Quality-dependent Deep Learning for Safe Autonomous Guidewire Navigation

Cardiovascular diseases are the main cause ofdeath worldwide. State-of-the-art treatment often includes theprocess of navigating endovascular instruments through thevasculature. Automation of the procedure receives much at-tention lately and may increase treatment quality and unburdenclinicians. However, in order to ensure the patient’s safety theendovascular device needs to be steered carefully through thebody. In this work, we present a collection of medical criteriathat are considered by physicians during an intervention andthat can be evaluated automatically enabling a highly objectiveassessment. Additionally, we trained an autonomous controllerwith deep reinforcement learning to gently navigate within a2D simulation of an aortic arch. Among others, the controllerreduced the maximum and mean contact force applied to thevessel walls by 43% and 29%, respectively

Learning-based autonomous vascular guidewire navigation without human demonstration in the venous system of a porcine liver

Purpose The navigation of endovascular guidewires is a dexterous task where physicians and patients can benefit from automation. Machine learning-based controllers are promising to help master this task. However, human-generated training data are scarce and resource-intensive to generate. We investigate if a neural network-based controller trained without human-generated data can learn human-like behaviors. Methods We trained and evaluated a neural network-based controller via deep reinforcement learning in a finite element simulation to navigate the venous system of a porcine liver without human-generated data. The behavior is compared to manual expert navigation, and real-world transferability is evaluated. Results The controller achieves a success rate of 100% in simulation. The controller applies a wiggling behavior, where the guidewire tip is continuously rotated alternately clockwise and counterclockwise like the human expert applies. In the ex vivo porcine liver, the success rate drops to 30%, because either the wrong branch is probed, or the guidewire becomes entangled. Conclusion In this work, we prove that a learning-based controller is capable of learning human-like guidewire navigation behavior without human-generated data, therefore, mitigating the requirement to produce resource-intensive human-generated training data. Limitations are the restriction to one vessel geometry, the neglected safeness of navigation, and the reduced transferability to the real world

Structure and Floristic Composition of Flood Plain Forests in the Peruvian Amazon. II. The Understorey of Restinga Forests

Structure and floristic composition of small trees and shrubs (1.5 m height to 10 cm diameter at breast height was described in two flood plain forests of the lower Ucayali river, Peruvian Amazon. The forests were of the high and low restinga type, on an annual average flooded around 1 and 2 months, respectively. The soils were nutrient rich entisols, and the vegetation forms closed high canopy forests with presence of emergents. A total of 25 permanent sample plots covering 0.64 ha were established. They were nested within six quadratic 1 ha permanent sample plots where large individuals (>10 cm DBH) were inventoried. Overall average density and basal area of the understorey were 4458 ha and 5.0 m2 /ha, respectively. The families of Moraceae, Leguminosae, Annonaceae, Euphorbiaceae, and Lauraceae were among the most important tree families, while important shrub and small tree families were Violaceae, Rubiaceae, Melastomataceae, and Olacaceae. Two hundred eight and 204 tree species were registered in the restinga forest overstories and understories, respectively. Fifty-six percent of the species were shared between the two forest strata, while around 22% were confined to each of them. Species present only in the understorey were predominantly shrubs or treelets, while some of the species with a presence only in the overstorey were probably early succession species about to disappear from the forests

The ResourcePlan—An Instrument for Resource-Efficient Development of Urban Neighborhoods

In Germany, the current sectoral urban planning often leads to inefficient use of resources, partly because municipalities lack integrated planning instruments and argumentation strength toward politics, investors, or citizens. The paper develops the ResourcePlan as (i) legal and (ii) a planning instrument to support the efficient use of resources in urban neighborhoods. The integrative, multi-methodological approach addresses the use of natural resources in the building and infrastructural sectors of (i) water (storm- and wastewater) management, (ii) construction and maintenance of buildings and infrastructure, (iii) urban energy system planning, and (iv) land-use planning. First, the development as legal instrument is carried out, providing (i) premises for integrating resource protection at all legal levels and (ii) options for implementing the ResourcePlan within German municipal structures. Second, the evaluation framework for resource efficiency of the urban neighborhoods is set up for usage as a planning instrument. The framework provides a two-stage process that runs through the phases of setting up and implementing the ResourcePlan. (Eco)system services are evaluated as well as life cycle assessment and economic aspects. As a legal instrument, the ResourcePlan integrates resource protection into municipal planning and decision-making processes. The multi-methodological evaluation framework helps to assess inter-disciplinary resource efficiency, supports the spatial identification of synergies and conflicting goals, and contributes to transparent, resource-optimized planning decisions.BMBF, 033W102E, RESZ - Verbundvorhaben: R2Q - RessourcenPlan im Quartier - Teilprojekt 5: Ganzheitliche Bewertung der Ressourceneffizienz von Stadtquartiere

Analog, digital - Opposition oder Kontinuum? : zur Theorie und Geschichte einer Unterscheidung

Forschungsprojekt gefördert durch die DFGDie Opposition der 'neuen digitalen' zu den 'alten analogen' Medien findet sich in Werbung, Popkultur, Wirtschaft, Politik und Wissenschaft. Offenbar hat sich die Unterscheidung analog/digital zur paradigmatischen Leitdifferenz des späten 20. und frühen 21. Jahrhunderts entwickelt. Doch was bedeutet 'analog' bzw. 'digital' in verschiedenen Kontexten genau und gibt es nicht auch Übergänge zwischen beiden Formen? Wann taucht die Unterscheidung auf und in welchem Zusammenhang? Indem sich die Anthologie mit diesen und anderen Fragen aus verschiedenen Perspektiven beschäftigt, räumt sie ein erhebliches Forschungsdefizit nicht nur in den Medienwissenschaften aus

Sarcoma classification by DNA methylation profiling

Sarcomas are malignant soft tissue and bone tumours affecting adults, adolescents and children. They represent a morphologically heterogeneous class of tumours and some entities lack defining histopathological features. Therefore, the diagnosis of sarcomas is burdened with a high inter-observer variability and misclassification rate. Here, we demonstrate classification of soft tissue and bone tumours using a machine learning classifier algorithm based on array-generated DNA methylation data. This sarcoma classifier is trained using a dataset of 1077 methylation profiles from comprehensively pre-characterized cases comprising 62 tumour methylation classes constituting a broad range of soft tissue and bone sarcoma subtypes across the entire age spectrum. The performance is validated in a cohort of 428 sarcomatous tumours, of which 322 cases were classified by the sarcoma classifier. Our results demonstrate the potential of the DNA methylation-based sarcoma classification for research and future diagnostic applications

Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia

Chronic limb-threatening ischemia (CLTI)is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG)are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD)in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI)is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR)hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP)and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen)has not been established. Regenerative medicine approaches (eg, cell, gene therapies)for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative. © 2019 Society for Vascular Surgery and European Society for Vascular Surger