Robotic implantation of intracerebral electrodes for deep brain stimulation

Dissertação de mestrado integrado em Engenharia BiomédicaThe objective of this dissertation is to develop an initial approach of a robotic system to play an assistive role in Deep Brain Stimulation (DBS) stereotactic neurosurgery. The robot is expected to position and manipulate several surgical instrumentation in a passive or semi-active role according to pre-operative directives and to medical team instructions. The current impact of neurological disorders sensitive to DBS, the underlying knowledge of neurostimulation and neuroanatomy, and practical insight about DBS surgery is studied to understand the ultimate goal of our project. We elaborated a state of the art search on neurosurgery robots to get the picture of what was done and what could be improved. Upon determining the optimal robotic system characteristics for DBS surgery, we conducted a search on industrial robotic manipulators to select the best candidates. The geometric and differential kinematic equations are developed for each robotic manipulator. To test the kinematic equations and the control application in a virtual operating room environment, we used the CoopDynSim simulator. Being this simulator oriented to mobile robots, we introduced the serial manipulator concept and implemented the selected robots with all specifications. We designed a control application to manoeuvre the robot and devised an initial interface towards positioning/manipulation of instrumentation along surgical trajectories, while emphasizing safety procedures. Although it was impossible to assess the robot’s precision in simulation, we studied how and where to place the manipulator to avoid collisions with surrounding equipment without restricting its flexibility.O objectivo desta dissertação é o desenvolvimento de uma abordagem inicial a um sistema robótico para desempenhar um papel de assistência em neurocirurgia estereotáxica de Estimulação Cerebral Profunda (DBS). O robô deve posicionar e manipular variados instrumentos cirúrgicos de uma forma passiva ou semi-ativa de acordo com diretivas pré-operativas ou com as instruções da equipa médica. O impacto atual dos distúrbios neurológicos sensíveis a DBS, o conhecimento subjacente de neuro-estimulação e neuro-anatomia, e conhecimento prático sobre a cirurgia de DBS são estudados para concluir sobre o objectivo final do nosso projeto. Nós elaborámos uma pesquisa sobre o estado da arte em robots neurocirúrgicos para perceber o que tem sido feito e o que pode ser melhorado. Após determinar o conjunto óptimo de características de um sistema robótico para cirurgia de DBS, nós procuramos manipuladores robóticos industriais para escolher os melhores candidatos. As cinemáticas geométricas e diferenciais são desenvolvidas para cada manipulador robótico. Para testar as equações cinemáticas e a aplicação de controlo num ambiente virtual de uma sala de operações, nós usamos o simulador CoopDynSim. Sendo este manipulador orientado a robôs móveis, nós introduzimos o conceito de manipuladores em série e implementamos os robôs selecionados com todas as especificações. Nós projetamos uma aplicação de controlo para manobrar os robôs e desenvolvemos uma interface inicial no sentido do posicionamento/manipulação de instrumentação ao longo de trajetórias cirúrgicas, enfatizando os procedimentos de segurança. Embora não tenha sido possível avaliar a precisão do robô em simulação, nós estudamos como e onde posicionar o manipulador de forma a evitar colisões com o equipamento circundante sem restringir a sua flexibilidade

Robotic implantation of intracerebral electrodes for deep brain stimulation

This dissertation objective is to contribute for the development of a robotic system towards neurosurgery assistance in Deep Brain Stimulation (DBS) stereotactic procedures. Being DBS neurosurgery typically a long, physically and cognitively demanding procedure; the introduction of a robotic assistant to hold, manipulate and position instrumentation would improve the medical team working conditions and lead to better surgery outcomes. Upon understanding how could the robot be used and what robotic systems were adequate to the task, we implemented a simulation environment to emulate several industrial robot manipulators and the operating room. It was also developed each robot geometric and differential kinematic equations, and control algorithms specifically oriented for DBS neurosurgery assistance. Taking into account the operating room arrangement, the robot characteristics and task requirements, we selected the most apt industrial robotic manipulator and further elaborated on its placement and orientation to achieve utmost performance.This work has been partially financed by projects FP7 Marie Curie ITN - NETT (project no289146), FCT FCOMP-01-0124-FEDER-022674, Pest-C/MAT-UI0013/2011 (FCT grant ref. UMINHO/BIC/8/2012) and FCT PhD grant (ref. SFRH/BD/86499/2012)

Production and nutritive value of pastures in integrated livestock production systems: shading and management effects

This study aimed to evaluate the production characteristics of pastures in integrated livestock production systems. For that, an experiment was carried out in São Carlos, SP, Brazil, from 2013 to 2015. Forage development, production and nutritive value were evaluated in five beef cattle production systems: extensive continuous stocking (Urochloa decumbens) = EXT; intensive = INT; crop-livestock = iCL; livestock-forest = iLF and crop-livestock-forest = iCLF. Rotational stocking pastures in INT, iCL, iLF and iCLF systems were established with Urochloa brizantha cv. BRS Piatã. In iCL and iCLF, pastures were renovated by resowing the grass simultaneously with corn. In iLF and iCLF, eucalyptus (Eucalyptus urograndis clone GG100) was planted in Apr 2011 in single rows with 15 × 2 m spacing. In the 2013/2014 crop season, INT, iCL, and iCLF pastures were more productive than in iLF and EXT. Shading increase in the 2014/2015 season reduced pasture production in iLF and iCLF, compared with INT and iCL, but increased crude protein content and digestibility. In the shaded systems, pasture production was affected by proximity to trees, mainly due to reductions in solar radiation transmission. The principal component analyses showed that forage accumulation and leaf area index were associated with the position in the middle of the inter-row, and nutritive value was associated with the position at 1.5 m from the trees. In iCLF, solar radiation transmission greater than 60 % maintained forage accumulation similar to iCL, while in iLF, it reduced forage accumulation, evidencing that pasture renovation minimized shading effects in these systems

Consenso brasileiro para o tratamento da esclerose múltipla : Academia Brasileira de Neurologia e Comitê Brasileiro de Tratamento e Pesquisa em Esclerose Múltipla

O crescent arsenal terapêutico na esclerose múltipla (EM) tem permitido tratamentos mais efetivos e personalizados, mas a escolha e o manejo das terapias modificadoras da doença (TMDs) tem se tornado cada vez mais complexos. Neste contexto, especialistas do Comitê Brasileiro de Tratamento e Pesquisa em Esclerose Múltipla e do Departamento Científico de Neuroimunologia da Academia Brasileira de Neurologia reuniram-se para estabelecer este Consenso Brasileiro para o Tratamento da EM, baseados no entendimento de que neurologistas devem ter a possibilidade de prescrever TMDs para EM de acordo com o que é melhor para cada paciente, com base em evidências e práticas atualizadas. Por meio deste documento, propomos recomendações práticas para o tratamento da EM, com foco principal na escolha e no manejo das TMDs, e revisamos os argumentos que embasam as estratégias de tratamento na EM.The expanding therapeutic arsenal in multiple sclerosis (MS) has allowed for more effective and personalized treatment, but the choice and management of disease-modifying therapies (DMTs) is becoming increasingly complex. In this context, experts from the Brazilian Committee on Treatment and Research in Multiple Sclerosis and the Neuroimmunology Scientific Department of the Brazilian Academy of Neurology have convened to establish this Brazilian Consensus for the Treatment of MS, based on their understanding that neurologists should be able to prescribe MS DMTs according to what is better for each patient, based on up-to-date evidence and practice. We herein propose practical recommendations for the treatment of MS, with the main focus on the choice and management of DMTs, as well as present a review of the scientific rationale supporting therapeutic strategies in MS