Augmented reality visualization in brain lesions: a prospective randomized controlled evaluation of its potential and current limitations in navigated microneurosurgery

Background: Augmented reality (AR) has the potential to support complex neurosurgical interventions by including visual information seamlessly. This study examines intraoperative visualization parameters and clinical impact of AR in brain tumor surgery. Methods: Fifty-five intracranial lesions, operated either with AR-navigated microscope (n = 39) or conventional neuronavigation (n = 16) after randomization, have been included prospectively. Surgical resection time, duration/type/mode of AR, displayed objects (n, type), pointer-based navigation checks (n), usability of control, quality indicators, and overall surgical usefulness of AR have been assessed. Results: AR display has been used in 44.4% of resection time. Predominant AR type was navigation view (75.7%), followed by target volumes (20.1%). Predominant AR mode was picture-in-picture (PiP) (72.5%), followed by 23.3% overlay display. In 43.6% of cases, vision of important anatomical structures has been partially or entirely blocked by AR information. A total of 7.7% of cases used MRI navigation only, 30.8% used one, 23.1% used two, and 38.5% used three or more object segmentations in AR navigation. A total of 66.7% of surgeons found AR visualization helpful in the individual surgical case. AR depth information and accuracy have been rated acceptable (median 3.0 vs. median 5.0 in conventional neuronavigation). The mean utilization of the navigation pointer was 2.6 x /resection hour (AR) vs. 9.7 x /resection hour (neuronavigation); navigation effort was significantly reduced in AR (P < 0.001). Conclusions: The main benefit of HUD-based AR visualization in brain tumor surgery is the integrated continuous display allowing for pointer-less navigation. Navigation view (PiP) provides the highest usability while blocking the operative field less frequently. Visualization quality will benefit from improvements in registration accuracy and depth impression

Composition Effects on Kilonova Spectra and Light Curves: I

The merger of neutron star binaries is believed to eject a wide range of heavy elements into the universe. By observing the emission from this ejecta, scientists can probe the ejecta properties (mass, velocity and composition distributions). The emission (a.k.a. kilonova) is powered by the radioactive decay of the heavy isotopes produced in the merger and this emission is reprocessed by atomic opacities to optical and infra-red wavelengths. Understanding the ejecta properties requires calculating the dependence of this emission on these opacities. The strong lines in the optical and infra-red in lanthanide opacities have been shown to significantly alter the light-curves and spectra in these wavelength bands, arguing that the emission in these wavelengths can probe the composition of this ejecta. Here we study variations in the kilonova emission by varying individual lanthanide (and the actinide uranium) concentrations in the ejecta. The broad forest of lanthanide lines makes it difficult to determine the exact fraction of individual lanthanides. Nd is an exception. Its opacities above 1 micron are higher than other lanthanides and observations of kilonovae can potentially probe increased abundances of Nd. Similarly, at early times when the ejecta is still hot (first day), the U opacity is strong in the 0.2-1 micron wavelength range and kilonova observations may also be able to constrain these abundances

Predictive MGMT status in a homogeneous cohort of IDH wildtype glioblastoma patients

Methylation of the O(6)-Methylguanine-DNA methyltransferase (MGMT) promoter is predictive for treatment response in glioblastoma patients. However, precise predictive cutoff values to distinguish "MGMT methylated" from "MGMT unmethylated" patients remain highly debated in terms of pyrosequencing (PSQ) analysis. We retrospectively analyzed a clinically and molecularly very well-characterized cohort of 111 IDH wildtype glioblastoma patients, who underwent gross total tumor resection and received standard Stupp treatment. Detailed clinical parameters were obtained. Predictive cutoff values for MGMT promoter methylation were determined using ROC curve analysis and survival curve comparison using Log-rank (Mantel-Cox) test. MGMT status was analyzed using pyrosequencing (PSQ), semi-quantitative methylation specific PCR (sqMSP) and direct bisulfite sequencing (dBiSeq). Highly methylated (> 20%) MGMT correlated with significantly improved progression-free survival (PFS) and overall survival (OS) in our cohort. Median PFS was 7.2 months in the unmethylated group (UM, 20% mean methylation). Median OS was 13.4 months for UM, 17.9 months for LM and 29.93 months for HM. Within the LM group, correlation of PSQ and sqMSP or dBiSeq was only conclusive in 51.5% of our cases. ROC curve analysis revealed superior test precision for survival if additional sqMSP results were considered (AUC = 0.76) compared to PSQ (cutoff 10%) alone (AUC = 0.67). We therefore challenge the widely used, strict PSQ cutoff at 10% which might not fully reflect the clinical response to alkylating agents and suggest applying a second method for MGMT testing (e.g. MSP) to confirm PSQ results for patients with LM MGMT levels if therapeutically relevant

A Bioengineered Implant for a Predetermined Bone Cellular Response to Loading Forces. A Literature Review and Case Report

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142048/1/jper1276.pd

Successful Surgical Treatment of a Patient with a Solitary Asymptomatic Cardiac Metastasis from Breast Cancer, Identified by Elevated Tumor Markers and Circulating Tumor Cells

Indroduction: Cardiac metastases are a not infrequent autopsy finding in patients dying of metastatic cancer, but are less commonly diagnosed during life (1). Although the autopsy incidence of cardiac metastases ranges may be as high as 25%, solitary cardiac metastases in the absence of metastatic involvement of other organs are rare (2).Case Presentation: We report here the case of a 66-year old woman with a history of bilateral breast cancer, where a solitary metastasis in the right atrium was successfully resected.Conclusion: In the absence of any symptoms or clinical findings on physical examination, the presence of metastatic disease was first suggested by the detection of elevated tumor markers and circulating tumor cells during routine follow up after treatment for early stage breast cancer.

Significance of Keratinized Mucosa in Maintenance of Dental Implants With Different Surfaces

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142329/1/jper1410.pd

A review of implant provision for hypodontia patients within a Scottish referral centre

Background: Implant treatment to replace congenitally missing teeth often involves multidisciplinary input in a secondary care environment. High quality patient care requires an in-depth knowledge of treatment requirements. Aim: This service review aimed to determine treatment needs, efficiency of service and outcomes achieved in hypodontia patients. It also aimed to determine any specific difficulties encountered in service provision, and suggest methods to overcome these. Methods: Hypodontia patients in the Unit of Periodontics of the Scottish referral centre under consideration, who had implant placement and fixed restoration, or review completed over a 31 month period, were included. A standardised data collection form was developed and completed with reference to the patient's clinical record. Information was collected with regard to: the indication for implant treatment and its extent; the need for, complexity and duration of orthodontic treatment; the need for bone grafting and the techniques employed and indicators of implant success. Conclusion: Implant survival and success rates were high for those patients reviewed. Incidence of biological complications compared very favourably with the literature

Survival of dental implants in patients with oral cancer treated by surgery and radiotherapy: a retrospective study

BACKGROUND: The aim of this retrospective study was to evaluate the survival of dental implants placed after ablative surgery, in patients affected by oral cancer treated with or without radiotherapy. METHODS: We collected data for 34 subjects (22 females, 12 males; mean age: 51 ± 19) with malignant oral tumors who had been treated with ablative surgery and received dental implant rehabilitation between 2007 and 2012. Postoperative radiation therapy (less than 50 Gy) was delivered before implant placement in 12 patients. A total of 144 titanium implants were placed, at a minimum interval of 12 months, in irradiated and non-irradiated residual bone. RESULTS: Implant loss was dependent on the position and location of the implants (P = 0.05-0.1). Moreover, implant survival was dependent on whether the patient had received radiotherapy. This result was highly statistically significant (P < 0.01). Whether the implant was loaded is another highly significant (P < 0.01) factor determinin