Evaluation of a portable image overlay projector for the visualisation of surgical navigation data: phantom studies

Introduction: Presenting visual feedback for image-guided surgery on a monitor requires the surgeon to perform time-consuming comparisons and diversion of sight and attention away from the patient. Deficiencies in previously developed augmented reality systems for image-guided surgery have, however, prevented the general acceptance of any one technique as a viable alternative to monitor displays. This work presents an evaluation of the feasibility and versatility of a novel augmented reality approach for the visualisation of surgical planning and navigation data. The approach, which utilises a portable image overlay device, was evaluated during integration into existing surgical navigation systems and during application within simulated navigated surgery scenarios. Methods: A range of anatomical models, surgical planning data and guidance information taken from liver surgery, cranio-maxillofacial surgery, orthopaedic surgery and biopsy were displayed on patient-specific phantoms, directly on to the patient's skin and on to cadaver tissue. The feasibility of employing the proposed augmented reality visualisation approach in each of the four tested clinical applications was qualitatively assessed for usability, visibility, workspace, line of sight and obtrusiveness. Results: The visualisation approach was found to assist in spatial understanding and reduced the need for sight diversion throughout the simulated surgical procedures. The approach enabled structures to be identified and targeted quickly and intuitively. All validated augmented reality scenes were easily visible and were implemented with minimal overhead. The device showed sufficient workspace for each of the presented applications, and the approach was minimally intrusiveness to the surgical scene. Conclusion: The presented visualisation approach proved to be versatile and applicable to a range of image-guided surgery applications, overcoming many of the deficiencies of previously described AR approaches. The approach presents an initial step towards a widely accepted alternative to monitor displays for the visualisation of surgical navigation dat

Chaste: an open source C++ library for computational physiology and biology

Chaste - Cancer, Heart And Soft Tissue Environment - is an open source C++ library for the computational simulation of mathematical models developed for physiology and biology. Code development has been driven by two initial applications: cardiac electrophysiology and cancer development. A large number of cardiac electrophysiology studies have been enabled and performed, including high performance computational investigations of defibrillation on realistic human cardiac geometries. New models for the initiation and growth of tumours have been developed. In particular, cell-based simulations have provided novel insight into the role of stem cells in the colorectal crypt. Chaste is constantly evolving and is now being applied to a far wider range of problems. The code provides modules for handling common scientific computing components, such as meshes and solvers for ordinary and partial differential equations (ODEs/PDEs). Re-use of these components avoids the need for researchers to "re-invent the wheel" with each new project, accelerating the rate of progress in new applications. Chaste is developed using industrially-derived techniques, in particular test-driven development, to ensure code quality, re-use and reliability. In this article we provide examples that illustrate the types of problems Chaste can be used to solve, which can be run on a desktop computer. We highlight some scientific studies that have used or are using Chaste, and the insights they have provided. The source code, both for specific releases and the development version, is available to download under an open source Berkeley Software Distribution (BSD) licence at http://www.cs.ox.ac.uk/chaste, together with details of a mailing list and links to documentation and tutorials

Longitudinal Analysis of Quality of Life, Clinical, Radiographic, Echocardiographic, and Laboratory Variables in Dogs with Myxomatous Mitral Valve Disease Receiving Pimobendan or Benazepril: The QUEST Study

Peer reviewe

Using the Barthel Index and modified Rankin Scale as outcome measures for stroke rehabilitation trials; A comparison of minimum sample size requirements

Objectives Underpowered trials risk inaccurate results. Recruitment to stroke rehabilitation randomised controlled trials (RCTs) is often a challenge. Statistical simulations offer an important opportunity to explore the adequacy of sample sizes in the context of specific outcome measures. We aimed to examine and compare the adequacy of stroke rehabilitation RCT sample sizes using the Barthel Index (BI) or modified Rankin Scale (mRS) as primary outcomes. Methods We conducted computer simulations using typical experimental event rates (EER) and control event rates (CER) based on individual participant data (IPD) from stroke rehabilitation RCTs. Event rates are the proportion of participants who experienced clinically relevant improvements in the RCT experimental and control groups. We examined minimum sample size requirements and estimated the number of participants required to achieve a number needed to treat within clinically acceptable boundaries for the BI and mRS. Results We secured 2350 IPD (18 RCTs). For a 90% chance of statistical accuracy on the BI a rehabilitation RCT would require 273 participants per randomised group. Accurate interpretation of effect sizes would require 1000s of participants per group. Simulations for the mRS were not possible as a clinically relevant improvement was not detected when using this outcome measure. Conclusions Stroke rehabilitation RCTs with large sample sizes are required for accurate interpretation of effect sizes based on the BI. The mRS lacked sensitivity to detect change and thus may be unsuitable as a primary outcome in stroke rehabilitation trials

Topical NSAIDs for acute pain: a meta-analysis

BACKGROUND: A previous systematic review reported that topical NSAIDs were effective in relieving pain in acute conditions like sprains and strains, with differences between individual drugs for efficacy. More trials, a better understanding of trial quality and bias, and a reclassification of certain drugs necessitate a new review. METHODS: Studies were identified by searching electronic databases and writing to manufacturers. We selected randomised double blind trials comparing topical NSAID with either placebo or another active treatment in adults with acute pain, and extracted dichotomous information approximating to a 50% reduction in pain at one week, together with details of adverse events and withdrawals. Relative benefit and number-needed-to-treat (NNT), and relative risk and number-needed-to-harm (NNH) were calculated, with sensitivity analyses where appropriate to investigate differences between individual drugs and aspects of trial design. RESULTS: Twenty-six double blind placebo controlled trials had information from 2,853 patients for evaluation of efficacy. Topical NSAID was significantly better than placebo in 19 of the 26 trials, with a pooled relative benefit of 1.6 (95% confidence interval 1.4 to 1.7), and NNT of 3.8 (95% confidence interval 3.4 to 4.4) compared with placebo for the outcome of half pain relief at seven days. Results were not affected by outcome reported, or condition treated, but smaller trials yielded a larger estimate of efficacy. Indirect comparisons of individual topical NSAIDs showed that ketoprofen was significantly better than all other topical NSAIDs, while indomethacin was barely distinguished from placebo. Three trials, with 433 patients, compared topical with oral NSAID (two trials compared the same drug, one compared different drugs) and found no difference in efficacy. Local adverse events, systemic adverse events, or withdrawals due to an adverse event were rare, and no different between topical NSAID and placebo. CONCLUSIONS: Topical NSAIDs were effective and safe in treating acute painful conditions for one week

Metabolic alterations during the growth of tumour spheroids

Solid tumours undergo considerable alterations in their metabolism of nutrients in order to generate sufficient energy and biomass for sustained growth and proliferation. During growth, the tumour microenvironment exerts a number of influences (e.g. hypoxia and acidity) that affect cellular biology and the flux or utilisation of fuels including glucose. The tumour spheroid model was used to characterise the utilisation of glucose and describe alterations to the activity and expression of key glycolytic enzymes during the tissue growth curve. Glucose was avidly consumed and associated with the production of lactate and an acidified medium, confirming the reliance on glycolytic pathways and a diminution of oxidative phosphorylation. The expression levels and activities of hexokinase, phosphofructokinase-1, pyruvate kinase and lactate dehydrogenase in the glycolytic pathway were measured to assess glycolytic capacity. Similar measurements were made for glucose-6-phosphate dehydrogenase, the entry point and regulatory step of the pentose-phosphate pathway (PPP) and for cytosolic malate dehydrogenase, a key link to TCA cycle intermediates. The parameters for these key enzymes were shown to undergo considerable variation during the growth curve of tumour spheroids. In addition, they revealed that the dynamic alterations were influenced by both transcriptional and posttranslational mechanisms

Metabolic alterations during the growth of tumour spheroids

Solid tumours undergo considerable alterations in their metabolism of nutrients in order to generate sufficient energy and biomass for sustained growth and proliferation. During growth, the tumour microenvironment exerts a number of influences (e.g. hypoxia and acidity) that affect cellular biology and the flux or utilisation of fuels including glucose. The tumour spheroid model was used to characterise the utilisation of glucose and describe alterations to the activity and expression of key glycolytic enzymes during the tissue growth curve. Glucose was avidly consumed and associated with the production of lactate and an acidified medium, confirming the reliance on glycolytic pathways and a diminution of oxidative phosphorylation. The expression levels and activities of hexokinase, phosphofructokinase-1, pyruvate kinase and lactate dehydrogenase in the glycolytic pathway were measured to assess glycolytic capacity. Similar measurements were made for glucose-6-phosphate dehydrogenase, the entry point and regulatory step of the pentose-phosphate pathway (PPP) and for cytosolic malate dehydrogenase, a key link to TCA cycle intermediates. The parameters for these key enzymes were shown to undergo considerable variation during the growth curve of tumour spheroids. In addition, they revealed that the dynamic alterations were influenced by both transcriptional and posttranslational mechanisms

Synchronization in periodically driven and coupled stochastic systems-A discrete state approach

Wir untersuchen das Verhalten von stochastischen bistabilen und erregbaren Systemen auf der Basis einer Modellierung mit diskreten Zuständen. In Ergänzung zum bekannten Markovschen Zwei-Zustandsmodell bistabiler stochastischer Dynamik stellen wir ein nicht Markovsches Drei-Zustandsmodell für erregbare Systeme vor. Seine relative Einfachheit, verglichen mit stochastischen Modellen erregbarer Dynamik mit kontinuierlichem Phasenraum, ermöglicht eine teilweise analytische Auswertung in verschiedenen Zusammenhängen. Zunächst untersuchen wir den gemeinsamen Einfluß eines periodischen Treibens und Rauschens. Dieser wird entweder mit Hilfe spektraler Größen oder durch Synchronisation des Systems mit dem treibenden Signal charakterisiert. Wir leiten analytische Ausdrücke für die spektrale Leistungsverstärkung und das Signal-zu-Rauschen Verhältnis für periodisch getriebene Renewal-Prozesse her und wenden diese auf das diskrete Modell für erregbare Dynamik an. Stochastische Synchronization des Systems mit dem treibenden Signal wird auf der Basis der Diffusionseigenschaften der Übergangsereignisse zwischen den diskreten Zuständen untersucht. Wir leiten allgemeine Formeln her, um die mittlere Häufigkeit dieser Ereignisse sowie deren effektiven Diffusionskoeffizienten zu berechnen. Über die konkrete Anwendung auf die untersuchten diskreten Modelle hinaus stellen diese Ergebnisse ein neues Werkzeug für die Untersuchung periodischer Renewal-Prozesse dar. Schließlich betrachten wir noch das Verhalten global gekoppelter bistabiler und erregbarer Systeme. Im Gegensatz zu bistabilen System können erregbare Systeme synchronisiert werden und zeigen kohärente Oszillationen. Alle Untersuchungen des nicht Markovschen Drei-Zustandsmodells werden mit dem prototypischen Modell für erregbare Dynamik, dem FitzHugh-Nagumo System, verglichen und zeigen eine gute Übereinstimmung.We investigate the behavior of stochastic bistable and excitable dynamics based on a discrete state modeling. In addition to the well known Markovian two state model for bistable dynamics we introduce a non Markovian three state model for excitable systems. Its relative simplicity compared to stochastic models of excitable dynamics with continuous phase space allows to obtain analytical results in different contexts. First, we study the joint influence of periodic signals and noise, both based on a characterization in terms of spectral quantities and in terms of synchronization with the periodic driving. We present expressions for the spectral power amplification and signal to noise ratio for renewal processes driven by periodic signals and apply these results to the discrete model for excitable systems. Stochastic synchronization of the system to the driving signal is investigated based on diffusion properties of the transition events between the discrete states. We derive general results for the mean frequency and effective diffusion coefficient which, beyond the application to the discrete models considered in this work, provide a new tool in the study of periodically driven renewal processes. Finally the behavior of globally coupled excitable and bistable units is investigated based on the discrete state description. In contrast to the bistable systems, the excitable system exhibits synchronization and thus coherent oscillations. All investigations of the non Markovian three state model are compared with the prototypical continuous model for excitable dynamics, the FitzHugh-Nagumo system, revealing a good agreement between both models