Search results for: ultrasound prostate segmentation

Authors: Morten Brøgger, Kim Wittchen

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Focus on reducing energy consumption in existing buildings at large scale, e.g. in cities or countries, has been increasing in recent years. In order to reduce energy consumption in existing buildings, political incentive schemes are put in place and large scale investments are made by utility companies. Prioritising these investments requires a comprehensive overview of the energy consumption in the existing building stock, as well as potential energy-savings. However, a building stock comprises thousands of buildings with different characteristics making it difficult to model energy consumption accurately. Moreover, the complexity of the building stock makes it difficult to convey model results to policymakers and other stakeholders. In order to manage the complexity of the building stock, building archetypes are often employed in building stock energy models (BSEMs). Building archetypes are formed by segmenting the building stock according to specific characteristics. Segmenting the building stock according to building type and building age is common, among other things because this information is often easily available. This segmentation makes it easy to convey results to non-experts. However, using a single archetypical building to represent all buildings in a segment of the building stock is associated with loss of detail. Thermal characteristics are aggregated while other characteristics, which could affect the energy efficiency of a building, are disregarded. Thus, using a simplified representation of the building stock could come at the expense of the accuracy of the model. The present study evaluates the accuracy of a conventional archetype-based BSEM that segments the building stock according to building type- and age. The accuracy is evaluated in terms of the archetypes’ ability to accurately emulate the average energy demands of the corresponding buildings they were meant to represent. This is done for the buildings’ energy demands as a whole as well as for relevant sub-demands. Both are evaluated in relation to the type- and the age of the building. This should provide researchers, who use archetypes in BSEMs, with an indication of the expected accuracy of the conventional archetype model, as well as the accuracy lost in specific parts of the calculation, due to use of the archetype method.

Keywords: building stock energy modelling, energy-savings, archetype

Procedia PDF Downloads 132

Authors: Emanuela Zilli, Antonio Madia, Milvia Marchiori, Paola Anello, Chiara Cabbia, Emanuela Velo, Delia Campagnolo, Michele Scomazzon, Emanuela Salvatico, S. Tikvina, Antonio Miotti

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Hepatitis C is an inflammation of the liver caused by the hepatitis C virus (HCV). Antiviral medicines can cure more than 95% of cases of hepatitis C infection, but access to diagnosis and treatment remains low. The ULSS 6 Euganea – Health Trust has implemented a campaign to eradicate hepatitis C in the province of Padua (North-East of Italy), which can be subdivided into three areas: North (300.000 inhabitants), Centre (400.000) and South (300.000). In September 2021, the project was launched in the Northern area; a set of brochures was distributed in outpatient services, general practitioners’ clinics and offices, community pharmacy services, social health districts, and through social networks. The Hepatology Service contacted 460 patients selected by the Clinical Laboratory (positivity for HCV antibodies): 83 patients (18.0%) had been already cured of HCV infection, missing or deceased; 377 patients (82.0%) met the criteria to be eligible for HCV eradication therapy and were therefore included in a Day Service specific agenda and followed by a multidisciplinary team of healthcare professionals, with a dedicated telephone line. Haemato-chemical tests, general medical check-ups and ultrasound tests with fibroscan were performed. Patients were tested for Sars-CoV-2 positivity; those not yet vaccinated against Covid-19 were encouraged to complete the vaccination scheme. All 377 patients (100%) received HCV eradication therapy at the community pharmacy service; a detailed explanation of how to take their medication was provided. At the end of the first phase, Covid-19 vaccination rate was 100% (377/377), including patients already vaccinated and new-vaccinated. Check-up appointments were arranged after 2 or 3 months, according to the treatment plan. The awareness campaign and the organization of HCV eradication therapy service by ULSS 6 Euganea are proving to be effective; the project is now going to be applied to Central and Southern areas of the province (1.132 patients).

Keywords: public health, HCV-eradication, Covid-19 emergency, health communication strategies

Procedia PDF Downloads 82

Authors: Hritwik Ghosh, Irfan Sadiq Rahat, Sachi Nandan Mohanty, J. V. R. Ravindra

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In the rapidly evolving landscape of medical diagnostics, the early detection and accurate classification of skin cancer remain paramount for effective treatment outcomes. This research delves into the transformative potential of Artificial Intelligence (AI), specifically Deep Learning (DL), as a tool for discerning and categorizing various skin conditions. Utilizing a diverse dataset of 3,000 images representing nine distinct skin conditions, we confront the inherent challenge of class imbalance. This imbalance, where conditions like melanomas are over-represented, is addressed by incorporating class weights during the model training phase, ensuring an equitable representation of all conditions in the learning process. Our pioneering approach introduces a hybrid model, amalgamating the strengths of two renowned Convolutional Neural Networks (CNNs), VGG16 and ResNet50. These networks, pre-trained on the ImageNet dataset, are adept at extracting intricate features from images. By synergizing these models, our research aims to capture a holistic set of features, thereby bolstering classification performance. Preliminary findings underscore the hybrid model's superiority over individual models, showcasing its prowess in feature extraction and classification. Moreover, the research emphasizes the significance of rigorous data pre-processing, including image resizing, color normalization, and segmentation, in ensuring data quality and model reliability. In essence, this study illuminates the promising role of AI and DL in revolutionizing skin cancer diagnostics, offering insights into its potential applications in broader medical domains.

Keywords: artificial intelligence, machine learning, deep learning, skin cancer, dermatology, convolutional neural networks, image classification, computer vision, healthcare technology, cancer detection, medical imaging

Procedia PDF Downloads 54

Authors: Ravinder Singh, Pratima Syal

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Background: The rising prevalence and incidence of Acute Pancreatitis (AP) and its associated metabolic variables known as metabolic syndrome (MetS) are common medical conditions with catastrophic consequences and substantial treatment costs. The correlation between MetS and AP, as well as their impact on Health Related Quality of Life (HRQoL) is uncertain, and because there are so few published studies, further research is needed. As a result, we planned this study to determine the relationship between MetS components impact on HRQoL in AP patients. Patients and Methods: A prospective, observational study involving the recruitment of patients with AP with and without MetS was carried out in tertiary care hospital of North India. Patients were classified with AP if they were diagnosed with two or more components of the following criteria, abdominal pain, serum amylase and lipase levels two or more times normal, imaging trans-abdominal ultrasound, computed tomography, or magnetic resonance. The National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATP III) criterion was used to diagnose the MetS. The various socio-demographic variables were also taken into consideration for the calculation of statistical significance (P≤.05) in AP patients. Finally, the correlation between AP and MetS, along with their impact on HRQoL was assessed using Student's t test, Pearson Correlation Coefficient, and Short Form-36 (SF-36). Results: AP with MetS (n = 100) and AP without MetS (n = 100) patients were divided into two groups. Gender, Age, Educational Status, Tobacco use, Body Mass Index (B.M.I), and Waist Hip Ratio (W.H.R) were the socio-demographic parameters found to be statistically significant (P≤.05) in AP patients with MetS. Also, all the metabolic variables were also found to statistically significant (P≤.05) and found to be increased in patients with AP with MetS as compared to AP without MetS except HDL levels. Using the SF-36 form, a greater significant decline was observed in physical component summary (PCS) and mental component summary (MCS) in patients with AP with MetS as compared to patients without MetS (P≤.05). Furthermore, a negative association between all metabolic variables with the exception of HDL, and AP was found to be producing deterioration in PCS and MCS. Conclusion: The study demonstrated that patients with AP with MetS had a worse overall HRQOL than patients with AP without MetS due to number of socio-demographic and metabolic variables having direct correlation impacting physical and mental health of patients.

Keywords: metabolic disorers, QOL, cost effectiveness, pancreatitis

Procedia PDF Downloads 89

Authors: Harley Bray, Helen Pymar, Michelle Liu, Chau Pham, Tomislav Jelic, Fran Mulhall

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Background: Our study assesses the impact of the COVID-19 pandemic on Early Pregnancy Assessment Clinic (EPAC) referrals and the use of virtual consultation in Winnipeg, Manitoba. Our clinic expanded to accept referrals from all Winnipeg Emergency Department (ED)/Urgent Care (UC) sites beginning November 2019 to April 2020. By May 2020, the COVID-19 pandemic reached Manitoba, and EPAC virtual care was expanded by performing hCG remotely and reviewing blood and ED/UC ultrasound results by phone. Methods: Emergency Department Information Systems (EDIS) and EPAC data reviewed ED/UC visits for pregnancy <20 weeks and vaginal bleeding 1-year pre-COVID (March 12, 2019, to March 11, 2020) and during COVID (March 12, 2020 (first case in Manitoba) to March 11, 2021). Results: There were fewer patient visits for vaginal bleeding or pregnancy of <20 weeks (4264 vs. 5180), diagnoses of threatened abortion (1895 vs. 2283), and ectopic pregnancy (78 vs. 97) during COVID compared with pre-COVID, respectively. International Classification of Disease 10 codes were missing in 849 (20%) and 1183 (23%) of patients during COVID and pre-COVID, respectively. Wait times for all patient visits improved during COVID-19 compared to pre-COVID (5.1 ±4.4 hours vs. 5.5 ± 3.8 hours), more patients received obstetrical ultrasounds, 761 (18%) vs. 787 (15%), and fewer patients returned within 30 days (1360 (32%) vs. 1848 (36%); p<0.01). EPAC saw 708 patients (218; 31% new ED/UC) during COVID compared to 552 (37; 7% new ED/UC) pre-COVID. Fewer operative interventions for pregnancy loss (346 vs. 456) and retained products (236 vs. 272) were noted. Surgeries to treat ectopic pregnancy (106 vs. 113) remained stable during the study time interval. Conclusion: Accurate identification of pregnancy complications was difficult, with over 20% missing ICD-10 diagnostic codes. There were fewer ED/UC visits and surgical management for threatened abortion during COVID, but ectopic pregnancy operative management remained unchanged.

Keywords: obstetrics and gynecology, EPAC, early pregnancy assessment, first trimester, emergency department, abortion, pregnancy, COVID-19

Procedia PDF Downloads 45

Authors: Elena B. Cherepetskaya, Alexander A. Karabutov, Natalia B. Podymova, Ivan Sas

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Nonlinear evolution of broadband ultrasonic pulses passed through the rock specimens is studied using the apparatus ‘GEOSCAN-02M’. Ultrasonic pulses are excited by the pulses of Q-switched Nd:YAG laser with the time duration of 10 ns and with the energy of 260 mJ. This energy can be reduced to 20 mJ by some light filters. The laser beam radius did not exceed 5 mm. As a result of the absorption of the laser pulse in the special material – the optoacoustic generator–the pulses of longitudinal ultrasonic waves are excited with the time duration of 100 ns and with the maximum pressure amplitude of 10 MPa. The immersion technique is used to measure the parameters of these ultrasonic pulses passed through a specimen, the immersion liquid is distilled water. The reference pulse passed through the cell with water has the compression and the rarefaction phases. The amplitude of the rarefaction phase is five times lower than that of the compression phase. The spectral range of the reference pulse reaches 10 MHz. The cubic-shaped specimens of the Karelian gabbro are studied with the rib length 3 cm. The ultimate strength of the specimens by the uniaxial compression is (300±10) MPa. As the reference pulse passes through the area of the specimen without cracks the compression phase decreases and the rarefaction one increases due to diffraction and scattering of ultrasound, so the ratio of these phases becomes 2.3:1. After preloading some horizontal cracks appear in the specimens. Their location is found by one-sided scanning of the specimen using the backward mode detection of the ultrasonic pulses reflected from the structure defects. Using the computer processing of these signals the images are obtained of the cross-sections of the specimens with cracks. By the increase of the reference pulse amplitude from 0.1 MPa to 5 MPa the nonlinear transformation of the ultrasonic pulse passed through the specimen with horizontal cracks results in the decrease by 2.5 times of the amplitude of the rarefaction phase and in the increase of its duration by 2.1 times. By the increase of the reference pulse amplitude from 5 MPa to 10 MPa the time splitting of the phases is observed for the bipolar pulse passed through the specimen. The compression and rarefaction phases propagate with different velocities. These features of the powerful broadband ultrasonic pulses passed through the rock specimens can be described by the hysteresis model of Preisach-Mayergoyz and can be used for the location of cracks in the optically opaque materials.

Keywords: cracks, geological materials, nonlinear evolution of ultrasonic pulses, rock

Procedia PDF Downloads 325

Authors: Kam Wen Hang, Tan Kee Teng, Huang Poh Ching, Chia Kai Xiang, H. V. Annegowda, H. S. Naveen Kumar

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Gynura procumbens (G. procumbens) leaves, commonly known as ‘sambung nyawa’ in Malaysia is a well-known medicinal plant commonly used as folk medicines in controlling blood glucose, cholesterol level as well as treating cancer. These medicinal properties were believed to be related to the polyphenolic content present in G. procumbens extract, therefore optimization of its extraction process is vital to obtain highest possible antioxidant activities. The current study was conducted to investigate the effect of different concentrations of extracting solvent (ethanol) on the amount of polyphenolic content and antioxidant activities of G. procumbens leaf extract. The concentrations of ethanol used were 30-70%, with the temperature and time kept constant at 50°C and 30 minutes, respectively using ultrasound-assisted extraction. The polyphenolic content of these extracts were quantified by Folin-Ciocalteu colorimetric method and results were expressed as milligram gallic acid equivalent (mg GAE)/g. Phosphomolybdenum method and 1, 1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging assays were used to investigate the antioxidant properties of the extract and the results were expressed as milligram ascorbic acid equivalent (mg AAE)/g and effective concentration (EC50) respectively. Among the three different (30%, 50% and 70%) concentrations of ethanol studied, the 50% ethanolic extract showed total phenolic content of 31.565 ± 0.344 mg GAE/g and total antioxidant activity of 78.839 ± 0.199 mg AAE/g while 30% ethanolic extract showed 29.214 ± 0.645 mg GAE/g and 70.701 ± 1.394 mg AAE/g, respectively. With respect to DPPH radical scavenging assay, 50% ethanolic extract had exhibited slightly lower EC50 (314.3 ± 4.0 μg/ml) values compared to 30% ethanol extract (340.4 ± 5.3 μg/ml). Out of all the tested extracts, 70% ethanolic extract exhibited significantly (p< 0.05) highest total phenolic content (38.000 ± 1.009 mg GAE/g), total antioxidant capacity (95.874 ± 2.422 mg AAE/g) and demonstrated the lowest EC50 in DPPH assay (244.2 ± 5.9 μg/ml). An excellent correlations were drawn between total phenolic content, total antioxidant capacity and DPPH radical scavenging activity (R2 = 0.949 and R2 = 0.978, respectively). It was concluded from this study that, 70% ethanol should be used as the optimal polarity solvent to obtain G. procumbens leaf extract with maximum polyphenolic content with antioxidant properties.

Keywords: antioxidant activity, DPPH assay, Gynura procumbens, phenolic compounds

Procedia PDF Downloads 380

Authors: Ismaila Olabisi Ogundiji, Hakeem Mayowa Olujide, Qasim Usamot

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The main reasons for site-specific management for agricultural inputs are to increase the profitability of crop production, to protect the environment and to improve products’ quality. Information about the variability of different soil attributes within a field is highly essential for the decision-making process. Lack of fast and accurate acquisition of soil characteristics remains one of the biggest limitations of precision agriculture due to being expensive and time-consuming. Adaptive sampling has been proven as an accurate and affordable sampling technique for planning within a field for site-specific management of agricultural inputs. This study employed spatial uncertainty of soil apparent electrical conductivity (ECa) estimates to identify adaptive re-survey areas in the field. The original dataset was grouped into validation and calibration groups where the calibration group was sub-grouped into three sets of different measurements pass intervals. A conditional simulation was performed on the field ECa to evaluate the ECa spatial uncertainty estimates by the use of the geostatistical technique. The grouping of high-uncertainty areas for each set was done using image segmentation in MATLAB, then, high and low area value-separate was identified. Finally, an adaptive re-survey was carried out on those areas of high-uncertainty. Adding adaptive re-surveying significantly minimized the time required for resampling whole field and resulted in ECa with minimal error. For the most spacious transect, the root mean square error (RMSE) yielded from an initial crude sampling survey was minimized after an adaptive re-survey, which was close to that value of the ECa yielded with an all-field re-survey. The estimated sampling time for the adaptive re-survey was found to be 45% lesser than that of all-field re-survey. The results indicate that designing adaptive sampling through spatial uncertainty models significantly mitigates sampling cost, and there was still conformity in the accuracy of the observations.

Keywords: soil electrical conductivity, adaptive sampling, conditional simulation, spatial uncertainty, site-specific management

Procedia PDF Downloads 109

Authors: F. DelGaudio, H. Gill

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Resuscitation during cardiopulmonary (CPA) arrest is dynamic, high stress, high acuity situation, which can easily lead to communication breakdown, and errors. The care of these high acuity patients has also been shown to increase physiologic stress and task saturation of providers, which can negatively impact the care being provided. These difficulties are further complicated during a global pandemic and pose a significant safety risk to bedside providers. Nurse-led codes are a relatively new concept that may be a potential solution for alleviating some of these difficulties. An experienced nurse who has completed advanced cardiac life support (ACLS), and additional training, assumed the responsibility of directing the mechanics of the appropriate ACLS algorithm. This was done in conjunction with a physician who also acted as a physician leader. The additional nurse-led code training included a multi-disciplinary in situ simulation of a CPA on a suspected COVID-19 patient. During the CPA, the nurse leader’s responsibilities include: ensuring adequate compression depth and rate, minimizing interruptions in chest compressions, the timing of rhythm/pulse checks, and appropriate medication administration. In addition, the nurse leader also functions as a last line safety check for appropriate personal protective equipment and limiting exposure of staff. The use of nurse-led codes for CPA has shown to decrease the cognitive overload and task saturation for the physician, as well as limiting the number of staff being exposed to a potentially infectious patient. The real-world application has allowed physicians to perform and oversee high-risk procedures such as intubation, line placement, and point of care ultrasound, without sacrificing the integrity of the resuscitation. Nurse-led codes have also given the physician the bandwidth to review pertinent medical history, advanced directives, determine reversible causes, and have the end of life conversations with family. While there is a paucity of research on the effectiveness of nurse-led codes, there are many potentially significant benefits. In addition to its value during a pandemic, it may also be beneficial during complex circumstances such as extracorporeal cardiopulmonary resuscitation.

Keywords: cardiopulmonary arrest, COVID-19, nurse-led code, task saturation

Procedia PDF Downloads 126

Authors: Sanjeev Prasher, T. Sai Vijay, Chandan Parsad, Abhishek Banerjee, Sahakari Nikhil Krishna, Subham Chatterjee

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With rapid rise in internet retailing, the industry is set for a major implosion. Due to the little difference among competitors, companies find it difficult to segment and target the right shoppers. The objective of the study is to segment Indian online shoppers on the basis of the factors – website characteristics and shopping values. Together, these cover extrinsic and intrinsic factors that affect shoppers as they visit web retailers. Data were collected using questionnaire from 319 Indian online shoppers, and factor analysis was used to confirm the factors influencing the shoppers in their selection of web portals. Thereafter, cluster analysis was applied, and different segments of shoppers were identified. The relationship between income groups and online shoppers’ segments was tracked using correspondence analysis. Significant findings from the study include that web entertainment and informativeness together contribute more than fifty percent of the total influence on the web shoppers. Contrary to general perception that shoppers seek utilitarian leverages, the present study highlights the preference for fun, excitement, and entertainment during browsing of the website. Four segments namely Information Seekers, Utility Seekers, Value Seekers and Core Shoppers were identified and profiled. Value seekers emerged to be the most dominant segment with two-fifth of the respondents falling for hedonic as well as utilitarian shopping values. With overlap among the segments, utilitarian shopping value garnered prominence with more than fifty-eight percent of the total respondents. Moreover, a strong relation has been established between the income levels and the segments of Indian online shoppers. Web shoppers show different motives from being utility seekers to information seekers, core shoppers and finally value seekers as income levels increase. Companies can strategically use this information for target marketing and align their web portals accordingly. This study can further be used to develop models revolving around satisfaction, trust and customer loyalty.

Keywords: online shopping, shopping values, effectiveness of information content, web informativeness, web entertainment, information seekers, utility seekers, value seekers, core shoppers

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Authors: Ruth Goldschmidt, Vyacheslav Kalchenko, Lilah Agemy, Rachel Elmoalem, Avigdor Scherz

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Vascular Targeted Photodynamic therapy (VTP) is a new modality for selective cancer treatment that leads to the complete tumor ablation. A photosensitizer, a bacteriochlorophyll derivative in our case, is first administered to the patient and followed by the illumination of the tumor area, by a near-IR laser for its photoactivation. The photoactivated drug releases reactive oxygen species (ROS) in the circulation, which reacts with blood cells and the endothelium leading to the occlusion of the blood vasculature. If the blood vessels are only partially closed, the tumor may recover, and cancer cells could survive. On the other hand, excessive treatment may lead to toxicity of healthy tissues nearby. Simultaneous VTP monitoring and image processing independent of the photoexcitation laser has not yet been reported, to our knowledge. Here we present a method for blood flow monitoring, using a real-time laser speckle imaging (RTLSI) in the tumor during VTP. We have synthesized over the years a library of bacteriochlorophyll derivatives, among them WST11 and STL-6014. Both are water soluble derivatives that are retained in the blood vasculature through their partial binding to HSA. WST11 has been approved in Mexico for VTP treatment of prostate cancer at a certain drug dose, and time/intensity of illumination. Application to other bacteriochlorophyll derivatives or other cancers may require different treatment parameters (such as light/drug administration). VTP parameters for STL-6014 are still under study. This new derivative mainly differs from WST11 by its lack of the central Palladium, and its conjugation to an Arg-Gly-Asp (RGD) sequence. RGD is a tumor-specific ligand that is used for targeting the necrotic tumor domains through its affinity to αVβ3 integrin receptors. This enables the study of cell-targeted VTP. We developed a special RTLSI module, based on Labview software environment for data processing. The new module enables to acquire raw laser speckle images and calculate the values of the laser temporal statistics of time-integrated speckles in real time, without additional off-line processing. Using RTLSI, we could monitor the tumor’s blood flow following VTP in a CT26 colon carcinoma ear model. VTP with WST11 induced an immediate slow down of the blood flow within the tumor and a complete final flow arrest, after some sporadic reperfusions. If the irradiation continued further, the blood flow stopped also in the blood vessels of the surrounding healthy tissue. This emphasizes the significance of light dose control. Using our RTLSI system, we could prevent any additional healthy tissue damage by controlling the illumination time and restrict blood flow arrest within the tumor only. In addition, we found that VTP with STL-6014 was the most effective when the photoactivation was conducted 4h post-injection, in terms of tumor ablation success in-vivo and blood vessel flow arrest. In conclusion, RTSLI application should allow to optimize VTP efficacy vs. toxicity in both the preclinical and clinical arenas.

Keywords: blood vessel occlusion, cancer treatment, photodynamic therapy, real time imaging

Procedia PDF Downloads 198

Authors: Dorith Tavor, Adi Wolfson

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In the past two decades a variety of green solvents have been proposed, including water, ionic liquids, fluorous solvents, and supercritical fluids. However, their implementation in industrial processes is still limited due to their tedious and non-sustainable synthesis, lack of experimental data and familiarity, as well as operational restrictions and high cost. Several years ago we presented, for the first time, the use of glycerol-based solvents as alternative sustainable reaction mediums in both catalytic and non-catalytic organic synthesis. Glycerol is the main by-product from the conversion of oils and fats in oleochemical production. Moreover, in the past decade, its price has substantially decreased due to an increase in supply from the production and use of fatty acid derivatives in the food, cosmetics, and drugs industries and in biofuel synthesis, i.e., biodiesel. The renewable origin, beneficial physicochemical properties and reusability of glycerol-based solvents, enabled improved product yield and selectivity as well as easy product separation and catalyst recycling. Furthermore, their high boiling point and polarity make them perfect candidates for non-conventional heating and mixing techniques such as ultrasound- and microwave-assisted reactions. Finally, in some reactions, such as catalytic transfer-hydrogenation or transesterification, they can also be used simultaneously as both solvent and reactant. In our ongoing efforts to design a viable protocol that will facilitate the acceptance of glycerol and its derivatives as sustainable solvents, pure glycerol and glycerol triacetate (triacetin) as well as various glycerol-triacetin mixtures were tested as sustainable solvents in several representative organic reactions, such as nucleophilic substitution of benzyl chloride to benzyl acetate, Suzuki-Miyaura cross-coupling of iodobenzene and phenylboronic acid, baker’s yeast reduction of ketones, and transfer hydrogenation of olefins. It was found that reaction performance was affected by the glycerol to triacetin ratio, as the solubility of the substrates in the solvent determined product yield. Thereby, employing optimal glycerol to triacetin ratio resulted in maximum product yield. In addition, using glycerol-based solvents enabled easy and successful separation of the products and recycling of the catalysts.

Keywords: glycerol, green chemistry, sustainability, catalysis

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Authors: Sang Chul Lee, Gi-Young Park, Dong Rak Kwon

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Objective: The aim of this study was to investigate regenerative effects of ultrasound (US)-guided injection with human umbilical cord blood-derived mesenchymal stem cells (UCB-MSCs) and/or polydeoxyribonucleotide (PDRN) injection in a chronic traumatic full-thickness rotator cuff tendon tear (FTRCTT) in a rabbit model. Material and Methods: Rabbits (n = 32) were allocated into 4 groups. After a 5-mm sized FTRCTT just proximal to the insertion site on the subscapularis tendon was created by excision, the wound was immediately covered by silicone tube to prevent natural healing. After 6 weeks, 4 injections (0.2 mL normal saline, G1; 0.2 mL PDRN, G2; 0.2 mL UCB-MSCs, G3; and 0.2 mL UCB-MSCs with 0.2ml PDRN, G4) were injected into FTRCTT under US guidance. We evaluated gross morphologic changes on all rabbits after sacrifice. Masson’s trichrome, anti-type 1 collagen antibody, bromodeoxyuridine, proliferating cell nuclear antigen, vascular endothelial growth factor and platelet endothelial cell adhesion molecule stain were performed to evaluate histological changes. Motion analysis was also performed. Results: The gross morphologic mean tendon tear size in G3 and 4 was significantly smaller than that of G1 and 2 (p < .05). However, there were no significant differences in tendon tear size between G3 and 4. In G4, newly regenerated collagen type 1 fibers, proliferating cells activity, angiogenesis, walking distance, fast walking time, and mean walking speed were greater than in the other three groups on histological examination and motion analysis. Conclusion: Co-injection of UCB-MSCs and PDRN was more effective than UCB-MSCs injection alone in histological and motion analysis in a rabbit model of chronic traumatic FTRCTT. However, there was no significant difference in gross morphologic change of tendon tear between UCB-MSCs with/without PDRN injection. The results of this study regarding the combination of UCB-MSCs and PDRN are worth additional investigations.

Keywords: mesenchymal stem cell, umbilical cord, polydeoxyribonucleotides, shoulder, rotator cuff, ultrasonography, injections

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Authors: Joy Cao, Min Zhou

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Purpose: Acute Type A aortic dissection is a well-known cause of extremely high mortality rate. A highly accurate and cost-effective non-invasive predictor is critically needed so that the patient can be treated at earlier stage. Although various CFD approaches have been tried to establish some prediction frameworks, they are sensitive to uncertainty in both image segmentation and boundary conditions. Tedious pre-processing and demanding calibration procedures requirement further compound the issue, thus hampering their clinical applicability. Using the latest physics informed deep learning methods to establish an accurate and cost-effective predictor framework are amongst the main goals for a better Type A aortic dissection treatment. Methods: Via training a novel physics-informed deep residual network, with non-invasive 4D MRI displacement vectors as inputs, the trained model can cost-effectively calculate all these biomarkers: aortic blood pressure, WSS, and OSI, which are used to predict potential type A aortic dissection to avoid the high mortality events down the road. Results: The proposed deep learning method has been successfully trained and tested with both synthetic 3D aneurysm dataset and a clinical dataset in the aortic dissection context using Google colab environment. In both cases, the model has generated aortic blood pressure, WSS, and OSI results matching the expected patient’s health status. Conclusion: The proposed novel physics-informed deep residual network shows great potential to create a cost-effective, non-invasive predictor framework. Additional physics-based de-noising algorithm will be added to make the model more robust to clinical data noises. Further studies will be conducted in collaboration with big institutions such as Cleveland Clinic with more clinical samples to further improve the model’s clinical applicability.

Keywords: type-a aortic dissection, deep residual networks, blood flow modeling, data-driven modeling, non-invasive diagnostics, deep learning, artificial intelligence.

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Authors: Berkan Ural, Arif Eser, Sinan Apaydin

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Medical image processing is generally become a challenging task nowadays. Indeed, processing of brain MRI images is one of the difficult parts of this area. This study proposes a hybrid well-defined approach which is consisted from tumor detection, extraction and analyzing steps. This approach is mainly consisted from a computer aided diagnostics system for identifying and detecting the tumor formation in any region of the brain and this system is commonly used for early prediction of brain tumor using advanced image processing and probabilistic neural network methods, respectively. For this approach, generally, some advanced noise removal functions, image processing methods such as automatic segmentation and morphological operations are used to detect the brain tumor boundaries and to obtain the important feature parameters of the tumor region. All stages of the approach are done specifically with using MATLAB software. Generally, for this approach, firstly tumor is successfully detected and the tumor area is contoured with a specific colored circle by the computer aided diagnostics program. Then, the tumor is segmented and some morphological processes are achieved to increase the visibility of the tumor area. Moreover, while this process continues, the tumor area and important shape based features are also calculated. Finally, with using the probabilistic neural network method and with using some advanced classification steps, tumor area and the type of the tumor are clearly obtained. Also, the future aim of this study is to detect the severity of lesions through classes of brain tumor which is achieved through advanced multi classification and neural network stages and creating a user friendly environment using GUI in MATLAB. In the experimental part of the study, generally, 100 images are used to train the diagnostics system and 100 out of sample images are also used to test and to check the whole results. The preliminary results demonstrate the high classification accuracy for the neural network structure. Finally, according to the results, this situation also motivates us to extend this framework to detect and localize the tumors in the other organs.

Keywords: image processing algorithms, magnetic resonance imaging, neural network, pattern recognition

Procedia PDF Downloads 388

Authors: A. Hakem, Y. Bouafia

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Characterization of materials used for various mechanical components is of great importance in their design. Several studies were conducted by various authors in order to improve their physical and/or chemical properties in general and mechanical or metallurgical properties in particular. The foundry alloy AlSi7Zn3Cu2Mg is one of the main components constituting the various mechanisms for the implementation of applications and various industrial projects. Obtaining a reliable product is not an easy task; several results proposed by different authors show sometimes results that can contradictory. Due to their high mechanical characteristics, these alloys are widely used in engineering. Silicon improves casting properties and magnesium allows heat treatment. It is thus possible to obtain various degrees of hardening and therefore interesting compromise between tensile strength and yield strength, on one hand, and elongation, on the other hand. These mechanical characteristics can be further enhanced by a series of mechanical treatments or heat treatments. Their light weight coupled with high mechanical characteristics, aluminum alloys are very much used in cars and aircraft industry. The present study is focused on the influence of heat treatments which cause significant micro structural changes, usually hardening by variation of annealing temperatures by increments of 10°C and 20°C on the evolution of the main elastic characteristics, the resistance, the ductility and the structural characteristics of AlSi7Zn3Cu2Mg foundry alloy cast in sand by gravity. These elastic properties are determined in three directions for each specimen of dimensions 200x150x20 mm³ by the ultrasonic method based on acoustic or elastic waves. The hardness, the micro hardness and the structural characteristics are evaluated by a non-destructive method. The aim of this work is to study the hardening ability of AlSi7Zn3Cu2Mg alloy by considering ten states. To improve the mechanical properties obtained with the raw casting, one should use heat treatment for structural hardening; the addition of magnesium is necessary to increase the sensitivity to this specific heat treatment: Treatment followed by homogenization which generates a diffusion of atoms in a substitution solid solution inside a hardening furnace at 500°C during 8h, followed immediately by quenching in water at room temperature 20 to 25°C, then an ageing process for 17h at room temperature and at different annealing temperature (150, 160, 170, 180, 190, 240, 200, 220 and 240°C) for 20h in an annealing oven. The specimens were allowed to cool inside the oven.

Keywords: aluminum, foundry alloy, magnesium, mechanical characteristics, silicon

Procedia PDF Downloads 240

Authors: Maria Medeiros, Suren Surenthiran, Abitha Muralithar, Soushma Seeburuth, Mohammed Mohammed

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Introduction: Appendicitis is the most common surgical emergency globally and can have devastating consequences. Diagnostic imaging in acute appendicitis has become increasingly common in aiding the diagnosis of acute appendicitis. Computerized tomography (CT) and ultrasound (US) are the most commonly used imaging modalities for diagnosing acute appendicitis. Pre-operative imaging has contributed to a reduction of negative appendicectomy rates from between 10-29% to 5%. Literature report CT scan has a diagnostic sensitivity of 94% in acute appendicitis. This clinical audit was conducted to establish if the CT scan's diagnostic yield for acute appendicitis matches the literature. CT scan has a high sensitivity and specificity for diagnosing acute appendicitis and its use can result in a lower negative appendicectomy rate. The aim of this study is to compare the pre-operative imaging findings from CT scans to the histopathology results post-operatively and establish the accuracy of CT scans in aiding the diagnosis of acute appendicitis. Methods: This was a retrospective study focusing on adult presentations to the general surgery department in a district general hospital in central London with an impression of acute appendicitis. We analyzed all patients from July 2022 to December 2022 who underwent a CT scan preceding appendicectomy. Pre-operative CT findings and post-operative histopathology findings were compared to establish the efficacy of CT scans in diagnosing acute appendicitis. Our results were also cross-referenced with pre-existing literature. Data was collected and anonymized using CERNER and analyzed in Microsoft Excel. Exclusion criteria: Children, age <16. Results: 65 patients had CT scans in which the report stated acute appendicitis. Of those 65 patients, 62 patients underwent diagnostic laparoscopies. 100% of patients who underwent an appendicectomy with a pre-operative CT scan showing acute appendicitis had acute appendicitis in histopathology analysis. 3 of the 65 patients who had a CT scan showing appendicitis received conservative treatment. Conclusion: CT scans positive for acute appendicitis had 100% sensitivity and a positive predictive value, which matches published research studies (sensitivity of 94%). The use of CT scans in the diagnostic work-up for acute appendicitis can be extremely helpful in a) confirming the diagnosis and b) reducing the rates of negative appendicectomies and consequently reducing unnecessary operative-associated risks for patients, reducing costs and reducing pressure on emergency theatre lists.

Keywords: acute apendicitis, CT scan, general surgery, imaging

Procedia PDF Downloads 57

Authors: Xiyao Shan, Pavlos Evangelidis, Adam Kositsky, Naoki Ikeda, Yasuo Kawakami

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The human triceps surae (two bi-articular gastrocnemii and one mono-articular soleus) have aponeuroses in the posterior and anterior aspects of each muscle, where the anterior aponeuroses of the gastrocnemii adjoin the posterior aponeurosis of the soleus, possibly contributing to the intermuscular force transmission between gastrocnemii and soleus. Since the mechanical behavior of these aponeuroses at different knee- and ankle-joint positions remains unclear, the purpose of this study was to clarify this through observations of the localized changes in passive stiffness of the posterior aponeuroses, muscle belly and adjoining aponeuroses of the medial gastrocnemius (MG) induced by different knee and ankle angles. Eleven healthy young males (25 ± 2 yr, 176.7 ± 4.7 cm, 71.1 ± 11.1 kg) participated in this study. Each subject took either a prone position on an isokinetic dynamometer while the knee joint was fully extended (K180) or a kneeling position while the knee joint was 90° flexed (K90), in a randomized and counterbalanced order. The ankle joint was then passively moved through a 50° range of motion (ROM) by the dynamometer from 30° of plantar flexion (PF) to 20° of dorsiflexion (DF) at 2°/s and the ultrasound shear-wave velocity was measured to obtain shear moduli of the posterior aponeurosis, MG belly, and adjoining aponeuroses. The main findings were: 1) shear modulus in K180 was significantly higher (p < 0.05) than K90 for the posterior aponeurosis (across all ankle angles, 10.2 ± 5.7 kPa-59.4 ± 28.7 kPa vs. 5.4 ± 2.2 kPa-11.6 ± 4.1 kPa), MG belly (from PF10° to DF20°, 9.7 ± 2.2 kPa-53.6 ± 18.6 kPa vs. 8.0 ± 2.7 kPa-9.5 ± 3.7 kPa), and adjoining aponeuroses (across all ankle angles, 17.3 ± 7.8 kPa-80 ± 25.7 kPa vs. 12.2 ± 4.5 kPa-52.4 ± 23.0 kPa); 2) shear modulus of the posterior aponeuroses significantly increased (p < 0.05) from PF10° to PF20° in K180, while shear modulus of MG belly significantly increased (p < 0.05) from 0° to PF20° only in K180 and shear modulus of adjoining aponeuroses significantly increased (p < 0.05) across the whole ROM of ankle both in K180 and K90. These results suggest that different knee-joint positions can affect not only the bi-articular gastrocnemius but also influence the mechanical behavior of aponeuroses. In addition, compared to the gradual stiffening of the adjoining aponeuroses across the whole ROM of ankle, the posterior aponeurosis became slack in the plantar flexed positions and then was stiffened gradually as the knee was fully extended. This suggests distinct stiffening for the posterior and adjoining aponeuroses which is joint position-dependent.

Keywords: aponeurosis, plantar flexion and dorsiflexion, shear modulus, shear wave elastography

Procedia PDF Downloads 165

Authors: Christina Hagen, Pragathi Kamale Gurmurthy, Thorsten M. Buzug

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CFD simulations are performed in the upper airway of a patient suffering from obstructive sleep apnea (OSA) that is a sleep related breathing disorder characterized by repetitive partial or complete closures of the upper airways. The simulations are aimed at getting a better understanding of the pathophysiological flow patterns in an OSA patient. The simulation is compared to medical data of a sleep endoscopic examination under sedation. A digital model consisting of surface triangles of the upper airway is extracted from the MR images by a region growing segmentation process and is followed by a careful manual refinement. The computational domain includes the nasal cavity with the nostrils as the inlet areas and the pharyngeal volume with an outlet underneath the larynx. At the nostrils a flat inflow velocity profile is prescribed by choosing the velocity such that a volume flow rate of 150 ml/s is reached. Behind the larynx at the outlet a pressure of -10 Pa is prescribed. The stationary incompressible Navier-Stokes equations are numerically solved using finite elements. A grid convergence study has been performed. The results show an amplification of the maximal velocity of about 2.5 times the inlet velocity at a constriction of the pharyngeal volume in the area of the tongue. It is the same region that also shows the highest pressure drop from about 5 Pa. This is in agreement with the sleep endoscopic examinations of the same patient under sedation showing complete contractions in the area of the tongue. CFD simulations can become a useful tool in the diagnosis and therapy of obstructive sleep apnea by giving insight into the patient’s individual fluid dynamical situation in the upper airways giving a better understanding of the disease where experimental measurements are not feasible. Within this study, it could been shown on one hand that constriction areas within the upper airway lead to a significant pressure drop and on the other hand a good agreement of the area of pressure drop and the area of contraction could be shown.

Keywords: biomedical engineering, obstructive sleep apnea, pharynx, upper airways

Procedia PDF Downloads 282

Authors: Swati Swati, Yuhang Chen, Robert Reuben

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Coronary stents are devices resembling the shape of a tube which are placed in coronary arteries, to keep the arteries open in the treatment of coronary arterial diseases. Coronary stents are routinely deployed to clear atheromatous plaque. The stent essentially applies an internal pressure to the artery because its structure is cylindrically symmetrical and this may introduce some abnormalities in final arterial shape. The goal of the project is to develop segmented circumferential arterial compliance measuring devices which can be deployed (eventually) in vivo. The segmentation of the device will allow the mechanical asymmetry of any stenosis to be assessed. The purpose will be to assess the quality of arterial tissue for applications in tailored stents and in the assessment of aortic aneurism. Arterial distensibility measurement is of utmost importance to diagnose cardiovascular diseases and for prediction of future cardiac events or coronary artery diseases. In order to arrive at some generic outcomes, a preliminary experimental set-up has been devised to establish the measurement principles for the device at macro-scale. The measurement methodology consists of a strain gauge system monitored by LABVIEW software in a real-time fashion. This virtual instrument employs a balloon within a gelatine model contained in a split cylinder with strain gauges fixed on it. The instrument allows automated measurement of the effect of air-pressure on gelatine and measurement of strain with respect to time and pressure during inflation. Compliance simple creep model has been applied to the results for the purpose of extracting some measures of arterial compliance. The results obtained from the experiments have been used to study the effect of air pressure on strain at varying time intervals. The results clearly demonstrate that with decrease in arterial volume and increase in arterial pressure, arterial strain increases thereby decreasing the arterial compliance. The measurement system could lead to development of portable, inexpensive and small equipment and could prove to be an efficient automated compliance measurement device.

Keywords: arterial compliance, atheromatous plaque, mechanical symmetry, strain measurement

Procedia PDF Downloads 249

Authors: Manpreet Kaur, Cheol-Hong Min

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The increasing advancement in the robotics equipped with machine vision sensors applied to precision agriculture is a demanding solution for various problems in the agricultural farms. An important issue related with the machine vision system concerns crop row and weed detection. This paper proposes an automatic furrow detection system based on real-time processing for identifying crop rows in maize fields in the presence of weed. This vision system is designed to be installed on the farming vehicles, that is, submitted to gyros, vibration and other undesired movements. The images are captured under image perspective, being affected by above undesired effects. The goal is to identify crop rows for vehicle navigation which includes weed removal, where weeds are identified as plants outside the crop rows. The images quality is affected by different lighting conditions and gaps along the crop rows due to lack of germination and wrong plantation. The proposed image processing method consists of four different processes. First, image segmentation based on HSV (Hue, Saturation, Value) decision tree. The proposed algorithm used HSV color space to discriminate crops, weeds and soil. The region of interest is defined by filtering each of the HSV channels between maximum and minimum threshold values. Then the noises in the images were eliminated by the means of hybrid median filter. Further, mathematical morphological processes, i.e., erosion to remove smaller objects followed by dilation to gradually enlarge the boundaries of regions of foreground pixels was applied. It enhances the image contrast. To accurately detect the position of crop rows, the region of interest is defined by creating a binary mask. The edge detection and Hough transform were applied to detect lines represented in polar coordinates and furrow directions as accumulations on the angle axis in the Hough space. The experimental results show that the method is effective.

Keywords: furrow detection, morphological, HSV, Hough transform

Procedia PDF Downloads 208

Authors: Sumit Kanwar, Manisha Chand, Gregory Gilot

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Background: Septic arthritis of the shoulder has infrequently been discussed. Focus on infection of the untouched shoulder has not heretofore been described. We present four patients with glenohumeral septic arthritis. Methods: Case 1: A 59 year old male with left shoulder pain in the anterior, posterior and superior aspects. Case 2: A 60 year old male with fever, chills, and generalized muscle aches. Case 3: A 70 year old male with right shoulder pain about the anterior and posterior aspects. Case 4: A 55 year old male with global right shoulder pain, swelling, and limited ROM. Results: In case 1, the left shoulder was affected. Physical examination, swelling was notable, there was global tenderness with a painful range of motion (ROM). The lab values indicated an erythrocyte sedimentation rate (ESR) of 96, and a C-reactive protein (CRP) of 304.30. Imaging studies were performed and MRI indicated a high suspicion for an abscess with osteomyelitis of the humeral head. Our second case’s left arm was affected. He had swelling, global tenderness and painful ROM. His ESR was 38, CRP was 14.9. X-ray showed severe arthritis. Case 3 differed with the right arm being affected. Again, global tenderness and painful ROM was observed. His ESR was 94, and CRP was 10.6. X-ray displayed an eroded glenoid space. Our fourth case’s right shoulder was affected. He had global tenderness and painful, limited ROM. ESR was 108 and CRP was 2.4. X-ray was non-significant. Discussion: Monoarticular septic arthritis of the virgin glenohumeral joint is seldom diagnosed in clinical practice. Common denominators include elevated ESR, painful, limited ROM, and involvement of the dominant arm. The male population is more frequently affected with an average age of 57. Septic arthritis is managed with incision and drainage or needle aspiration of synovial fluid supplemented with 3-6 weeks of intravenous antibiotics. Due to better irrigation and joint visualization, arthroscopy is preferred. Open surgical drainage may be indicated if the above methods fail. Conclusion: If a middle-aged male presents with vague anterior or posterior shoulder pain, elevated inflammatory markers and a low grade fever, an x-ray should be performed. If this displays degenerative joint disease, the complete further workup with advanced imaging, such as an MRI, CT scan, or an ultrasound. If these imaging modalities display anterior space joint effusion with soft tissue involvement, we can suspect septic arthritis of the untouched glenohumeral joint and surgery is indicated.

Keywords: glenohumeral joint, identification, infection, septic arthritis, shoulder

Procedia PDF Downloads 398

Authors: Allyson Augusta Shrikhande, Alexa Rains, Tayyaba Ahmed, Marjorie Mamsaang, Rakhi Vyas, Janaki Natarajan, Erika Moody, Christian Reutter, Kimberlee Leishear, Yogita Tailor, Sandra Sandhu-Restaino, Lora Liu, Neha James, Rosemarie Filart

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Characterized by consistent difficulty getting and keeping an erection firm enough for intercourse, Erectile Dysfunction may affect up to 15% of adult men. Although awareness and access to treatment have improved in recent years, many patients do not actively seek diagnosis or treatment due to the stigma surrounding this condition. Patients who do seek treatment are often dissatisfied by the efficacy of the medication. The condition inhibits patients’ quality of life by worsening mental health and relationships. The purpose of this study was to test the effectiveness of an outpatient neuromuscular treatment protocol in treating the symptoms of Chronic Pelvic Pain and Erectile Dysfunction, improving pain and function. 56 patients ages 20-79 presented to an outpatient clinic for treatment of pelvic pain and Erectile Dysfunction symptoms. These symptoms had persisted for an average of 4 years. All patients underwent external ultrasound-guided hydro-dissection technique targeted at pelvic peripheral nerves in combination with pelvic floor musculature trigger-point injections. To measure the effects of this treatment, a five question Erectile Dysfunction questionnaire was completed by each patient at their first visit to a clinic and three months after treatment began. Answers were summed for a total score of 5-25, with a higher score indicating optimal function. The average score before treatment was 14.125 (SD 5.411) (a=0.05; CI 12.708-15.542), which increased by 18% to an average of 16.625 (SD 6.423) (a=0.05; CI 14.943-18.307) after treatment (P=0.0004). Secondary outcome variables included a Visual Analogue Scale (VAS) to measure pelvic pain intensity and the Functional Pelvic Pain Scale (FPPS) to measure function across multiple areas. VAS scores reduced by 51% after three months. Before treatment, the mean VAS score was 5.87, and the posttreatment mean VAS score was 2.89. Pelvic pain functionality improved by 34% after three months. Pretreatment FPPS scores averaged at 7.48, decreasing to 4.91 after treatment. These results indicate that this unique treatment was very effective at relieving pain and increasing function for patients with Erectile Dysfunction.

Keywords: chronic pelvic pain, erectile dysfunction, nonsurgical, outpatient, trigger point injections

Procedia PDF Downloads 56

Authors: Filip Rusak, Yulia Arzhaeva, Dadong Wang

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Machine learning based Computer-Aided Diagnosis (CAD) is gaining much popularity in medical imaging and diagnostic radiology. However, it requires a large amount of high quality and labeled training image datasets. The training images may come from different sources and be acquired from different radiography machines produced by different manufacturers, digital or digitized copies of film radiographs, with various sizes as well as different pixel intensity distributions. In this paper, a content-aware image augmentation method is presented to deal with these variations. The results of the proposed method have been validated graphically by plotting the removed and added seams of pixels on original images. Two different chest X-ray (CXR) datasets are used in the experiments. The CXRs in the datasets defer in size, some are digital CXRs while the others are digitized from analog CXR films. With the proposed content-aware augmentation method, the Seam Carving algorithm is employed to resize CXRs and the corresponding labels in the form of image masks, followed by histogram matching used to normalize the pixel intensities of digital radiography, based on the pixel intensity values of digitized radiographs. We implemented the algorithms, resized the well-known Montgomery dataset, to the size of the most frequently used Japanese Society of Radiological Technology (JSRT) dataset and normalized our digital CXRs for testing. This work resulted in the unified off-the-shelf CXR dataset composed of radiographs included in both, Montgomery and JSRT datasets. The experimental results show that even though the amount of augmentation is large, our algorithm can preserve the important information in lung fields, local structures, and global visual effect adequately. The proposed method can be used to augment training and testing image data sets so that the trained machine learning model can be used to process CXRs from various sources, and it can be potentially used broadly in any medical imaging applications.

Keywords: computer-aided diagnosis, image augmentation, lung segmentation, medical imaging, seam carving

Procedia PDF Downloads 187

Authors: Christophe Spaas, Lies Pottel, Joke De Ceulaer, Johan Abeloos, Philippe Lamoral, Tom De Backer, Calix De Clercq

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We aimed to evaluate the accuracy of an in-house developed low-cost computer-assisted surgery (CAS) protocol for osseous free flap mandibular reconstruction. All patients who underwent primary or secondary mandibular reconstruction with a free (solely or composite) osseous flap, either a fibula free flap or iliac crest free flap, between January 2014 and December 2017 were evaluated. The low-cost protocol consisted out of a virtual surgical planning, a prebend custom reconstruction plate and an individualized free flap positioning guide. The accuracy of the protocol was evaluated through comparison of the postoperative outcome with the 3D virtual planning, based on measurement of the following parameters: intercondylar distance, mandibular angle (axial and sagittal), inner angular distance, anterior-posterior distance, length of the fibular/iliac crest segments and osteotomy angles. A statistical analysis of the obtained values was done. Virtual 3D surgical planning and cutting guide design were performed with Proplan CMF® software (Materialise, Leuven, Belgium) and IPS Gate (KLS Martin, Tuttlingen, Germany). Segmentation of the DICOM data as well as outcome analysis were done with BrainLab iPlan® Software (Brainlab AG, Feldkirchen, Germany). A cost analysis of the protocol was done. Twenty-two patients (11 fibula /11 iliac crest) were included and analyzed. Based on voxel-based registration on the cranial base, 3D virtual planning landmark parameters did not significantly differ from those measured on the actual treatment outcome (p-values >0.05). A cost evaluation of the in-house developed CAS protocol revealed a 1750 euro cost reduction in comparison with a standard CAS protocol with a patient-specific reconstruction plate. Our results indicate that an accurate transfer of the planning with our in-house developed low-cost CAS protocol is feasible at a significant lower cost.

Keywords: CAD/CAM, computer-assisted surgery, low-cost, mandibular reconstruction

Procedia PDF Downloads 121

Authors: Allan F. F. Alves, Fernando A. Bacchim Neto, Guilherme Giacomini, Marcela de Oliveira, Ana L. M. Pavan, Maria E. D. Rosa, Diana R. Pina

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Stroke is a worldwide concern, only in Brazil it accounts for 10% of all registered deaths. There are 2 stroke types, ischemic (87%) and hemorrhagic (13%). Early diagnosis is essential to avoid irreversible cerebral damage. Non-enhanced computed tomography (NECT) is one of the main diagnostic techniques used due to its wide availability and rapid diagnosis. Detection depends on the size and severity of lesions and the time spent between the first symptoms and examination. The Alberta Stroke Program Early CT Score (ASPECTS) is a subjective method that increases the detection rate. The aim of this work was to implement an image segmentation system to enhance ischemic stroke and to quantify the area of ischemic and hemorrhagic stroke lesions in CT scans. We evaluated 10 patients with NECT examinations diagnosed with ischemic stroke. Analyzes were performed in two axial slices, one at the level of the thalamus and basal ganglion and one adjacent to the top edge of the ganglionic structures with window width between 80 and 100 Hounsfield Units. We used different image processing techniques such as morphological filters, discrete wavelet transform and Fuzzy C-means clustering. Subjective analyzes were performed by a neuroradiologist according to the ASPECTS scale to quantify ischemic areas in the middle cerebral artery region. These subjective analysis results were compared with objective analyzes performed by the computational algorithm. Preliminary results indicate that the morphological filters actually improve the ischemic areas for subjective evaluations. The comparison in area of the ischemic region contoured by the neuroradiologist and the defined area by computational algorithm showed no deviations greater than 12% in any of the 10 examination tests. Although there is a tendency that the areas contoured by the neuroradiologist are smaller than those obtained by the algorithm. These results show the importance of a computer aided diagnosis software to assist neuroradiology decisions, especially in critical situations as the choice of treatment for ischemic stroke.

Keywords: ischemic stroke, image processing, CT scans, Fuzzy C-means

Procedia PDF Downloads 343

Authors: Maria L. G. Lourenco, Keylla H. N. P. Pereira, Viviane Y. Hibaru, Fabiana F. Souza, Joao C. P. Ferreira, Simone B. Chiacchio, Luiz H. A. Machado

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Neonatal sepsis is a systemic response of acute infection by bacteria that may lead to high mortality in a litter. This study aims to report a case of sepsis by alpha-hemolytic Streptococcus and Mannheimia haemolytica in neonate dogs. A pregnant, mixed-breed bitch at approximately the 60th day of pregnancy was admitted to the Sao Paulo State University (UNESP) Veterinary Hospital, Botucatu, Sao Paulo, Brazil, and subjected to a c-section due to uterine atony and fetuses no heartbeats on the ultrasound examination. The mother presented leukopenia of 1.6 thousand leukocytes, and there was no other information regarding previous clinical history. Among the offspring, four were stillborn, and five were born alive. On clinical examination, neonates weighed between 312 and 384 grams. Reflexes were present, and the newborn's body temperature was between 89.9 ºF and 96.4 ºF. Neonates also presented clinical signs of neonatal infection: omphalitis, abdomen, and extremities with cyanotic color, hematuria, and diarrhea (meconium). Complementary tests revealed leukopenia. The presence of alpha hemolytic streptococcus and Mannheimia haemolytica was revealed in the bacterial culture. The bacteria were sensitive to cephalosporins and penicillin on the antibiogram. Treatment for sepsis was instituted with the drug ceftriaxone, at a dose of 50 mg per kilogram, administered intravenous (jugular vein). Subsequently administered subcutaneous, every 12 hours, for seven days. Heated fluid therapy was performed, with Ringer lactate, at a dose of 4 ml per 100 grams of weight, intravenous. Heating measures were instituted. Blood plasma was also administered, at a dose of 2 mL per 100 grams of weight, administered subcutaneous, as a source of passive immunity. A maternal milk substitute was instituted, and lactation was discontinued since the mother was unable to nurse due to the infection. The mother was neutered during the c-section and treated with ceftriaxone (50 mg/kg). After seven days, the newborns presented normal clinical signs and no alterations in the hemogram. Early diagnosis and intervention were essential for the survival of these patients.

Keywords: neonatal infection, puppies, bacteria, newborn

Procedia PDF Downloads 96

Authors: Tanu Khanuja, Harikrishnan N. Unni

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Head is the most vulnerable part of human body and may cause severe life threatening injuries. As the in vivo brain response cannot be recorded during injury, computational investigation of the head model could be really helpful to understand the injury mechanism. Majority of the physical damage to living tissues are caused by relative motion within the tissue due to tensile and shearing structural failures. The present Finite Element study focuses on investigating intracranial pressure and stress/strain distributions resulting from impact loads on various sites of human head. This is performed by the development of the 3D model of a human head with major segments like cerebrum, cerebellum, brain stem, CSF (cerebrospinal fluid), and skull from patient specific MRI (magnetic resonance imaging). The semi-automatic segmentation of head is performed using AMIRA software to extract finer grooves of the brain. To maintain the accuracy high number of mesh elements are required followed by high computational time. Therefore, the mesh optimization has also been performed using tetrahedral elements. In addition, model validation with experimental literature is performed as well. Hard tissues like skull is modeled as elastic whereas soft tissues like brain is modeled with viscoelastic prony series material model. This paper intends to obtain insights into the severity of brain injury by analyzing impacts on frontal, top, back, and temporal sites of the head. Yield stress (based on von Mises stress criterion for tissues) and intracranial pressure distribution due to impact on different sites (frontal, parietal, etc.) are compared and the extent of damage to cerebral tissues is discussed in detail. This paper finds that how the back impact is more injurious to overall head than the other. The present work would be helpful to understand the injury mechanism of traumatic brain injury more effectively.

Keywords: dynamic impact analysis, finite element analysis, intracranial pressure, MRI, traumatic brain injury, von Misses stress

Procedia PDF Downloads 139

Authors: Madeleine Cox

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Objective: discussion of diagnosis of vernix caseosa peritonitis, recovery and subsequent caesarean seciton Case: 30 year old G4P1 presented in labour at 40 weeks, planning a vaginal birth afterprevious caesarean section. She underwent an emergency caesarean section due to concerns for fetal wellbeing on CTG. She was found to have a thin lower segment with a very small area of dehiscence centrally. The operation was uncomplicated, and she recovered and went home 2 days later. She then represented to the emergency department day 6 post partum feeling very unwell, with significant abdominal pain, tachycardia as well as urinary retention. Raised white cell count of 13.7 with neutrophils of 11.64, CRP of 153. An abdominal ultrasound was poorly tolerated by the patient and did not aide in the diagnosis. Chest and abdominal xray were normal. She underwent a CT chest and abdomen, which found a small volume of free fluid with no apparent collection. Given no obvious cause of her symptoms were found and the patient did not improve, she had a repeat CT 2 days later, which showed progression of free fluid. A diagnostic laparoscopy was performed with general surgeons, which reveled turbid fluid, an inflamed appendix which was removed. The patient improved remarkably post operatively. The histology showed periappendicitis with acute appendicitis with marked serosal inflammatory reaction to vernix caseosa. Following this, the patient went on to recover well. 4 years later, the patient was booked for an elective caesarean section, on entry into the abdomen, there were very minimal adhesions, and the surgery and her subsequent recovery was uncomplicated. Discussion: this case represents the diagnostic dilemma of a patient who presents unwell without a clear cause. In this circumstance, multiple modes of imaging did not aide in her diagnosis, and so she underwent diagnostic surgery. It is important to evaluate if a patient is or is not responding to the typical causes of post operative pain and adjust management accordingly. A multiteam approach can help to provide a diagnosis for these patients. Conclusion: Vernix caseosa peritonitis is a rare cause of acute abdomen post partum. There are few reports in the literature of the initial presentation and no reports on the possible effects on future pregnancies. This patient did not have any complications in her following pregnancy or delivery secondary to her diagnosis of vernix caseosa peritonitis. This may assist in counselling other women who have had this uncommon diagnosis.

Keywords: peritonitis, obstetrics, caesarean section, pain

Procedia PDF Downloads 75

Authors: G. Scremin, I. Y. Suh, S. Doukas

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Spectators follow their favorite sports teams for different reasons. While some attend a sporting event simply for its entertainment value, others do so because of the personal sense of achievement and accomplishment their connection with a sports team creates. Moreover, the level of identity spectators feel toward their favorite sports team falls in a broad continuum. Some are mere spectators. For those spectators, their association to a sports team has little impact on their self-image. Others are die-hard fans who are proud of their association with their team and whose connection with that team is an important reflection of who they are. Several motives for sports consumption can be used to explain the level of spectator support in a variety of sports. Those motives can also be used to explain the variance in the identification, attachment, and loyalty spectators feel toward their favorite sports team. Motives for sports consumption can be used to discriminate the degree of identification spectators have with their favorite sports team. In this study, motives for sports consumption was used to discriminate the level of identity spectators feel toward their sports team. It was hypothesized that spectators with a strong level of team identity would report higher rates of interest in player, interest in sports, and interest in team than spectators with a low level of team identity. And spectators with a low level of team identity would report higher rates for entertainment value, bonding with friends or family, and wholesome environment. Football spectators in the United States and England were surveyed about their motives for football consumption and their level of identification with their favorite football team. To assess if the motives of sports fans differed by level of team identity and allegiance to an American or English football team, a Multivariate Analysis of Variance (MANOVA) under the General Linear Model (GLM) procedure found in SPSS was performed. The independent variables were level of team identity and allegiance to an American or English football team, and the dependent variables were the sport fan motives. A tripartite split (low, moderate, high) was used on a composite measure for team identity. Preliminary results show that effect of team identity is statistically significant (p < .001) for at least nine of the 17 motives for sports consumption assessed in this investigation. These results indicate that the motives of spectators with a strong level of team identity differ significantly from spectators with a low level of team identity. Those differences can be used to discriminate the degree of identification spectators have with their favorite sports team. Sports marketers can use these methods and results to develop identity profiles of spectators and create marketing strategies specifically designed to attract those spectators based on their unique motives for consumption and their level of team identification.

Keywords: fan identification, market segmentation of sports fans, motives for sports consumption, team identity

Procedia PDF Downloads 143