Elastographie ultrasonore des tissus mous du membre inférieur en vue de la caractérisation des effets mécaniques de dispositifs médicaux textiles

Elastic compression of the leg is a widely used treatment in case of pathologies related to venous insufficiency. Its benefits are not to be proven, but still, for some patients, the therapeutic goal is not reached. One goal of this treatment is to reduce transmural pressure applied to veins in order to restore or increase blood return to the heart by the transmission of the external pressure through soft tissues. This is a complex mechanism that can be predicted by patient-specific finite element models. To be patient-specific, these models must take into account the geometry and the distribution of mechanical properties of each subject.In this study, two methodologies are developed to identify the mechanical properties of soft tissues. First, the elastic modulus distribution inside the superficial soft tissues is measured by shear wave ultrasound elastography. Second, the mechanical properties of deep soft tissues are identified through an inverse method combining the data acquired from an experimental localized compression of the leg to a bi-dimensional finite element model.These two methodologies allow to evaluate the mechanical properties heterogeneity from the skin to the fascia cruris and to characterize the non-linear behaviour of deep soft tissues. Finally, the results from both methodologies are brought together to generate a biomechanical model of the leg under elastic compression to predict pressure distribution inside soft tissues for four healthy subjects.La compression élastique de la jambe est le traitement de référence des pathologies liées à l’insuffisance veineuse. Bien que l’efficacité ne soit plus à prouver, les objectifs thérapeutiques restent non atteints pour certains patients. Un objectif de la compression élastique est la réduction de la pression pariétale des veines afin de rétablir ou d’augmenter le retour du sang vers le cœur par une transmission de pression au travers des tissus mous. Ce mécanisme est complexe et peut être prédit par des modèles éléments finis personnalisés. Pour être personnalisés, ces modèles doivent prendre en compte la géométrie et la carte des propriétés mécaniques du sujet.Dans cette étude, on développe deux méthodologies permettant d’identifier les propriétés mécaniques des tissus mous. Dans un premier temps, on mesure par élastographie ultrasonore par onde de cisaillement la distribution du module élastique au sein des tissus mous superficiels. Dans un deuxième temps, on identifie par une méthode inverse les propriétés mécaniques des tissus mous profonds. Cette méthode associe l’acquisition de données d’un essai expérimental de compression localisée de la jambe à un modèle éléments finis bidimensionnel. Ces deux méthodologies nous permettent d’évaluer l’hétérogénéité des propriétés mécaniques de la peau au fascia cruris et de caractériser le comportement non-linéaire des tissus mous profonds. Enfin, les résultats de ces deux méthodologies sont couplés afin de générer un modèle biomécanique de la jambe sous compression élastique pour prédire la distribution de pression au sein des tissus mous pour quatre sujets sains

International Guidelines for Veterinary Tumor Pathology: A Call to Action

Standardization of tumor assessment lays the foundation for validation of grading systems, permits reproducibility of oncologic studies among investigators, and increases confidence in the significance of study results. Currently, there is minimal methodological standardization for assessing tumors in veterinary medicine, with few attempts to validate published protocols and grading schemes. The current article attempts to address these shortcomings by providing standard guidelines for tumor assessment parameters and protocols for evaluating specific tumor types. More detailed information is available in the Supplemental Files, the intention of which is 2-fold: publication as part of this commentary, but more importantly, these will be available as “living documents” on a website (www.vetcancerprotocols.org), which will be updated as new information is presented in the peer-reviewed literature. Our hope is that veterinary pathologists will agree that this initiative is needed, and will contribute to and utilize this information for routine diagnostic work and oncologic studies. Journal editors and reviewers can utilize checklists to ensure publications include sufficient detail and standardized methods of tumor assessment. To maintain the relevance of the guidelines and protocols, it is critical that the information is periodically updated and revised as new studies are published and validated with the intent of providing a repository of this information. Our hope is that this initiative (a continuation of efforts published in this journal in 2011) will facilitate collaboration and reproducibility between pathologists and institutions, increase case numbers, and strengthen clinical research findings, thus ensuring continued progress in veterinary oncologic pathology and improving patient care

Mechanical modelling of the abdominal wall and biomaterials for hernia surgery

Abdominal surgery for hernia repair is based on the implantation of a synthetic mesh in the defect area which aims at reinforcing the damaged wall. This clinical intervention is common in today's society and, in unfavorable cases such as obese patients or patients with large defects, could lead to a number of problems that reduce the quality of life of patients. The most common problems are the appearance of fibrosis, the hernia recurrence and occurrence of abdominal discomfort due to poor compliance between the host tissue and the prosthesis. Currently, surgeons have no definitive and universally accepted guidelines for the selection of the appropriate prosthesis for each patient and type of defect. Therefore, the choice of one or another mesh, and their placement in case of anisotropic meshes, is a decision to be taken by the surgeons according to their experience. This thesis aims to study the abdominal hernia surgery from the continuum mechanics point of view. However, for the supply and validation of the generated models, it is necessary to perform an experimental study in an animal model. Since this is a multidisciplinary problem, the study approached was developed in collaboration with the Translational Research Group in Biomaterials and Tissue Engineering at the University of Alcalá de Henares (Madrid). The final goal of hernia surgery is that the prosthesis ensures adequate tissular integration, being capable, among other things, to reproduce the mechanical behaviour of the healthy abdominal wall and to absorb the stresses due to the physiological loads to which the abdomen is subjected. Therefore, in addition to addressing the study in animal models to analyze the integration on the wall, the mechanical modelling of the abdominal wall and the biomaterials used in hernia repair is essential. For this, the construction of an ``in silico'' model of the human abdomen has been developed. Due to the diversity of commercial products on the market, this thesis focusses on the study of three representative prostheses, specifically Surgipro, Optilene and Infinit. These meshes are characterized by different geometric parameters and are made of different materials. In this work, the mechanical properties of the prostheses have been determined experimentally and different constitutive models, that reproduce the patterns of the mechanical behaviour observed in both, the abdominal muscle and implanted biomaterials, have been proposed. Specifically, the numerical modelling of the response of the abdominal muscle, including both active and passive responses, and prostheses have been approached within the framework of the nonlinear hyperelasticity in large deformations. The latter approach of this thesis aims to model, using the finite element method, the mechanical response of the wall with the implanted mesh. A complete model of the human abdomen has been defined from nuclear magnetic resonance imaging. This complete model allows differentiating the main anatomical units of the abdomen and it is used to simulate the passive and active responses. Furthermore, this model allows the study of the response of the healthy wall and the analysis of the final mechanical response of the herniated human abdomen to the placement of different prostheses. In summary, this thesis establishes a methodology to the automation of computational models for personalized surgical procedures in order to select the most appropriate mesh for each patient as well as the appropriate placement on the defect in the case of anisotropic prostheses

Mastering Endo-Laparoscopic and Thoracoscopic Surgery

This is an open access book. The book focuses mainly on the surgical technique, OR setup, equipments and devices necessary in minimally invasive surgery (MIS). It serves as a compendium of endolaparoscopic surgical procedures. It is an official publication of the Endoscopic and Laparoscopic Surgeons of Asia (ELSA). The book includes various sections covering basic skills set, devices, equipments, OR setup, procedures by area. Each chapter cover introduction, indications and contraindications, pre-operative patient’s assessment and preparation, OT setup (instrumentation required, patient’s position, etc.), step by step description of surgical procedures, management of complications, post-operative care. It includes original illustrations for better understanding and visualization of specific procedures. The book serves as a practical guide for surgical residents, surgical trainees, surgical fellows, junior surgeons, surgical consultants and anyone interested in MIS. It covers most of the basic and advanced laparoscopic and thoracoscopic surgery procedures meeting the curriculum and examination requirements of the residents

Updated Topics in Minimally Invasive Abdominal Surgery

Updated topics in minimally invasive abdominal surgery provides surgeons interested in minimally invasive abdominal surgery with the most recent techniques and discussions in laparoscopic surgery. This book includes different topics covering a big variety of medical conditions with up-to-date information. It discusses many controversies in a clear and user-friendly manner. This book is made for young junior surgeons in training and also senior surgeons who need to know the most recent work in the field of laparoscopy. To make the material easily digestive, we provided the book with many figures and illustrations for different procedures and technical pearls

Mastering Endo-Laparoscopic and Thoracoscopic Surgery

This is an open access book. The book focuses mainly on the surgical technique, OR setup, equipments and devices necessary in minimally invasive surgery (MIS). It serves as a compendium of endolaparoscopic surgical procedures. It is an official publication of the Endoscopic and Laparoscopic Surgeons of Asia (ELSA). The book includes various sections covering basic skills set, devices, equipments, OR setup, procedures by area. Each chapter cover introduction, indications and contraindications, pre-operative patient’s assessment and preparation, OT setup (instrumentation required, patient’s position, etc.), step by step description of surgical procedures, management of complications, post-operative care. It includes original illustrations for better understanding and visualization of specific procedures. The book serves as a practical guide for surgical residents, surgical trainees, surgical fellows, junior surgeons, surgical consultants and anyone interested in MIS. It covers most of the basic and advanced laparoscopic and thoracoscopic surgery procedures meeting the curriculum and examination requirements of the residents

Memorias XII Congeso Colombiano de Morfología Pontificia Universidad Javeriana Cali (Colombia)

Memorias XII Congeso Colombiano de Morfología Pontificia Universidad Javeriana Cali (Colombia), del 29 de septiembre al 01 de octubre de 201