revisions were necessary in 14 patients (11.7% (28 screws [4.2%] of group B. Twenty-three patients (10.2% (28 K-wires [2.3%] of group A underwent intraoperative correction due to primary intraoperative detected K-wire mal-position. None of the corrected K-wires resulted in a corresponding neurological deficit. Conclusion: Three-dimensional imaging after transpedicular K-wire positioning leads to solid intraoperative identification of misplaced K-wires prior to screw placement and reduces screw revision rates compared with conventional fluoroscopic control. When no clinical deterioration emerges, a

  13. Intra-operative blood transfusion among adult surgical patients in a ...

    African Journals Online (AJOL)

    This retrospective study was designed to audit the pattern of intra-operative whole blood transfusion among adult surgical patients over a two-year period. Data were collected on the rate of intra-operative transfusion, estimated blood loss, units of donor blood transfused, pattern of use of autologous blood and circumstances ...

  14. Is Intraoperative Diffusion tensor Imaging at 3.0T Comparable to Subcortical Corticospinal tract Mapping?

    Czech Academy of Sciences Publication Activity Database

    Ostrý, S.; Belšan, T.; Otáhal, Jakub; Beneš, V.; Netuka, D.

    2013-01-01

    Roč. 73, č. 5 (2013), s. 797-807 ISSN 0148-396X Institutional support: RVO:67985823 Keywords : corticospinal tract * intraoperative tractography * intraoperative image distortion * motor -evoked potentials * subcortical mapping Subject RIV: FH - Neurology Impact factor: 3.031, year: 2013

  15. Intra-operative removal of chest tube in video-assisted thoracoscopic procedures

    Directory of Open Access Journals (Sweden)

    Moustafa M. El-Badry

    2017-12-01

    Conclusions: Intra-operative removal of chest tube during VATS procedures was a safe technique in well selected patients with an intra-operative successful air-leak test with radiological and clinical follow-up. This technique provided lesser post-operative pain with shorter hospital stay.

  16. Study on intraoperative radiotherapy applying hyperthermia together with radiation sensitizers for progressive local carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Abe, M; Takahashi, M; Ono, K; Hiraoka, M [Kyoto Univ. (Japan). Faculty of Medicine

    1980-08-01

    Intraoperative radiotherapy for gastric cancer, colonic cancer, pancreatic cancer, cancer of the biliary tract, prostatic carcinoma, cerebral tumor, tumor of soft tissues, and osteosarcoma and its clinical results were described. Basic and clinical studies on effects of both hyperthermia and radiation sensitizers to elevate radiation sensitivity were also described, because effects of intraoperative radiotherapy were raised by applying hyperthermia and hypoxic cell sensitizers.

  17. Intraoperative hypothermia and its clinical outcomes in patients undergoing general anesthesia: National study in China.

    Directory of Open Access Journals (Sweden)

    Jie Yi

    Full Text Available Inadvertent intraoperative hypothermia (core temperature 2 h (OR = 2.60, 95% CI 2.09-3.24.The incidence of intraoperative hypothermia in China is high, and the rate of active warming of patients during operation is low. Hypothermia is associated with more postoperative shivering, increased ICU admissions, and longer postoperative hospital days.

  18. INTRAOPERATIVE MOTIVE FOR PERFORMING A LAPAROSCOPIC APPENDECTOMY ON A POSTOPERATIVE HISTOLOGICAL PROVEN NORMAL APPENDIX

    NARCIS (Netherlands)

    Slotboom, T.; Hamminga, J. T. H.; Hofker, H. S.; Heineman, E.; Haveman, J. W.

    2014-01-01

    Background: Diagnostic laparoscopy is the ultimate tool to evaluate the appendix. However, the intraoperative evaluation of the appendix is difficult, as the negative appendectomy rate remains 12%-18%. The aim of this study is to analyze the intraoperative motive for performing a laparoscopic

  19. Fiber-Optic Vibration Sensor Based on Multimode Fiber

    Directory of Open Access Journals (Sweden)

    I. Lujo

    2008-06-01

    Full Text Available The purpose of this paper is to present a fiberoptic vibration sensor based on the monitoring of the mode distribution in a multimode optical fiber. Detection of vibrations and their parameters is possible through observation of the output speckle pattern from the multimode optical fiber. A working experimental model has been built in which all used components are widely available and cheap: a CCD camera (a simple web-cam, a multimode laser in visible range as a light source, a length of multimode optical fiber, and a computer for signal processing. Measurements have shown good agreement with the actual frequency of vibrations, and promising results were achieved with the amplitude measurements although they require some adaptation of the experimental model. Proposed sensor is cheap and lightweight and therefore presents an interesting alternative for monitoring large smart structures.

  20. Multi-Modal Intelligent Traffic Signal Systems GPS

    Data.gov (United States)

    Department of Transportation — Data were collected during the Multi-Modal Intelligent Transportation Signal Systems (MMITSS) study. MMITSS is a next-generation traffic signal system that seeks to...

  1. Multimodality and children's participation in classrooms: Instances of ...

    African Journals Online (AJOL)

    Multimodality and children's participation in classrooms: Instances of research. ... deficit models of children, drawing on their everyday experiences and their existing ... It outlines the theoretical framework supporting the pedagogical approach, ...

  2. Squeezing in multi-mode nonlinear optical state truncation

    International Nuclear Information System (INIS)

    Said, R.S.; Wahiddin, M.R.B.; Umarov, B.A.

    2007-01-01

    In this Letter, we show that multi-mode qubit states produced via nonlinear optical state truncation driven by classical external pumpings exhibit squeezing condition. We restrict our discussions to the two- and three-mode cases

  3. Multi-Modal Traveler Information System - Gateway Functional Requirements

    Science.gov (United States)

    1997-11-17

    The Multi-Modal Traveler Information System (MMTIS) project involves a large number of Intelligent Transportation System (ITS) related tasks. It involves research of all ITS initiatives in the Gary-Chicago-Milwaukee (GCM) Corridor which are currently...

  4. Multimodal transport and TransLoad facilities in Arkansas.

    Science.gov (United States)

    2015-01-01

    National Priorities consist of building a clean and ecient 21st century : transportation sector, and Multimodal Transportation is one of ve : Transportation System Eciency strategies at the US Department of Energy. Six : locomotives co...

  5. Reliability-Based Decision Fusion in Multimodal Biometric Verification Systems

    Directory of Open Access Journals (Sweden)

    Kryszczuk Krzysztof

    2007-01-01

    Full Text Available We present a methodology of reliability estimation in the multimodal biometric verification scenario. Reliability estimation has shown to be an efficient and accurate way of predicting and correcting erroneous classification decisions in both unimodal (speech, face, online signature and multimodal (speech and face systems. While the initial research results indicate the high potential of the proposed methodology, the performance of the reliability estimation in a multimodal setting has not been sufficiently studied or evaluated. In this paper, we demonstrate the advantages of using the unimodal reliability information in order to perform an efficient biometric fusion of two modalities. We further show the presented method to be superior to state-of-the-art multimodal decision-level fusion schemes. The experimental evaluation presented in this paper is based on the popular benchmarking bimodal BANCA database.

  6. Photoacoustic-Based Multimodal Nanoprobes: from Constructing to Biological Applications.

    Science.gov (United States)

    Gao, Duyang; Yuan, Zhen

    2017-01-01

    Multimodal nanoprobes have attracted intensive attentions since they can integrate various imaging modalities to obtain complementary merits of single modality. Meanwhile, recent interest in laser-induced photoacoustic imaging is rapidly growing due to its unique advantages in visualizing tissue structure and function with high spatial resolution and satisfactory imaging depth. In this review, we summarize multimodal nanoprobes involving photoacoustic imaging. In particular, we focus on the method to construct multimodal nanoprobes. We have divided the synthetic methods into two types. First, we call it "one for all" concept, which involves intrinsic properties of the element in a single particle. Second, "all in one" concept, which means integrating different functional blocks in one particle. Then, we simply introduce the applications of the multifunctional nanoprobes for in vivo imaging and imaging-guided tumor therapy. At last, we discuss the advantages and disadvantages of the present methods to construct the multimodal nanoprobes and share our viewpoints in this area.

  7. Multimodal OCT for complex assessment of tumors response to therapy

    Science.gov (United States)

    Sirotkina, Marina A.; Kiseleva, Elena B.; Gubarkova, Ekaterina V.; Matveev, Lev A.; Zaitsev, Vladimir Yu.; Matveyev, Alexander L.; Shirmanova, Marina V.; Sovetsky, Alexander A.; Moiseev, Alexander A.; Zagaynova, Elena V.; Vitkin, Alex; Gladkova, Natalia D.

    2017-07-01

    Multimodal OCT is a promising tool for monitoring of individual tumor response to antitumor therapies. The changes of tumor cells, connective tissue, microcirculation and stiffness can be estimated simultaneously in real time with high resolution.

  8. Image fusion of MRI and fMRI with intraoperative MRI data: methods and clinical relevance for neurosurgical interventions; Fusion von MRT-, fMRT- und intraoperativen MRT-Daten. Methode und klinische Bedeutung am Beispiel neurochirurgischer Interventionen

    Energy Technology Data Exchange (ETDEWEB)

    Moche, M.; Busse, H.; Dannenberg, C.; Schulz, T.; Schmidt, F.; Kahn, T. [Universitaetsklinikum Leipzig (Germany). Klinik und Poliklinik fuer Diagnostische Radiologie; Schmitgen, A. [GMD Forschungszentrum Informationstechnik GmbH-FIT, Sankt Augustin (Germany); Trantakis, C.; Winkler, D. [Klinik und Poliklinik fuer Neurochirurgie, Universitaetsklinikum Leipzig (Germany)

    2001-11-01

    The aim of this work was to realize and clinically evaluate an image fusion platform for the integration of preoperative MRI and fMRI data into the intraoperative images of an interventional MRI system with a focus on neurosurgical procedures. A vertically open 0.5 T MRI scanner was equipped with a dedicated navigation system enabling the registration of additional imaging modalities (MRI, fMRI, CT) with the intraoperatively acquired data sets. These merged image data served as the basis for interventional planning and multimodal navigation. So far, the system has been used in 70 neurosurgical interventions (13 of which involved image data fusion - requiring 15 minutes extra time). The augmented navigation system is characterized by a higher frame rate and a higher image quality as compared to the system-integrated navigation based on continuously acquired (near) real time images. Patient movement and tissue shifts can be immediately detected by monitoring the morphological differences between both navigation scenes. The multimodal image fusion allowed a refined navigation planning especially for the resection of deeply seated brain lesions or pathologies close to eloquent areas. Augmented intraoperative orientation and instrument guidance improve the safety and accuracy of neurosurgical interventions. (orig.) [German] Ziel dieser Arbeit waren die Realisierung und klinische Bewertung einer Bildfusion praeoperativer MRT- und fMRT-Bilder mit intraoperativen Datensaetzen eines interventionellen MRT-Systems am Beispiel neurochirurgischer Eingriffe. Ein vertikal offenes 0,5-T-MRT-System wurde mit einem erweiterten Navigationssystem ausgestattet, welches eine Integration zusaetzlicher Bildinformationen (Hochfeld-MRT, fMRT, CT) in die intraoperativ akquirierten Datensaetze erlaubt. Diese fusionierten Bilddaten wurden zur Interventionsplanung und multimodalen Navigation verwendet. Bisher wurde das System bei insgesamt 70 neurochirurgischen Eingriffen eingesetzt, davon 13

  9. Agrupador de imágenes multimodal no supervisado

    OpenAIRE

    Pérez Hernando, Jesús

    2013-01-01

    Trabajo Fin de Máster donde se implementa un método multimodal para la clasificación de imágenes sin etiquetar y sin intervención humana. Treball Fi de Màster on s'implementa un mètode multimodal per a la classificació d'imatges sense etiquetar i sense intervenció humana. Master thesis for the Computer Science Engineering program.

  10. Approaching Athenian Graffiti as a Multimodal Genre with GIS Application

    OpenAIRE

    Stampoulidis, Georgios

    2017-01-01

    Graffiti as an ever-changing form of urban art and visual communication is naturally multimodal, focusing on text–image relations (Bateman 2014; Forceville 2008; Kress 2006), which owe their existence mainly to the sociocultural and historical knowledge of the represented world of our experience – Husserlian Lebenswelt [Lifeworld] (Sonesson 2008; 2015). These relations constitute an interesting challenge to multimodal interpretations, because both verbal and/or pictorial representations can i...

  11. Acting rehearsal in collaborative multimodal mixed reality environments

    OpenAIRE

    Steptoe, William; Normand, Jean-Marie; Oyekoya, Oyewole; Pece, Fabrizio; Giannopoulos, Elias; Tecchia, Franco; Steed, Anthony; Weyrich, Tim; Kautz, Jan; Slater, Mel

    2012-01-01

    This paper presents the use of our multimodal mixed reality telecommunication system to support remote acting rehearsal. The rehearsals involved two actors, located in London and Barcelona, and a director in another location in London. This triadic audiovisual telecommunication was performed in a spatial and multimodal collaborative mixed reality environment based on the 'destination-visitor' paradigm, which we define and put into use. We detail our heterogeneous system architecture, which sp...

  12. Exploring Multimodal Registers in and Across Organizations and Institutional Fields

    DEFF Research Database (Denmark)

    Meyer, Renate; Jancsary, Dennis; Höllerer, Markus

    In this article, we develop methodology that enables a systematic analysis of the structuralaspects of multimodal discourse from larger amounts of data. While existing research in visualorganization studies has provided interesting insights into the content and meaning(s) of visualand multimodal ......Responsibility (CSR), a complex and multivocal management idea that touches a variety oftopics and incorporates multiple levels of audience engagement with regard to a substantialdiversity of audiences....

  13. Optical sensor in planar configuration based on multimode interference

    Science.gov (United States)

    Blahut, Marek

    2017-08-01

    In the paper a numerical analysis of optical sensors based on multimode interference in planar one-dimensional step-index configuration is presented. The structure consists in single-mode input and output waveguides and multimode waveguide which guide only few modes. Material parameters discussed refer to a SU8 polymer waveguide on SiO2 substrate. The optical system described will be designed to the analysis of biological substances.

  14. Multi-modal RGB–Depth–Thermal Human Body Segmentation

    DEFF Research Database (Denmark)

    Palmero, Cristina; Clapés, Albert; Bahnsen, Chris

    2016-01-01

    This work addresses the problem of human body segmentation from multi-modal visual cues as a first stage of automatic human behavior analysis. We propose a novel RGB-Depth-Thermal dataset along with a multi-modal seg- mentation baseline. The several modalities are registered us- ing a calibration...... to other state-of-the-art meth- ods, obtaining an overlap above 75% on the novel dataset when compared to the manually annotated ground-truth of human segmentations....

  15. Intraoperative near-infrared fluorescent imaging during robotic operations.

    Science.gov (United States)

    Macedo, Antonio Luiz de Vasconcellos; Schraibman, Vladimir

    2016-01-01

    The intraoperative identification of certain anatomical structures because they are small or visually occult may be challenging. The development of minimally invasive surgery brought additional difficulties to identify these structures due to the lack of complete tactile sensitivity. A number of different forms of intraoperative mapping have been tried. Recently, the near-infrared fluorescence imaging technology with indocyanine green has been added to robotic platforms. In addition, this technology has been tested in several types of operations, and has advantages such as safety, low cost and good results. Disadvantages are linked to contrast distribution in certain clinical scenarios. The intraoperative near-infrared fluorescent imaging is new and promising addition to robotic surgery. Several reports show the utility of this technology in several different procedures. The ideal dose, time and site for dye injection are not well defined. No high quality evidence-based comparative studies and long-term follow-up outcomes have been published so far. Initial results, however, are good and safe. RESUMO A identificação intraoperatória de certas estruturas anatômicas, por seu tamanho ou por elas serem ocultas à visão, pode ser desafiadora. O desenvolvimento da cirurgia minimamente invasiva trouxe dificuldades adicionais, pela falta da sensibilidade tátil completa. Diversas formas de detecção intraoperatória destas estruturas têm sido tentadas. Recentemente, a tecnologia de fluorescência infravermelha com verde de indocianina foi associada às plataformas robóticas. Além disso, essa tecnologia tem sido testada em uma variedade de cirurgias, e suas vantagens parecem estar ligadas a baixo custo, segurança e bons resultados. As desvantagens estão associadas à má distribuição do contraste em determinados cenários. A imagem intraoperatória por fluorescência infravermelha é uma nova e promissora adição à cirurgia robótica. Diversas séries mostram

  16. Intraoperative performance and postoperative outcomes of microcoaxial phacoemulsification. Observational study.

    Science.gov (United States)

    Vasavada, Viraj; Vasavada, Vaishali; Raj, Shetal M; Vasavada, Abhay R

    2007-06-01

    To evaluate the intraoperative performance and postoperative outcomes after microcoaxial phacoemulsification. Iladevi Cataract & IOL Research Centre, Ahmedabad, India. A prospective observational case series comprised 84 eyes with age-related uncomplicated cataract having microcoaxial phacoemulsification through a 2.2 mm clear corneal incision by a standard surgical technique. Phacoemulsification parameters (Infiniti Vision System, Alcon) were microburst width, 30 ms; preset power, 50%; vacuum, 650 mm Hg; aspiration flow rate, 25 cc/minute. A single-piece Alcon AcrySof intraocular lens was implanted with the C cartridge (Alcon) cartridge. The incision was measured at the end of surgery. Observations included surgical time (from commencement of sculpting to end of epinucleus removal), cumulative dissipated energy (CDE), wound burns, intraoperative complications, postoperative increase in mean central corneal thickness (CCT) at 1 day and 1 month, mean % decrease in endothelial cell density (ECD), absolute mean change in coefficient of variation (cv) 3 months, and uncorrected visual acuity (UCVA) at 1 day. Data were analyzed using a 1-sample t test with 95% confidence intervals (CIs). The mean follow up was 3 months +/- 0.3 (SD). The mean incision size at the end of surgery was 2.3 +/- .09 mm; mean surgical time, 4.5 +/- 1.5 minutes; and mean CDE, 2.3 +/- 2.2 seconds. No wound burns or other intraoperative complications occurred. The postoperative CCT increased by a mean of 16 microm at 1 day (95% CI, 8-25; P = .66;) and by a mean of 3.14 microm at 1 month (95% CI, 2.26-4.05; P = .92). The ECD decreased by a mean of 5.8% (95% CI, 6.8-3.5; P = .82) and the mean coefficient of variation, by 3.3 (95% CI, 4.5-2.0; P = .65). At 1 day, the UCVA was 20/20 in 29% of cases, 20/20 to 20/40 in 58%, and 20/40 to 20/50 in 12%. Microcoaxial phacoemulsification was safely and effectively performed, achieving consistent and satisfactory postoperative outcomes.

  17. Intraoperative electron beam radiation therapy (IOEBRT) for carcinoma of the exocrine pancreas

    International Nuclear Information System (INIS)

    Dobelbower, R.R. Jr.; Konski, A.A.; Merrick, H.W. III; Bronn, D.G.; Schifeling, D.; Kamen, C.

    1991-01-01

    The abdominal cavities of 50 patients were explored in a specially constructed intraoperative radiotherapy operating amphitheater at the Medical College of Ohio. Twenty-six patients were treated with intraoperative and postoperative precision high dose external beam therapy, 12 with intraoperative irradiation but no external beam therapy, and 12 with palliative surgery alone. All but two patients completed the postoperative external beam radiation therapy as initially prescribed. The median survival time for patients treated with palliative surgery alone was 4 months, and that for patients treated with intraoperative radiotherapy without external beam therapy was 3.5 months. Patients undergoing intraoperative irradiation and external beam radiation therapy had a median survival time of 10.5 months. Four patients died within 30 days of surgery and two patients died of gastrointestinal hemorrhage 5 months posttreatment

  18. Intra-operative radiotherapy of malignant tumors: Past, present and perspectives

    International Nuclear Information System (INIS)

    Mazeron, J.J.; Le Bourgeois, J.P.; Ganem, G.

    1986-01-01

    Intra-operative radiotherapy consists of electron or photon radiation which is used during the operative procedure. The treatment field is arranged very precisely after critical organs have been previously arranged out of the field. The target volume includes the remaining tumor which could not be removed surgically, and the surrounding tumor bed which is also felt to be high risk for recurrence. It is preferable to have as little tumor remaining as possible before the intra-operative treatment radiation is given. Intra-operative radiotherapy was developed less than a quarter century ago in Japon, and it was later used in U.S.A. The accumulated experience in Japan and U.S.A. is rewieved here. Intra-operative radiotherapy has only recently been introduced to France. The biology, physics and medical and technical problems of intra-operative therapy are discussed [fr

  19. Multimodal processes scheduling in mesh-like network environment

    Directory of Open Access Journals (Sweden)

    Bocewicz Grzegorz

    2015-06-01

    Full Text Available Multimodal processes planning and scheduling play a pivotal role in many different domains including city networks, multimodal transportation systems, computer and telecommunication networks and so on. Multimodal process can be seen as a process partially processed by locally executed cyclic processes. In that context the concept of a Mesh-like Multimodal Transportation Network (MMTN in which several isomorphic subnetworks interact each other via distinguished subsets of common shared intermodal transport interchange facilities (such as a railway station, bus station or bus/tram stop as to provide a variety of demand-responsive passenger transportation services is examined. Consider a mesh-like layout of a passengers transport network equipped with different lines including buses, trams, metro, trains etc. where passenger flows are treated as multimodal processes. The goal is to provide a declarative model enabling to state a constraint satisfaction problem aimed at multimodal transportation processes scheduling encompassing passenger flow itineraries. Then, the main objective is to provide conditions guaranteeing solvability of particular transport lines scheduling, i.e. guaranteeing the right match-up of local cyclic acting bus, tram, metro and train schedules to a given passengers flow itineraries.

  20. [Intraoperative detection of the sentinel lymph nodes in lung cancer].

    Science.gov (United States)

    Akopov, A L; Papayan, G V; Chistyakov, I V

    2015-01-01

    An analysis of the scientific data was made. It was used the literature devoted to the intraoperative visualization of the sentinel lymph nodes in patients with lung cancer. Correct detection of such lymph nodes with following pathologic investigation allowed limiting the volume of lympho-dissection in a number of patients. There is the possibility of maximal in-depth study of the sentinel lymph nodes by purposeful application of most sensible pathologic and molecular methods for detection their micrometastatic lesions. At the same time the treatment strategy and prognosis could be determined. The authors present the results of an application of dye techniques, radioactive preparation and fluorescence imaging for sentinel lymph node detection. Advantages and disadvantages of the methods are shown in the article. There are validated the prospects of technical development, study of information value of new applications and the most perspective method of fluorescence indocyanine green visualization by lymph outflow.

  1. Intraoperative Assessment of Esophagogastric Junction Distensibility During Laparoscopic Heller Myotomy.

    Science.gov (United States)

    DeHaan, Reece K; Frelich, Matthew J; Gould, Jon C

    2016-04-01

    We sought to characterize the changes in esophagogastric junction (EGJ) distensibility during Heller Myotomy with Dor fundoplication using the EndoFLIP device. Intraoperative distensibility measurements on 14 patients undergoing Heller myotomy with Dor fundoplication were conducted over an 18-month period. Minimum esophageal diameter, cross-sectional areas, and distensibility index were measured at 30 and 40 mL catheter volumes before myotomy, postmyotomy, and following Dor fundoplication. Distensibility index is defined as the narrowest cross-sectional area divided by the corresponding pressure expressed in mm/mm Hg. Heller myotomy was found to lead to significant changes in the distensibility characteristics of the EGJ. Minimum esophageal diameter and EGJ distensibility increased significantly with Heller myotomy.

  2. Videoscopic Heller Myotomy with Intraoperative Endoscopy Promotes Optimal Outcomes

    Science.gov (United States)

    Bloomston, Mark; Brady, Patrick

    2002-01-01

    Background and Objectives: Minimally invasive surgical techniques are applicable to achalasia, but the optimum approach to intraoperative assessment of adequacy of myotomy remains unestablished. We set out to show that videoscopic Heller myotomy with concurrent endoscopy ensures adequacy of myotomy while limiting postoperative clinically apparent reflux. Methods: Seventy-eight consecutive patients with achalasia underwent videoscopic Heller myotomy with concomitant endoscopy between 1992 and 1998. Fundoplication was not routinely undertaken. Results: Preoperative symptoms consisted of dysphagia (100%), emesis/regurgitation (68%), heartburn (58%), and postprandial chest pain (49%). Following myotomy, significant improvement (P Heller myotomy guides the extent and adequacy of myotomy. By utilizing a focused dissection with preservation of the natural antireflux mechanisms around the gastroesophageal junction and limiting the extent of myotomy along the cardia, postoperative reflux symptoms are minimized. We advocate concomitant endoscopy during Heller myotomy to guide myotomy and submit that routine fundoplication is clinically unnecessary. PMID:12113416

  3. Is current clinical practice modified about intraoperative breast irradiation?

    Science.gov (United States)

    Massa, Michela; Franchelli, Simonetta; Panizza, Renzo; Massa, Tiberio

    2016-04-01

    After the results obtained in the two randomized clinical trial, the ELIOT trial and the TARGIT-A trial, a heated debate is going on concerning the question of applying intraoperative radiotherapy (IORT) instead of postoperative whole breast irradiation (WBI) after breast conservative treatment. Currently, many centers are applying the IORT following the strict selection criteria dictated by the working groups American Society for Radiation Oncology (ASTRO) and Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) and monitoring the oncological outcome together with radiation toxicity on breast tissue. The clinical experience of the Geneva University Hospital regarding the use of the Intrabeam system is evaluated and compared with current evidences.

  4. Non-radiographic intraoperative fluorescent cholangiography is feasible

    DEFF Research Database (Denmark)

    Larsen, Søren S; Schulze, Svend; Bisgaard, Thue

    2014-01-01

    INTRODUCTION: Intraoperative fluorescent cholangiography (IFC) with concomitant fluorescent angiography was recently developed for non-invasive identification of the anatomy during laparoscopic cholecystectomy. The objective of this study was to assess the time required for routine-use of IFC...... and to evaluate the success rate of the procedures. MATERIAL AND METHODS: A total of 35 patients scheduled for laparoscopic cholecystectomy and operated by the same surgeon were consecutively enrolled. A standardised protocol with IFC including angiography was performed during laparoscopic cholecystectomy...... hepatic duct was identified by IFC in all patients. In 29 of the 35 patients (83%; 95% confidence interval: 71-96%), the cystic artery was visualised by fluorescent angiography. No adverse effects or complications were recorded. CONCLUSION: Routine-use of IFC with fluorescent angiography during...

  5. Intra-operative hearing monitoring methods in middle ear surgeries

    Directory of Open Access Journals (Sweden)

    Wei Ren

    2016-12-01

    Full Text Available Hearing loss is a condition affecting millions of people worldwide. Conductive hearing loss (CHL is mainly caused by middle ear diseases. The low frequency area is the pivotal part of speech frequencies and most frequently impaired in patients with CHL. Among various treatments of CHL, middle ear surgery is efficient to improve hearing. However, variable success rates and possible needs for prolonged revision surgery still frustrate both surgeons and patients. Nowadays, increasing numbers of researchers explore various methods to monitor the efficacy of ossicular reconstruction intraoperatively, including electrocochleography (ECochG, auditory brainstem response (ABR, auditory steady state response (ASSR, distortion product otoacoustic emissions (DPOAE, subjective whisper test, and optical coherence tomography (OCT. Here, we illustrate several methods used clinically by reviewing the literature.

  6. Upper gastrointestinal tract injuries by intraoperative radiotherapy for pancreatic cancer

    Energy Technology Data Exchange (ETDEWEB)

    Tabata, I; Isawa, T; Satomi, T; Tazima, T [Tokyo Metropolitan Komagome Hospital (Japan)

    1981-08-01

    Twenty-one patients with unresectable carcinoma of the pancreas were treated by intraoperative irradiation with a large electron dose of 1500 - 3000 rads and upper gastrointestinal complications were encountered in five cases. All of those five cases were for carcinoma of the pancreatic head, and were seen for gastrointestinal tract injuries of the duodenum as follows, gastric ulcer in 2 cases, ulcer of the 1st duodenal portion in one case and ulcer with severe stenosis of the 2nd or 3rd duodenal portion in one case, respectively. Endoscopic features of these postirradiation gastrointestinal ulcers were characterized by deep, punched-out ulcers with grayish bases and sharp margins. Clinically these ulcers and stenosis were very difficult to treat, so by-pass operations were performed in two cases, resulting in prolonged survival.

  7. Intraoperative radiation in the canine para-aortic abdomen

    International Nuclear Information System (INIS)

    Hoopes, P.J.; Gillette, E.L.

    1984-01-01

    Twenty adult beagle dogs received intraoperatively delivered 6 MeV electrons to the para-aortic abdomen and bladder. The dogs were equally divided into 4 dose groups receiving 22 Gy, 30 Gy, 38.5 Gy and 47 Gy. The 5 cm x 8 cm radiation field included a variable portion of the left kidney, the left ureter, the abdominal aorta and vena cava, the base of the bladder and the left sciatic and femoral nerves. The lesions observed were fibroelastic proliferation of the aortic intima, severe renal atrophy and fibrosis, ureteral stenosis, bladder fibrosis and demyelinating peripheral neuropathies. Histologic, morphometric and dose response analyses are compared with responses of dogs receiving more conventional fractionated doses to a total of 60 Gy, 70 Gy or 80 Gy x-ray in 6 weeks

  8. Tolerance of canine anastomoses to intraoperative radiation therapy

    International Nuclear Information System (INIS)

    Tepper, J.E.; Sindelar, W.; Travis, E.L.; Terrill, R.; Padikal, T.

    1983-01-01

    Radiation has been given intraoperatively to various abdominal structures in dogs, using a fixed horizontal 11 MeV electron beam at the Armed Forces Radiobiologic Research Institute. Animals were irradiated with single doses of 2000, 3000 and 4500 rad to a field which extended from the bifurcation of the aorta to the rib cage. All animals were irradiated during laparotomy under general anesthesia. Because the clinical use of intraoperative radiotherapy in cancer treatment will occasionally require irradiation of anastomosed large vessels and blind loops of bowel, the tolerance of aortic anastomoses and the suture lines of blind loops of jejunum to irradiation were studied. Responses in these experiments were scored at times up to one year after irradiation. In separate experiments both aortic and intestinal anastomoses were performed on each animal for evaluation of short term response. The dogs with aortic anastomoses showed adequate healing at all doses with no evidence of suture line weakening. On long-term follow-up one animal (2000 rad) had stenosis at the anastomosis and one animal (4500 rad) developed an arteriovenous fistula. Three of the animals that had an intestinal blind loop irradiated subsequently developed intussusception, with the irradiated loop acting as the lead point. One week after irradiation, bursting pressure of an intestinal blind loop was normal at 3000 rad, but markedly decreased at 4500 rad. No late complications were noted after the irradiation of the intestinal anastomosis. No late complicatons were observed after irradiation of intestinal anastomoses, but one needs to be cautious with regards to possible late stenosis at the site of an irradiated vascular anastomosis

  9. VATS intraoperative tattooing to facilitate solitary pulmonary nodule resection

    Directory of Open Access Journals (Sweden)

    Boutros Cherif

    2008-03-01

    Full Text Available Abstract Introduction Video-assisted thoracic surgery (VATS has become routine and widely accepted for the removal of solitary pulmonary nodules of unknown etiology. Thoracosopic techniques continue to evolve with better instruments, robotic applications, and increased patient acceptance and awareness. Several techniques have been described to localize peripheral pulmonary nodules, including pre-operative CT-guided tattooing with methylene blue, CT scan guided spiral/hook wire placement, and transthoracic ultrasound. As pulmonary surgeons well know, the lung and visceral pleura may appear featureless on top of a pulmonary nodule. Case description This paper presents a rapid, direct and inexpensive approach to peripheral lung lesion resection by marking the lung parenchyma on top of the nodule using direct methylene blue injection. Methods In two patients with peripherally located lung nodules (n = 3 scheduled for VATS, we used direct methylene blue injection for intraoperative localization of the pulmonary nodule. Our technique was the following: After finger palpation of the lung, a spinal 25 gauge needle was inserted through an existing port and 0.1 ml of methylene blue was used to tattoo the pleura perpendicular to the localized nodule. The methylene blue tattoo immediately marks the lung surface over the nodule. The surgeon avoids repeated finger palpation, while lining up stapler, graspers and camera, because of the visible tattoo. Our technique eliminates regrasping and repalpating the lung once again to identify a non marked lesion. Results Three lung nodules were resected in two patients. Once each lesion was palpated it was marked, and the area was resected with security of accurate localization. All lung nodules were resected in totality with normal lung parenchymal margins. Our technique added about one minute to the operative time. The two patients were discharged home on the second postoperative day, with no morbidity. Conclusion

  10. A surgical navigation system for non-contact diffuse optical tomography and intraoperative cone-beam CT

    Science.gov (United States)

    Daly, Michael J.; Muhanna, Nidal; Chan, Harley; Wilson, Brian C.; Irish, Jonathan C.; Jaffray, David A.

    2014-02-01

    A freehand, non-contact diffuse optical tomography (DOT) system has been developed for multimodal imaging with intraoperative cone-beam CT (CBCT) during minimally-invasive cancer surgery. The DOT system is configured for near-infrared fluorescence imaging with indocyanine green (ICG) using a collimated 780 nm laser diode and a nearinfrared CCD camera (PCO Pixelfly USB). Depending on the intended surgical application, the camera is coupled to either a rigid 10 mm diameter endoscope (Karl Storz) or a 25 mm focal length lens (Edmund Optics). A prototype flatpanel CBCT C-Arm (Siemens Healthcare) acquires low-dose 3D images with sub-mm spatial resolution. A 3D mesh is extracted from CBCT for finite-element DOT implementation in NIRFAST (Dartmouth College), with the capability for soft/hard imaging priors (e.g., segmented lymph nodes). A stereoscopic optical camera (NDI Polaris) provides real-time 6D localization of reflective spheres mounted to the laser and camera. Camera calibration combined with tracking data is used to estimate intrinsic (focal length, principal point, non-linear distortion) and extrinsic (translation, rotation) lens parameters. Source/detector boundary data is computed from the tracked laser/camera positions using radiometry models. Target registration errors (TRE) between real and projected boundary points are ~1-2 mm for typical acquisition geometries. Pre-clinical studies using tissue phantoms are presented to characterize 3D imaging performance. This translational research system is under investigation for clinical applications in head-and-neck surgery including oral cavity tumour resection, lymph node mapping, and free-flap perforator assessment.

  11. Comparison of the WarmCloud and Bair Hugger Warming Devices for the Prevention of Intraoperative Hypothermia in Patients Undergoing Orthotopic Liver Transplantation: A Randomized Clinical Trial

    Science.gov (United States)

    Pearce, Brett; Mattheyse, Linda; Ellard, Louise; Desmond, Fiona; Pillai, Param; Weinberg, Laurence

    2018-01-01

    Background The avoidance of hypothermia is vital during prolonged and open surgery to improve patient outcomes. Hypothermia is particularly common during orthotopic liver transplantation (OLT) and associated with undesirable physiological effects that can adversely impact on perioperative morbidity. The KanMed WarmCloud (Bromma, Sweden) is a revolutionary, closed-loop, warm-air heating mattress developed to maintain normothermia and prevent pressure sores during major surgery. The clinical effectiveness of the WarmCloud device during OLT is unknown. Therefore, we conducted a randomized controlled trial to determine whether the WarmCloud device reduces hypothermia and prevents pressure injuries compared with the Bair Hugger underbody warming device. Methods Patients were randomly allocated to receive either the WarmCloud or Bair Hugger warming device. Both groups also received other routine standardized multimodal thermoregulatory strategies. Temperatures were recorded by nasopharyngeal temperature probe at set time points during surgery. The primary endpoint was nasopharyngeal temperature recorded 5 minutes before reperfusion. Secondary endpoints included changes in temperature over the predefined intraoperative time points, number of patients whose nadir temperature was below 35.5°C and the development of pressure injuries during surgery. Results Twenty-six patients were recruited with 13 patients randomized to each group. One patient from the WarmCloud group was excluded because of a protocol violation. Baseline characteristics were similar. The mean (standard deviation) temperature before reperfusion was 36.0°C (0.7) in the WarmCloud group versus 36.3°C (0.6) in the Bairhugger group (P = 0.25). There were no statistical differences between the groups for any of the secondary endpoints. Conclusions When combined with standardized multimodal thermoregulatory strategies, the WarmCloud device does not reduce hypothermia compared with the Bair Hugger device in

  12. Effects of intraoperative irradiation (IORT) and intraoperative hyperthermia (IOHT) on canine sciatic nerve: histopathological and morphometric studies

    International Nuclear Information System (INIS)

    Vujaskovic, Zeljko; Powers, Barbara E.; Paardekoper, Gabriel; Gillette, Sharon M.; Gillette, Edward L.; Colacchio, Thomas A.

    1999-01-01

    Purpose/Objective: Peripheral neuropathies have emerged as the major dose-limiting complication reported after intraoperative radiation therapy (IORT). The combination of IORT with hyperthermia may further increase the risk of peripheral nerve injury. The objective of this study was to evaluate histopathological and histomorphometric changes in the sciatic nerve of dogs, after IORT with or without hyperthermia treatment. Methods and Materials: Young adult beagle dogs were randomized into five groups of 3-5 dogs each to receive IORT doses of 16, 20, 24, 28, or 32 Gy. Six groups of 4-5 dogs each received IORT doses of 12, 16, 20, 24, or 28 Gy simultaneously with 44 deg. C of intraoperative hyperthermia (IOHT) for 60 min. One group of dogs acted as hyperthermia-alone controls. Two years after the treatment, dogs were euthanized, and histopathological and morphometric analyses were performed. Results: Qualitative histological analysis showed prominant changes such as focal necrosis, mineralization, fibrosis, and severe fiber loss in dogs which received combined treatment. Histomorphometric results showed a significantly higher decrease in axon and myelin and small blood vessels, with a corresponding increase in connective tissue in dogs receiving IORT plus hyperthermia treatment. The effective dose for 50% of nerve fiber loss (ED 50 ) in dogs exposed to IORT only was 25.3 Gy. The ED 50 for nerve fiber loss in dogs exposed to IORT combined with IOHT was 14.8 Gy. The thermal enhancement ratio (TER) was 1.7. Conclusion: The probability of developing peripheral neuropathies in a large animal model is higher when IORT is combined with IOHT, when compared to IORT application alone. To minimize the risk of peripheral neuropathy, clinical treatment protocols for the combination of IORT and hyperthermia should not assume a thermal enhancement ratio (TER) to be lower than 1.5

  13. Effects on functional outcome after IORT-containing multimodality treatment for locally advanced primary and locally recurrent rectal cancer

    International Nuclear Information System (INIS)

    Mannaerts, Guido H.H.; Rutten, Harm J.T.; Martijn, Hendrik; Hanssens, Patrick E.J.; Wiggers, Theo

    2002-01-01

    Purpose: In the treatment of patients with locally advanced primary or locally recurrent rectal cancer, much attention is focused on the oncologic outcome. Little is known about the functional outcome. In this study, the functional outcome after a multimodality treatment for locally advanced primary and locally recurrent rectal cancer is analyzed. Methods and Materials: Between 1994 and 1999, 55 patients with locally advanced primary and 66 patients with locally recurrent rectal cancer were treated with high-dose preoperative external beam irradiation, followed by extended surgery and intraoperative radiotherapy. To assess long-term functional outcome, all patients still alive (n = 97) were asked to complete a questionnaire regarding ongoing morbidity, as well as functional and social impairment. Seventy-six of the 79 patients (96%) returned the questionnaire. The median follow-up was 14 months (range: 4-60 months). Results: The questionnaire revealed fatigue in 44%, perineal pain in 42%, radiating pain in the leg(s) in 21%, walking difficulties in 36%, and voiding dysfunction in 42% of the patients as symptoms of ongoing morbidity. Functional impairment consisted of requiring help with basic activities in 15% and sexual inactivity in 56% of the respondents. Social handicap was demonstrated by loss of former lifestyle in 44% and loss of professional occupation in 40% of patients. Conclusions: As a result of multimodality treatment, the majority of these patients have to deal with long-term physical morbidity, the need for help with daily care, and considerable social impairment. These consequences must be weighed against the chance of cure if the patient is treated and the disability eventually caused by uncontrolled tumor progression if the patient is not treated. These potential drawbacks should be discussed with the patient preoperatively and taken into account when designing a treatment strategy

  14. Multimodal Sensing Interface for Haptic Interaction

    Directory of Open Access Journals (Sweden)

    Carlos Diaz

    2017-01-01

    Full Text Available This paper investigates the integration of a multimodal sensing system for exploring limits of vibrato tactile haptic feedback when interacting with 3D representation of real objects. In this study, the spatial locations of the objects are mapped to the work volume of the user using a Kinect sensor. The position of the user’s hand is obtained using the marker-based visual processing. The depth information is used to build a vibrotactile map on a haptic glove enhanced with vibration motors. The users can perceive the location and dimension of remote objects by moving their hand inside a scanning region. A marker detection camera provides the location and orientation of the user’s hand (glove to map the corresponding tactile message. A preliminary study was conducted to explore how different users can perceive such haptic experiences. Factors such as total number of objects detected, object separation resolution, and dimension-based and shape-based discrimination were evaluated. The preliminary results showed that the localization and counting of objects can be attained with a high degree of success. The users were able to classify groups of objects of different dimensions based on the perceived haptic feedback.

  15. Multimodal three-dimensional dynamic signature

    Directory of Open Access Journals (Sweden)

    Yury E. Kozlov

    2017-11-01

    Full Text Available Reliable authentication in mobile applications is among the most important information security challenges. Today, we can hardly imagine a person who would not own a mobile device that connects to the Internet. Mobile devices are being used to store large amounts of confidential information, ranging from personal photos to electronic banking tools. In 2009, colleagues from Rice University together with their collaborators from Motorola, proposed an authentication through in-air gestures. This and subsequent work contributing to the development of the method are reviewed in our introduction. At the moment, there exists a version of the gesture-based authentication software available for Android mobile devices. This software has not become widespread yet. One of likely reasons for that is the insufficient reliability of the method, which involves similar to its earlier analogs the use of only one device. Here we discuss the authentication based on the multimodal three-dimensional dynamic signature (MTDS performed by two independent mobile devices. The MTDS-based authentication technique is an advanced version of in-air gesture authentication. We describe the operation of a prototype of MTDS-based authentication, including the main implemented algorithms, as well as some preliminary results of testing the software. We expect that our method can be used in any mobile application, provided a number of additional improvements discussed in the conclusion are made.

  16. Haptic-Multimodal Flight Control System Update

    Science.gov (United States)

    Goodrich, Kenneth H.; Schutte, Paul C.; Williams, Ralph A.

    2011-01-01

    The rapidly advancing capabilities of autonomous aircraft suggest a future where many of the responsibilities of today s pilot transition to the vehicle, transforming the pilot s job into something akin to driving a car or simply being a passenger. Notionally, this transition will reduce the specialized skills, training, and attention required of the human user while improving safety and performance. However, our experience with highly automated aircraft highlights many challenges to this transition including: lack of automation resilience; adverse human-automation interaction under stress; and the difficulty of developing certification standards and methods of compliance for complex systems performing critical functions traditionally performed by the pilot (e.g., sense and avoid vs. see and avoid). Recognizing these opportunities and realities, researchers at NASA Langley are developing a haptic-multimodal flight control (HFC) system concept that can serve as a bridge between today s state of the art aircraft that are highly automated but have little autonomy and can only be operated safely by highly trained experts (i.e., pilots) to a future in which non-experts (e.g., drivers) can safely and reliably use autonomous aircraft to perform a variety of missions. This paper reviews the motivation and theoretical basis of the HFC system, describes its current state of development, and presents results from two pilot-in-the-loop simulation studies. These preliminary studies suggest the HFC reshapes human-automation interaction in a way well-suited to revolutionary ease-of-use.

  17. Multimodal interaction for human-robot teams

    Science.gov (United States)

    Burke, Dustin; Schurr, Nathan; Ayers, Jeanine; Rousseau, Jeff; Fertitta, John; Carlin, Alan; Dumond, Danielle

    2013-05-01

    Unmanned ground vehicles have the potential for supporting small dismounted teams in mapping facilities, maintaining security in cleared buildings, and extending the team's reconnaissance and persistent surveillance capability. In order for such autonomous systems to integrate with the team, we must move beyond current interaction methods using heads-down teleoperation which require intensive human attention and affect the human operator's ability to maintain local situational awareness and ensure their own safety. This paper focuses on the design, development and demonstration of a multimodal interaction system that incorporates naturalistic human gestures, voice commands, and a tablet interface. By providing multiple, partially redundant interaction modes, our system degrades gracefully in complex environments and enables the human operator to robustly select the most suitable interaction method given the situational demands. For instance, the human can silently use arm and hand gestures for commanding a team of robots when it is important to maintain stealth. The tablet interface provides an overhead situational map allowing waypoint-based navigation for multiple ground robots in beyond-line-of-sight conditions. Using lightweight, wearable motion sensing hardware either worn comfortably beneath the operator's clothing or integrated within their uniform, our non-vision-based approach enables an accurate, continuous gesture recognition capability without line-of-sight constraints. To reduce the training necessary to operate the system, we designed the interactions around familiar arm and hand gestures.

  18. Fluorescent magnetic hybrid nanoprobe for multimodal bioimaging

    Energy Technology Data Exchange (ETDEWEB)

    Koktysh, Dmitry [Department of Chemistry, Vanderbilt University, Station B 351822, Nashville, TN 37235 (United States); Bright, Vanessa; Pham, Wellington, E-mail: dmitry.koktysh@vanderbilt.edu, E-mail: wellington.pham@vanderbilt.edu [Institute of Imaging Science, Vanderbilt University, 1161 21st Avenue South AA, 1105 MCN, Nashville, TN 37232 (United States)

    2011-07-08

    A fluorescent magnetic hybrid imaging nanoprobe (HINP) was fabricated by the conjugation of superparamagnetic Fe{sub 3}O{sub 4} nanoparticles and visible light emitting ({approx}600 nm) fluorescent CdTe/CdS quantum dots (QDs). The assembly strategy used the covalent linking of the oxidized dextran shell of magnetic particles to the glutathione ligands of QDs. The synthesized HINP formed stable water-soluble colloidal dispersions. The structure and properties of the particles were characterized by transmission electron and atomic force microscopy, energy dispersive x-ray analysis and inductively coupled plasma optical emission spectroscopy, dynamic light scattering analysis, optical absorption and photoluminescence spectroscopy, and fluorescent imaging. The luminescence imaging region of the nanoprobe was extended to the near-infrared (NIR) ({approx}800 nm) by conjugation of the superparamagnetic nanoparticles with synthesized CdHgTe/CdS QDs. Cadmium, mercury based QDs in HINP can be easily replaced by novel water-soluble glutathione stabilized AgInS{sub 2}/ZnS QDs to present a new class of cadmium-free multimodal imaging agents. The observed NIR photoluminescence of fluorescent magnetic nanocomposites supports their use for bioimaging. The developed HINP provides dual-imaging channels for simultaneous optical and magnetic resonance imaging.

  19. Multimodal treatment for resectable esophageal cancer

    International Nuclear Information System (INIS)

    Miyata, Hiroshi; Yamasaki, Makoto; Kurokawa, Yukinori; Takiguchi, Shuji; Nakajima, Kiyokazu; Fujiwara, Yoshiyuki; Mori, Masaki; Doki, Yuichiro

    2011-01-01

    Surgical resection has been traditionally the mainstay of treatment for localized esophageal cancers. However, survival after surgery alone for advanced esophageal cancer is not satisfactory. In Japan, the development of multimodal therapy for esophageal cancers has centered mainly on systemic chemotherapy plus surgery to control distant metastasis. Based on the results of the recent Japan Clinical Oncology Group (JCOG) 9907 study, preoperative chemotherapy (consisting of 5-fluorouracil (FU) and cisplatin) followed by surgery has emerged as the standard treatment. In Western countries, where chemoradiotherapy followed by surgery has been mainly explored for patients with resectable esophageal cancers, two large controlled trials that evaluated the effectiveness of preoperative chemotherapy reported conflicting results. However, a recent meta-analysis reported significant survival benefits for preoperative chemotherapy in patients with adenocarcinoma of the esophagus. We need to find new effective preoperative chemotherapeutic regimens, including molecular target agents, with response rates higher than that of the conventional chemotherapy of 5-FU and cisplatin. However, we also must compare the survival benefits of preoperative chemotherapy with preoperative chemoradiotherapy. (author)

  20. Ionizing radiation detector using multimode optical fibers

    International Nuclear Information System (INIS)

    Suter, J.J.; Poret, J.C.; Rosen, M.; Rifkind, J.M.

    1993-01-01

    An optical ionizing radiation detector, based on the attenuation of 850-nm light in 50/125-μm multimode fibers, is described. The detector is especially well suited for application on spacecraft because of its small design. The detection element consists of a section of coiled fibers that has been designed to strip higher-order optical modes. Cylindrical radiation shields with atomic numbers ranging from Z = 13 (aluminum too) Z = 82 (lead) were placed around the ionizing radiation detector so that the effectiveness of the detector could be measured. By exposing the shields and the detector to 1.25-MeV cobalt 60 radiation, the mass attenuation coefficients of the shields were measured. The detector is based on the phenomenon that radiation creates optical color centers in glass fibers. Electron spin resonance spectroscopy performed on the 50/125-μm fibers showed the presence of germanium oxide and phosphorus-based color centers. The intensity of these centers is directly related to the accumulated gamma radiation

  1. Multimodal approaches for emotion recognition: a survey

    Science.gov (United States)

    Sebe, Nicu; Cohen, Ira; Gevers, Theo; Huang, Thomas S.

    2005-01-01

    Recent technological advances have enabled human users to interact with computers in ways previously unimaginable. Beyond the confines of the keyboard and mouse, new modalities for human-computer interaction such as voice, gesture, and force-feedback are emerging. Despite important advances, one necessary ingredient for natural interaction is still missing-emotions. Emotions play an important role in human-to-human communication and interaction, allowing people to express themselves beyond the verbal domain. The ability to understand human emotions is desirable for the computer in several applications. This paper explores new ways of human-computer interaction that enable the computer to be more aware of the user's emotional and attentional expressions. We present the basic research in the field and the recent advances into the emotion recognition from facial, voice, and physiological signals, where the different modalities are treated independently. We then describe the challenging problem of multimodal emotion recognition and we advocate the use of probabilistic graphical models when fusing the different modalities. We also discuss the difficult issues of obtaining reliable affective data, obtaining ground truth for emotion recognition, and the use of unlabeled data.

  2. Intraoperative leak testing has no correlation with leak after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Sethi, Monica; Zagzag, Jonathan; Patel, Karan; Magrath, Melissa; Somoza, Eduardo; Parikh, Manish S; Saunders, John K; Ude-Welcome, Aku; Schwack, Bradley F; Kurian, Marina S; Fielding, George A; Ren-Fielding, Christine J

    2016-03-01

    Staple line leak is a serious complication of sleeve gastrectomy. Intraoperative methylene blue and air leak tests are routinely used to evaluate for leak; however, the utility of these tests is controversial. We hypothesize that the practice of routine intraoperative leak testing is unnecessary during sleeve gastrectomy. A retrospective cohort study was designed using a prospectively collected database of seven bariatric surgeons from two institutions. All patients who underwent sleeve gastrectomy from March 2012 to November 2014 were included. The performance of intraoperative leak testing and the type of test (air or methylene blue) were based on surgeon preference. Data obtained included BMI, demographics, comorbidity, presence of intraoperative leak test, result of test, and type of test. The primary outcome was leak rate between the leak test (LT) and no leak test (NLT) groups. SAS version 9.4 was used for univariate and multivariate analyses. A total of 1550 sleeve gastrectomies were included; most were laparoscopic (99.8%), except for one converted and two open cases. Routine intraoperative leak tests were performed in 1329 (85.7%) cases, while 221 (14.3%) did not have LTs. Of the 1329 cases with LTs, there were no positive intraoperative results. Fifteen (1%) patients developed leaks, with no difference in leak rate between the LT and NLT groups (1 vs. 1%, p = 0.999). After adjusting for baseline differences between the groups with a propensity analysis, the observed lack of association between leak and intraoperative leak test remained. In this cohort, leaks presented at a mean of 17.3 days postoperatively (range 1-67 days). Two patients with staple line leaks underwent repeat intraoperative leak testing at leak presentation, and the tests remained negative. Intraoperative leak testing has no correlation with leak due to laparoscopic sleeve gastrectomy and is not predictive of the later development of staple line leak.

  3. Multimode-singlemode-multimode optical fiber sensor coated with novolac resin for detecting liquid phase alcohol

    Science.gov (United States)

    Marfu'ah, Amalia, Niza Rosyda; Hatta, Agus Muhamad; Pratama, Detak Yan

    2018-04-01

    Alcohol sensor based on multimode-singlemode-multimode (MSM) optical fiber with novolac resin as the external medium is proposed and demonstrated experimentally. Novolac resin swells when it is exposed by the alcohol. This effect causes a change in the polymer density leading to the refractive index's variation. The transmission light of the sensor depends on the refractive index of external medium. Based on the results, alcohol sensor based on MSM optical fiber structure using novolac resin has a higher sensitivity compared to the sensor without using novolac resin in the mixture of alcohol and distilled water. Alcohol sensor based on MSM optical fiber structure using novolac resin in the mixture of alcohol and distilled water with a singlemode fiber length of 5 mm has a sensitivity of 0.028972 dBm per % V/V, and in the mixture of alcohol and sugar solution of 10% w/w has a sensitivity of 0.005005 dBm per % V/V.

  4. The dynamics of multimodal integration: The averaging diffusion model.

    Science.gov (United States)

    Turner, Brandon M; Gao, Juan; Koenig, Scott; Palfy, Dylan; L McClelland, James

    2017-12-01

    We combine extant theories of evidence accumulation and multi-modal integration to develop an integrated framework for modeling multimodal integration as a process that unfolds in real time. Many studies have formulated sensory processing as a dynamic process where noisy samples of evidence are accumulated until a decision is made. However, these studies are often limited to a single sensory modality. Studies of multimodal stimulus integration have focused on how best to combine different sources of information to elicit a judgment. These studies are often limited to a single time point, typically after the integration process has occurred. We address these limitations by combining the two approaches. Experimentally, we present data that allow us to study the time course of evidence accumulation within each of the visual and auditory domains as well as in a bimodal condition. Theoretically, we develop a new Averaging Diffusion Model in which the decision variable is the mean rather than the sum of evidence samples and use it as a base for comparing three alternative models of multimodal integration, allowing us to assess the optimality of this integration. The outcome reveals rich individual differences in multimodal integration: while some subjects' data are consistent with adaptive optimal integration, reweighting sources of evidence as their relative reliability changes during evidence integration, others exhibit patterns inconsistent with optimality.

  5. MULTIMODAL FEEDBACK PROVISION IN IMPROVING PRE-SERVICE TEACHERS’ COMPETENCE

    Directory of Open Access Journals (Sweden)

    Fazri Nur Yusuf

    2017-09-01

    Full Text Available Studies on potentials of feedback over English language teaching seem not to have not been well-revealed, including studies on the use of feedback to improve English pre-service teachers’ competence. The present study investigates to what extent a multimodal feedback can influence pre-service teachers’ teaching, and which teaching aspects are influenced. Twenty five pre-service teachers taking Microteaching Course served as respondents supervised by a course advisor. The data were collected by teacher observation in a rating-scale form, self-appraisal, and interviews. The data were analyzed by using correlated sample t-test and the eight teaching components proposed by Brown (2001. The results showed that after multimodal feedback provision, pre-service teachers indicated an improvement significantly in seven out of eight teaching aspects. The provision of multimodal feedback could improve their teaching competence on preparation, instructional objective elicitation, mastery of instructional materials, use of media, and classroom management, including classroom language. But, the results do not indicate that they perform well on reflection and follow-up due to some reasons. In addition, the results evince that multimodal feedback provision could improve pre-service teachers’ pedagogical competence when the multimodal feedback is integrated with content, interpersonal relationship, and management.

  6. Operative and economic evaluation of a 'Laser Printer Multimodality' System

    International Nuclear Information System (INIS)

    Battaglia, G.; Moscatelli, G.; Maroldi, R.; Chiesa, A.

    1991-01-01

    The increasing application of digital techniques to diagnostic imaging is causing significant changes in several related activities, such as a reproduction of digital images on film. In the Department of Diagnostic Imaging of the University of Brescia, about 70% of the whole of images are produced by digital techniques; at present, most of these images are reproduced on film with a Multimodality System interfacing CT, MR, DSA, and DR units with a single laser printer. Our analysis evaluates the operative and economics aspects of image reproduction, by comparing the 'single cassette' multiformat Camera and the Laser Printer Multimodality SAystem. Our results point out the advantages obtained by reproducing images with a Laser Printer Multimodality System: outstanding quality, reproduction of multiple originals, and marked reduction in the time needed for both image archiving and film handling. The Laser Printer Multimodality System allows over 5 hours/day to be saved -that is to say the working day of an operator, who can be thus shifted to other functions. The important economic aspect of the reproduction of digital images on film proves the Laser Printer Multimodality System to have some advantage over Cameras

  7. Multi-modality photoacoustic tomography, ultrasound, and light sheet microscopy for volumetric tumor margin detection

    Science.gov (United States)

    Sangha, Gurneet S.; Hu, Bihe; Bolus, Daniel; Wang, Mei; Skidmore, Shelby J.; Sholl, Andrew B.; Brown, J. Quincy; Goergen, Craig J.

    2018-02-01

    Current methods for breast tumor margin detection are invasive, time consuming, and typically result in a reoperative rate of over 25%. This marks a clear clinical need to develop improved tools to intraoperatively differentiate negative versus positive tumor margins. Here, we utilize photoacoustic tomography (PAT), ultrasound (US), and inverted Selective Plane Illumination Microscopy (iSPIM) to assess breast tumor margins in eight human breast biopsies. Our PAT/US system consists of a tunable Nd:YAG laser (NT 300, EKSPLA) coupled with a 40MHz central frequency US probe (Vevo2100, FUJIFILM Visual Sonics). This system allows for the delivery of 10Hz, 5ns pulses with fluence of 40mJ/cm2 to the tissue with PAT and US axial resolutions of 125μm and 40μm, respectively. For this study, we used a linear stepper motor to acquire volumetric PAT/US images of the breast biopsies using 1100nm light to identify bloodrich "tumor" regions and 1210nm light to identify lipid-rich "healthy" regions. iSPIM (Applied Scientific Instrumentation) is an advanced microscopy technique with lateral resolution of 1.5μm and axial resolution of 7μm. We used 488nm laser excitation and acridine orange as a general comprehensive histology stain. Our results show that PAT/US can be used to identify lipid-rich regions, dense areas of arterioles and arteries, and other internal structures such as ducts. iSPIM images correlate well with histopathology slides and can verify nuclear features, cell type and density, stromal features, and microcalcifications. Together, this multimodality approach has the potential to improve tumor margin detection with a high degree of sensitivity and specificity.

  8. Multimodal ophthalmic imaging using spectrally encoded scanning laser ophthalmoscopy and optical coherence tomography

    Science.gov (United States)

    El-Haddad, Mohamed T.; Malone, Joseph D.; Li, Jianwei D.; Bozic, Ivan; Arquitola, Amber M.; Joos, Karen M.; Patel, Shriji N.; Tao, Yuankai K.

    2017-08-01

    Ophthalmic surgery involves manipulation of delicate, layered tissue structures on milli- to micrometer scales. Traditional surgical microscopes provide an inherently two-dimensional view of the surgical field with limited depth perception which precludes accurate depth-resolved visualization of these tissue layers, and limits the development of novel surgical techniques. We demonstrate multimodal swept-source spectrally encoded scanning laser ophthalmoscopy and optical coherence tomography (SS-SESLO-OCT) to address current limitations of image-guided ophthalmic microsurgery. SS-SESLO-OCT provides inherently co-registered en face and cross-sectional field-of-views (FOVs) at a line rate of 400 kHz and >2 GPix/s throughput. We show in vivo imaging of the anterior segment and retinal fundus of a healthy volunteer, and preliminary results of multi-volumetric mosaicking for ultrawide-field retinal imaging with 90° FOV. Additionally, a scan-head was rapid-prototyped with a modular architecture which enabled integration of SS-SESLO-OCT with traditional surgical microscope and slit-lamp imaging optics. Ex vivo surgical maneuvers were simulated in cadaveric porcine eyes. The system throughput enabled volumetric acquisition at 10 volumes-per-second (vps) and allowed visualization of surgical dynamics in corneal sweeps, compressions, and dissections, and retinal sweeps, compressions, and elevations. SESLO en face images enabled simple real-time co-registration with the surgical microscope FOV, and OCT cross-sections provided depth-resolved visualization of instrument-tissue interactions. Finally, we demonstrate novel augmented-reality integration with the surgical view using segmentation overlays to aid surgical guidance. SS-SESLO-OCT may benefit clinical diagnostics by enabling aiming, registration, and mosaicking; and intraoperative imaging by allowing for real-time surgical feedback, instrument tracking, and overlays of computationally extracted biomarkers of disease.

  9. Quantitative analysis of intraoperative communication in open and laparoscopic surgery.

    Science.gov (United States)

    Sevdalis, Nick; Wong, Helen W L; Arora, Sonal; Nagpal, Kamal; Healey, Andrew; Hanna, George B; Vincent, Charles A

    2012-10-01

    -risk procedure (average, 2 communications/min). In the observed cases, surgeons actively directed and led OR teams in the intraoperative phase. The lack of communication between surgeons and anesthesiologists ought to be evaluated further. Simple, inexpensive interventions shown to streamline intraoperative communication and teamworking (preoperative briefing, surgeons' mental practice) should be considered further.

  10. [Multimodal pain therapy - implementation of process management - an attempt to consider management approaches].

    Science.gov (United States)

    Dunkel, Marion; Kramp, Melanie

    2012-07-01

    The combination of medical and economical proceedings allows new perspectives in the illustration of medical workflows. Considering structural and developmental aspects multimodal therapy programs show similarities with typical subjects of economic process systems. By pointing out the strategic appearance of the multimodal pain therapy concept multimodal approaches can be described to some extent by using management approaches. E. g., an economic process landscape can be used to represent procedures of a multimodal pain therapy program. © Georg Thieme Verlag Stuttgart · New York.

  11. Understanding and treating vaginismus: a multimodal approach.

    Science.gov (United States)

    Pacik, Peter T

    2014-12-01

    This clinical opinion was written to bring attention to the understanding and treatment of vaginismus, a condition that is often under diagnosed and therefore inadequately treated, yet affects millions of women worldwide. Despite its description more than a century ago, vaginismus is rarely taught in medical school, residency training, and medical meetings. The DSM 5 classification stresses that vaginismus is a penetration disorder in that any form of vaginal penetration such as tampons, finger, vaginal dilators, gynecological examinations, and intercourse is often painful or impossible. Compared with other sexual pain disorders such as vulvodynia and vestibulodynia, the treatment of vaginismus has the potential for a high rate of success. Stratifying the severity of vaginismus allows the clinician to choose among numerous treatment options and to better understand what the patient is experiencing. Vaginismus is both a physical and an emotional disorder. In the more severe cases of vaginismus women (and men) complain that attempted intercourse is like "hitting a wall" suggestive of spasm at the level of the introitus. The emotional fallout resulting from this needs to be addressed in any form of treatment applied. This article is based on lessons learned in the treatment of more than 250 patients and evaluation of more than 400 inquiries, and was written to make vaginismus more widely understood, to aid in the differential diagnosis of sexual pain, suggest a variety of effective treatments, and explain how Botox can be used as part of a multimodal treatment program to treat vaginismus. With greater awareness among clinicians it is hoped that medical schools, residency programs, and medical meetings will begin teaching the understanding and treatment of vaginismus.

  12. Object recognition through a multi-mode fiber

    Science.gov (United States)

    Takagi, Ryosuke; Horisaki, Ryoichi; Tanida, Jun

    2017-04-01

    We present a method of recognizing an object through a multi-mode fiber. A number of speckle patterns transmitted through a multi-mode fiber are provided to a classifier based on machine learning. We experimentally demonstrated binary classification of face and non-face targets based on the method. The measurement process of the experimental setup was random and nonlinear because a multi-mode fiber is a typical strongly scattering medium and any reference light was not used in our setup. Comparisons between three supervised learning methods, support vector machine, adaptive boosting, and neural network, are also provided. All of those learning methods achieved high accuracy rates at about 90% for the classification. The approach presented here can realize a compact and smart optical sensor. It is practically useful for medical applications, such as endoscopy. Also our study indicated a promising utilization of artificial intelligence, which has rapidly progressed, for reducing optical and computational costs in optical sensing systems.

  13. [Multimodal medical image registration using cubic spline interpolation method].

    Science.gov (United States)

    He, Yuanlie; Tian, Lianfang; Chen, Ping; Wang, Lifei; Ye, Guangchun; Mao, Zongyuan

    2007-12-01

    Based on the characteristic of the PET-CT multimodal image series, a novel image registration and fusion method is proposed, in which the cubic spline interpolation method is applied to realize the interpolation of PET-CT image series, then registration is carried out by using mutual information algorithm and finally the improved principal component analysis method is used for the fusion of PET-CT multimodal images to enhance the visual effect of PET image, thus satisfied registration and fusion results are obtained. The cubic spline interpolation method is used for reconstruction to restore the missed information between image slices, which can compensate for the shortage of previous registration methods, improve the accuracy of the registration, and make the fused multimodal images more similar to the real image. Finally, the cubic spline interpolation method has been successfully applied in developing 3D-CRT (3D Conformal Radiation Therapy) system.

  14. Quantitative multimodality imaging in cancer research and therapy.

    Science.gov (United States)

    Yankeelov, Thomas E; Abramson, Richard G; Quarles, C Chad

    2014-11-01

    Advances in hardware and software have enabled the realization of clinically feasible, quantitative multimodality imaging of tissue pathophysiology. Earlier efforts relating to multimodality imaging of cancer have focused on the integration of anatomical and functional characteristics, such as PET-CT and single-photon emission CT (SPECT-CT), whereas more-recent advances and applications have involved the integration of multiple quantitative, functional measurements (for example, multiple PET tracers, varied MRI contrast mechanisms, and PET-MRI), thereby providing a more-comprehensive characterization of the tumour phenotype. The enormous amount of complementary quantitative data generated by such studies is beginning to offer unique insights into opportunities to optimize care for individual patients. Although important technical optimization and improved biological interpretation of multimodality imaging findings are needed, this approach can already be applied informatively in clinical trials of cancer therapeutics using existing tools. These concepts are discussed herein.

  15. Joint sparse representation for robust multimodal biometrics recognition.

    Science.gov (United States)

    Shekhar, Sumit; Patel, Vishal M; Nasrabadi, Nasser M; Chellappa, Rama

    2014-01-01

    Traditional biometric recognition systems rely on a single biometric signature for authentication. While the advantage of using multiple sources of information for establishing the identity has been widely recognized, computational models for multimodal biometrics recognition have only recently received attention. We propose a multimodal sparse representation method, which represents the test data by a sparse linear combination of training data, while constraining the observations from different modalities of the test subject to share their sparse representations. Thus, we simultaneously take into account correlations as well as coupling information among biometric modalities. A multimodal quality measure is also proposed to weigh each modality as it gets fused. Furthermore, we also kernelize the algorithm to handle nonlinearity in data. The optimization problem is solved using an efficient alternative direction method. Various experiments show that the proposed method compares favorably with competing fusion-based methods.

  16. Content-based TV sports video retrieval using multimodal analysis

    Science.gov (United States)

    Yu, Yiqing; Liu, Huayong; Wang, Hongbin; Zhou, Dongru

    2003-09-01

    In this paper, we propose content-based video retrieval, which is a kind of retrieval by its semantical contents. Because video data is composed of multimodal information streams such as video, auditory and textual streams, we describe a strategy of using multimodal analysis for automatic parsing sports video. The paper first defines the basic structure of sports video database system, and then introduces a new approach that integrates visual stream analysis, speech recognition, speech signal processing and text extraction to realize video retrieval. The experimental results for TV sports video of football games indicate that the multimodal analysis is effective for video retrieval by quickly browsing tree-like video clips or inputting keywords within predefined domain.

  17. Modelling multimodal expression of emotion in a virtual agent.

    Science.gov (United States)

    Pelachaud, Catherine

    2009-12-12

    Over the past few years we have been developing an expressive embodied conversational agent system. In particular, we have developed a model of multimodal behaviours that includes dynamism and complex facial expressions. The first feature refers to the qualitative execution of behaviours. Our model is based on perceptual studies and encompasses several parameters that modulate multimodal behaviours. The second feature, the model of complex expressions, follows a componential approach where a new expression is obtained by combining facial areas of other expressions. Lately we have been working on adding temporal dynamism to expressions. So far they have been designed statically, typically at their apex. Only full-blown expressions could be modelled. To overcome this limitation, we have defined a representation scheme that describes the temporal evolution of the expression of an emotion. It is no longer represented by a static definition but by a temporally ordered sequence of multimodal signals.

  18. Multimodal approaches to use mobile, digital devices in learning practies

    DEFF Research Database (Denmark)

    Buhl, Mie

    , anthropology, psychology and sociology) and outlines the prospect of a trans-disciplinary learning mode. The learning mode reflects the current society where knowledge production is social collaborative process and is produced in formal as well as informal and non-formal contexts. My discussion’s theoretical......In this paper, I discuss the potential of multimodal approaches to enhance learning processes. I draw on a case based on Danish Master Courses in ICT and didactic designs where multimodal approaches are in the center of students’ practical design experience as well as in generation of theoretical...... knowledge. The design of the master courses takes its starting point in the assumption that theoretical knowledge generates from practical experiences. Thus, the organization of the students’ learning processes revolves around practical multimodal experiences followed by iterative reflexive sessions...

  19. Study on multimodal transport route under low carbon background

    Science.gov (United States)

    Liu, Lele; Liu, Jie

    2018-06-01

    Low-carbon environmental protection is the focus of attention around the world, scientists are constantly researching on production of carbon emissions and living carbon emissions. However, there is little literature about multimodal transportation based on carbon emission at home and abroad. Firstly, this paper introduces the theory of multimodal transportation, the multimodal transport models that didn't consider carbon emissions and consider carbon emissions are analyzed. On this basis, a multi-objective programming 0-1 programming model with minimum total transportation cost and minimum total carbon emission is proposed. The idea of weight is applied to Ideal point method for solving problem, multi-objective programming is transformed into a single objective function. The optimal solution of carbon emission to transportation cost under different weights is determined by a single objective function with variable weights. Based on the model and algorithm, an example is given and the results are analyzed.

  20. Multimode model for projective photon-counting measurements

    International Nuclear Information System (INIS)

    Tualle-Brouri, Rosa; Ourjoumtsev, Alexei; Dantan, Aurelien; Grangier, Philippe; Wubs, Martijn; Soerensen, Anders S.

    2009-01-01

    We present a general model to account for the multimode nature of the quantum electromagnetic field in projective photon-counting measurements. We focus on photon-subtraction experiments, where non-Gaussian states are produced conditionally. These are useful states for continuous-variable quantum-information processing. We present a general method called mode reduction that reduces the multimode model to an effective two-mode problem. We apply this method to a multimode model describing broadband parametric down-conversion, thereby improving the analysis of existing experimental results. The main improvement is that spatial and frequency filters before the photon detector are taken into account explicitly. We find excellent agreement with previously published experimental results, using fewer free parameters than before, and discuss the implications of our analysis for the optimized production of states with negative Wigner functions.