Adenoviral targeting of malignant melanoma for fluorescence-guided surgery prevents recurrence in orthotopic nude-mouse models.

Malignant melanoma requires precise resection in order to avoid metastatic recurrence. We report here that the telomerase-dependent, green fluorescent protein (GFP)-containing adenovirus OBP-401 could label malignant melanoma with GFP in situ in orthotopic mouse models. OBP-401-based fluorescence-guided surgery (FGS) resulted in the complete resection of malignant melanoma in the orthotopic models, where conventional bright-light surgery (BLS) could not. High-dose administration of OBP-401 enabled FGS without residual cancer cells or recurrence, due to its dual effect of cancer-cell labeling with GFP and killing

MRI-guided focused ultrasound surgery in musculoskeletal diseases: the hot topics

MRI-guided focused ultrasound surgery (MRgFUS) is a minimally invasive treatment guided by the most sophisticated imaging tool available in today's clinical practice. Both the imaging and therapeutic sides of the equipment are based on non-ionizing energy. This technique is a very promising option as potential treatment for several pathologies, including musculoskeletal (MSK) disorders. Apart from clinical applications, MRgFUS technology is the result of long, heavy and cumulative efforts exploring the effects of ultrasound on biological tissues and function, the generation of focused ultrasound and treatment monitoring by MRI. The aim of this article is to give an updated overview on a "new" interventional technique and on its applications for MSK and allied sciences

Towards a Radio-guided Surgery with β−\beta^{-} Decays: Uptake of a somatostatin analogue (DOTATOC) in Meningioma and High Grade Glioma

A novel radio guided surgery (RGS) technique for cerebral tumors using $\beta^{-}$ radiation is being developed. Checking the availability of a radio-tracer that can deliver a $\beta^{-}$ emitter to the tumor is a fundamental step in the deployment of such technique. This paper reports a study of the uptake of 90Y labeled (DOTATOC) in the meningioma and the high grade glioma (HGG) and a feasibility study of the RGS technique in these cases.Comment: 21 pages, 5 figure

Postoperative pain and morphine consumption after ultrasound-guided femoral and sciatic combined nerve block versus neurostimulation for femoral and sciatic combined nerve block or neurostimulation for femoral nerve block in primary elective total knee arthroplasty.

Abstract Congreso XXXVII National Meeting of the Spanish Society of Pharmacology with guest society: The British Pharmacological SocietyBackground and Aims: Total knee arthroplasty injuries are extremely painful and merit prompt attention to adequate postoperative analgesia. We aim to compare femoral and sciatic ultrasound-guided combined nerve block vs. neurostimulation for femoral and sciatic combined nerve block or for femoral nerve block in postoperative pain in primary elective total knee prosthesis. Summary of work and outcomes: A three arms, prospective longitudinal study of patients having primary elective unilateral knee prosthesis and randomly assigned to catheter insertion guided by ultrasound or neurostimulation was done: 1) Ultrasound-guided femoral and sciatic combined nerve block (USFSCN) (N=15); 2) Neurostimulation for femoral and sciatic combined nerve block (NSFSCN) (N=17); 3) Neurostimulation for femoral nerve block (NSFN) (N=11). Total analgesia (morphine) consumption after 48 hours was the primary endpoint. The postoperative pain intensity (visual analogue pain scale (VAS)) at post-anaesthetic recovery unit (PARU), 6, 24, 48 h, and during movement and postoperative complications were secondary outcomes. Results and discussion: 43 patients (68.3±8 years old, 77% female) subjected to elective unilateral knee prosthesis were enrolled. There were no differences in the demographic, anaesthetic and surgical variables between groups. Pain intensity was lower in the USFSCN group compared with NSFSCN and NSFN during the first 48 h post-surgery (% of intense pain at PARU/6h/24h/48h): USFSCN 0.8/1.4/3.2/1.6; NSFSCN 5.6/8.3/7.5/3; NSFN 7.2/5.3/6.4/5.4. The average consumption of morphine within 48 h after surgery was similar in the groups USFSCN and NSFSCN (3 mg vs. 3.11 mg), and significantly lower than NSFN (4.19 mg) (p<0.05). And the number of complications was significantly lower in the USFSCN group compared with NSFSCN and NSFN during the first 48 h of postoperative. Conclusion: Ultrasound-guided femoral and sciatic combined nerve block presented better analgesia and was more safety than neurostimulation for femoral and sciatic combined nerve block or for femoral nerve block in primary elective total knee arthroplasty.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Laparoscopic image analysis for automatic tracking of surgical tools

Laparoscopy is a surgical technique nowadays embedded in the clinical routine. Recent researches have been focused on analysing video information captured by the endoscope for extracting cues useful for surgeons, such as depth information. In particular, the 3D pose estimation of the surgical tools presents three important added values: (1) to extract objective parameters for the surgical training stage, (2) to develop an image-guided surgery based on the knowledge of the surgery tools localization, (3) to design new roboticsystems for an automatic laparoscope positioning, according to the visual feedback. Tool’s shape and orientation in the image is the key to get its 3D position. This work presents an image analysis for automatic laparoscopic tool’s detection along the recorded video without extra tool markers, using an edges detection strategy. Also, this analysis includes a previous stage of barrel distortion correction for videoendoscopic image

Precise navigation surgery of tumours in the lung in mouse models enabled by in situ fluorescence labelling with a killer-reporter adenovirus.

BackgroundCurrent methods of image-guided surgery of tumours of the lung mostly rely on CT. A sensitive procedure of selective tumour fluorescence labelling would allow simple and high-resolution visualisation of the tumour for precise surgical navigation.MethodsHuman lung cancer cell lines H460 and A549 were genetically transformed to express red fluorescent protein (RFP). Tumours were grown subcutaneously for each cell line and harvested and minced for surgical orthotopic implantation on the left lung of nude mice. Tumour growth was measured by fluorescence imaging. After the tumours reached 5 mm in diameter, they were injected under fluorescence guidance with the telomerase-dependent green fluorescent protein (GFP)-containing adenovirus, OBP-401. Viral labelling of the lung tumours with GFP precisely colocalised with tumour RFP expression. Three days after administration of OBP-401, fluorescence-guided surgery (FGS) was performed.ResultsFGS of tumours in the lung was enabled by labelling with a telomerase-dependent adenovirus containing the GFP gene. Tumours in the lung were selectively and brightly labelled. FGS enabled complete lung tumour resection with no residual fluorescent tumour.ConclusionsFGS of tumours in the lung is feasible and more effective than bright-light surgery

Efektifitas Teknik Relaksasi Nafas Dalam Dan Guided Imagery Terhadap Penurunan Nyeri Pada Pasien Post Operasi Sectio Caesare Di Irina D Blu Rsup Prof. Dr. R. D. Kandou Manado

: Pain is an unpleasant symptom that felt by patients post sectio caesarea. Alternatives to reduce pain with deep breathing relaxation techniques and guided imagery not definitely known how its effectiveness. The purpose of this research was to determine the effectivity of deep breathing relaxation techniques and guided imagery to reduction pain in post surgery patients sectio caesarea. This research is an analytical research with quasi-experimental research methods. The research design was a single group pre-post test without control group. The sampling technique used is accidental sampling where found samples as many as 20 people. The data analysis using paired sample t-test in SPSS 17 programe at 95% significance level (α=0.05). The results showed that deep breathing relaxation techniques and guided imagery proved to be effective in reducing pain intensity in post surgery patients sectio caesarea in the Irina D Department of RSUP Prof. Dr. R. D. Kandou Manado (p value=0.000; α 0.05) which means that the hypothesis is accepted. Conclusion, deep breathing relaxation techniques and guided imagery can reduce pain intensity in post surgery patients sectio caesarea in the Irina D Department of RSUP Prof. Dr. R. D. Kandou Manado. Implementation of deep breathing relaxation techniques and guided imagery to reduce pain in post surgery patients sectio caesarea can be be done according to the SOP so not just focus on the pharmacological treatment only

Fluorescence-guided surgery of a highly-metastatic variant of human triple-negative breast cancer targeted with a cancer-specific GFP adenovirus prevents recurrence.

We have previously developed a genetically-engineered GFP-expressing telomerase-dependent adenovirus, OBP-401, which can selectively illuminate cancer cells. In the present report, we demonstrate that targeting a triple-negative high-invasive human breast cancer, orthotopically-growing in nude mice, with OBP-401 enables curative fluorescence-guided surgery (FGS). OBP-401 enabled complete resection and prevented local recurrence and greatly inhibited lymph-node metastasis due to the ability of the virus to selectively label and subsequently kill cancer cells. In contrast, residual breast cancer cells become more aggressive after bright (white)-light surgery (BLS). OBP-401-based FGS also improved the overall survival compared with conventional BLS. Thus, metastasis from a highly-aggressive triple-negative breast cancer can be prevented by FGS in a clinically-relevant mouse model

Fractional flow reserve versus angiography in guiding management to optimize outcomes in non–ST-elevation myocardial infarction (FAMOUS-NSTEMI): rationale and design of a randomized controlled clinical trial

&lt;p&gt;Background: In patients with acute non–ST-elevation myocardial infarction (NSTEMI), coronary arteriography is usually recommended; but visual interpretation of the angiogram is subjective. We hypothesized that functional assessment of coronary stenosis severity with a pressure-sensitive guide wire (fractional flow reserve [FFR]) would have additive diagnostic, clinical, and health economic utility as compared with angiography-guided standard care.&lt;/p&gt; &lt;p&gt;Methods and design: A prospective multicenter parallel-group 1:1 randomized controlled superiority trial in 350 NSTEMI patients with ≥1 coronary stenosis ≥30% severity (threshold for FFR measurement) will be conducted. Patients will be randomized immediately after coronary angiography to the FFR-guided group or angiography-guided group. All patients will then undergo FFR measurement in all vessels with a coronary stenosis ≥30% severity including culprit and nonculprit lesions. Fractional flow reserve will be disclosed to guide treatment in the FFR-guided group but not disclosed in the “angiography-guided” group. In the FFR-guided group, an FFR ≤0.80 will be an indication for revascularization by percutaneous coronary intervention or coronary artery bypass surgery, as appropriate. The primary outcome is the between-group difference in the proportion of patients allocated to medical management only compared with revascularization. Secondary outcomes include the occurrence of cardiac death or hospitalization for myocardial infarction or heart failure, quality of life, and health care costs. The minimum and average follow-up periods for the primary analysis are 6 and 18 months, respectively.&lt;/p&gt; &lt;p&gt;Conclusions: Our developmental clinical trial will address the feasibility of FFR measurement in NSTEMI and the influence of FFR disclosure on treatment decisions and health and economic outcomes.&lt;/p&gt

Access via the internal jugular vein

Central venous access via the internal jugular vein (IJV) is safe, relatively easy and very commonly used in infants and children undergoing cardiac surgery for congenital heart disease. Because of the wide range of anatomical variations an ultrasound-guided technique is advantageous in many cases, in particular in patients who have had previous punctures or those in whom difficulties are anticipated for various reasons. The right internal jugular vein is the preferred vein for central venous access as it offers straight access to the superior vena cava. The rate of complications - insertion-related as well as long term - are lower compared to the femoral and the subclavian access.peer-reviewe