Audit of the first > 7500 noninvasive prenatal aneuploidy tests in a Swiss genetics center

Objectives Noninvasive prenatal testing (NIPT) is actually the most accurate method of screening for fetal chromosomal aberration (FCA). We used pregnancy outcome record to evaluate a complete data set of single nucleotide polymorphism-based test results performed by a Swiss genetics center. Materials and methods The Panorama® test assesses the risk of fetal trisomies (21, 18 and 13), gonosomal aneuploidy (GAN), triploidy or vanishing twins (VTT) and five different microdeletions (MD). We evaluated all 7549 test results meeting legal and quality requirements taken in women with nondonor singleton pregnancies between April 2013 and September 2016 classifying them as high or low risk. Follow-up ended after 9 months, data collection 7 months later. Results The Panorama® test provided conclusive results in 96.1% of cases, detecting 153 FCA: T21 n = 76, T18 n = 19, T13 n = 15, GAN n = 19, VTT n = 13 and MD n = 11 (overall prevalence 2.0%). Pregnancy outcome record was available for 68.6% of conclusive laboratory results, including 2.0% high-risk cases. In this cohort the Panorama® test exhibited 99.90% sensitivity for each trisomy; specificity was 99.90% for T21, 99.98% for T18 and 99.94% for T13. False positive rate was 0.10% for T21, 0.02% for T18 and 0.06% for T13. Conclusion SNP-based testing by a Swiss genetics center confirms the expected accuracy of NIPT in FCA detection

Pelvic inflammatory disease

Die in der Regel klinisch diagnostizierte «pelvic inflammatory disease» umschreibt eine Entzündung des oberen weiblichen Genitaltrakts. Die Symptome sind unspezifisch, häufig nur diskret ausgebildet oder fehlen. Unverzügliche Therapieeinleitung und Prävention sexuell übertragbarer Krankheiten – etwa durch Einführung eines geeigneten Screenings – mindern das Langzeitrisiko der Sterilität, Extrauteringravidität und chronischer Bauchschmerzen

Inverse finite element characterization of the human myometrium derived from uniaxial compression experiments

The low strain-rate behavior of the human myometrium under compression was determined. To this end, uniaxial, unconstrained compression experiments were conducted on a total of 25 samples from three excised human uteri at strain rates between 0.001s-1 and 0.008s-1. A three-dimensional finite element model of each sample was created and used together with an optimization algorithm to find material parameters in an inverse estimation process. Friction and shape irregularities of samples were incorporated in the models. The uterine specimens in compression were modeled as viscoelastic, non-linear, nearly incompressible and isotropic continua. Simulations of uniaxial, frictionless compressions of an idealized cuboid were used to compare the resulting material parameters among each other. The intra- and inter-subject variability in stiffness of specimens was found to be large and to cover such a wide range that the effect of anisotropy which is of minor influence under compressive deformations in the first place could be neglected. Material parameters for a viscoelastic model based on a decoupled, reduced quadratic strain-energy function were presented for the uterine samples representing a median stiffnes

Establishing construct validity of a virtual-reality training simulator for hysteroscopy via a multimetric scoring system

Background: The aims of this study are to determine construct validity for the HystSim virtual-reality (VR) training simulator for hysteroscopy via a new multimetric scoring system (MMSS) and to explore learning curves for both novices and experienced surgeons. Methods: Fifteen relevant metrics had been identified for diagnostic hysteroscopy by means of hierarchical task decomposition. They were grouped into four modules (visualization, ergonomics, safety, and fluid handling) and individually weighted, building the MMSS for this study. In a first step, 24 novice medical students and 12 experienced gynecologists went through a self-paced teaching tutorial, in which all participants received clearly stated goals and instructions on how to carry out hysteroscopic procedures properly for this study. All subjects performed five repeated trials on two different exercises on HystSim (exploration and diagnosis exercises). After each trial the results were presented to the participants in the form of an automated objective feedback report (AOFR). Construct validity for the MMSS and learning curves were investigated by comparing the performance between novices and experienced surgeons and in between the repeated trials. To study the effect of repeated practice, 23 of the novices returned 2weeks later for a second training session. Results: Comparing novices with the experienced group, the ergonomics and fluid handling modules resulted in construct validity, while the visualization module did not, and for the safety module the experienced group even scored significantly lower than novices in both exercises. The overall score showed only construct validity when the safety module was excluded. Concerning learning curves, all subjects improved significantly during the training on HystSim, with clear indication that the second training session was beneficial for novice surgeons. Conclusions: Construct validity for HystSim has been established for different modules of VR metrics on a new MMSS developed for diagnostic hysteroscopy. Careful refinement and further testing of metrics and scores is required before using them as assessment tools for operative skill

Evaluation of a new virtual-reality training simulator for hysteroscopy

Background: To determine realism and training capacity of HystSim, a new virtual-reality simulator for the training of hysteroscopic interventions. Methods: Sixty-two gynaecological surgeons with various levels of expertise were interviewed at the 13th Practical Course in Gynaecologic Endoscopy in Davos, Switzerland. All participants received a 20-min hands-on training on the simulator and filled out a four-page questionnaire. Twenty-three questions with respect to the realism of the simulation and the training capacity were answered on a seven-point Likert scale along with 11 agree-disagree statements concerning the HystSim training in general. Results: Twenty-six participants had performed more than 50 hysteroscopies ("experts”) and 36 equal to or fewer than 50 ("novices”). Four of 60 (6.6%) responding participants judged the overall impression as "7 - absolutely realistic”, 40 (66.6%) as "6 - realistic”, and 16 (26.6%) as "5 - somewhat realistic”. Novices (6.48; 95% confidence interval [CI] 6.28-6.7) rated the overall training capacity significantly higher than experts (6.08; 95% CI 5.85-6.3), however, high-grade acceptance was found in both groups. In response to the statements, 95.2% believe that HystSim allows procedural training of diagnostic and therapeutic hysteroscopy, and 85.5% suggest that HystSim training should be offered to all novices before performing surgery on real patients. Conclusion: Face validity has been established for a new hysteroscopic surgery simulator. Potential trainees and trainers assess it to be a realistic and useful tool for the training of hysteroscopy. Further systematic validation studies are needed to clarify how this system can be optimally integrated into the gynaecological curriculu

Pressure-dependent hydrometra dimensions in hysteroscopy

Aim: To investigate the relation between intrauterine pressures and volumes for virtual-reality-based surgical training in hysteroscopy. Material and methods: Ten fresh extirpated uteri were insufflated by commercial hysteroscopy pump and imaged by computer tomography (CT) under intrauterine air pressure in distension-collapse cycles between 0, 20 (150mmHg), and 0kPa, performing a CT scan at every step at about 2.7kPa (20mmHg). Results: An initial threshold pressure to distend the cavity was avoided by introducing the insufflation tube up to the fundus. The filling and release phases of seven uteri that were completely distended showed the typical characteristics of a hysteresis curve which is expected from a viscoelastic, nonlinear, anisotropic soft tissue organ like the uterus. In three cases tightening the extirpated uterus especially at the lateral resection lines caused significant problems that inhibited registration of a complete distension-collapse cycle. Interpolated volumes for complete distended cavities and extrapolated for incomplete data sets, derived from the digitally reconstructed three-dimensional (3D) geometries, ranged from 0.6 to 11.4mL at 20kPa. These values highly correlate with the uterine volume (not insufflated) considering different biometric data of the uteri and patient data. Linear (R 2=0.66) and quadratic least-squares fits (R 2=0.74) were used to derive the formulas y=0.069x and y=0.00037x 2+0.036x, where x is the uterine volume in mL (not insufflated) and y is the cavity volume in mL at 20kPa intrauterine pressure. Conclusions: Our experimental hysteroscopical setup enabled us to reconstruct the changes in volumes of insufflated uteri under highly realistic conditions in 3D. The relation between intrauterine pressure and cavity volume in distension-collapse cycles describes a typical hysteresis curv

Correlation between Macular Neovascularization (MNV) Type and Druse Type in Neovascular Age-Related Macular Degeneration (AMD) Based on the CONAN Classification

To investigate associations and predictive factors between macular neovascularization (MNV) lesion variants and drusen types in patients with treatment-naïve neovascular age-related macular degeneration (AMD). Methods: Multimodal imaging was retrospectively reviewed for druse type (soft drusen, subretinal drusenoid deposits (SDDs) or mixed) and MNV type (MNV 1, MNV 2, MNV 1/2 or MNV 3). The Consensus on Neovascular AMD Nomenclature (CONAN) classification was used for characterizing MNV at baseline. Results: One eye of each eligible patient was included (n = 191). Patients with predominant SDDs had an increased adjusted odds ratio (aOR) for MNV 2 (23.4453, p = 0.0025) and any type of MNV 3 (8.7374, p < 0.0001). Patients with MNV 1/2 had an aOR for predominant SDDs (0.3284, p = 0.0084). Patients with MNV1 showed an aOR for SDDs (0.0357, p < 0.0001). Eyes with SDDs only without other drusen types showed an aOR for MNV 2 (9.2945, p < 0.0001). Conclusions: SDDs represent a common phenotypic characteristic in AMD eyes with treatment-naïve MNV. The aOR for eyes with predominant SDDs to develop MNV 2 and MNV 3 was much higher, possibly due to their location in the subretinal space. The predominant druse type may help to predict which type of MNV will develop during the course of AMD

Evaluation of a new virtual-reality training simulator for hysteroscopy

BACKGROUND: To determine realism and training capacity of HystSim, a new virtual-reality simulator for the training of hysteroscopic interventions. METHODS: Sixty-two gynaecological surgeons with various levels of expertise were interviewed at the 13(th) Practical Course in Gynaecologic Endoscopy in Davos, Switzerland. All participants received a 20-min hands-on training on the simulator and filled out a four-page questionnaire. Twenty-three questions with respect to the realism of the simulation and the training capacity were answered on a seven-point Likert scale along with 11 agree-disagree statements concerning the HystSim training in general. RESULTS: Twenty-six participants had performed more than 50 hysteroscopies ("experts") and 36 equal to or fewer than 50 ("novices"). Four of 60 (6.6%) responding participants judged the overall impression as "7 - absolutely realistic", 40 (66.6%) as "6 - realistic", and 16 (26.6%) as "5 - somewhat realistic". Novices (6.48; 95% confidence interval [CI] 6.28-6.7) rated the overall training capacity significantly higher than experts (6.08; 95% CI 5.85-6.3), however, high-grade acceptance was found in both groups. In response to the statements, 95.2% believe that HystSim allows procedural training of diagnostic and therapeutic hysteroscopy, and 85.5% suggest that HystSim training should be offered to all novices before performing surgery on real patients. CONCLUSION: Face validity has been established for a new hysteroscopic surgery simulator. Potential trainees and trainers assess it to be a realistic and useful tool for the training of hysteroscopy. Further systematic validation studies are needed to clarify how this system can be optimally integrated into the gynaecological curriculum

Antikonzeption – Wo der Ultraschall massgeblich unterstützt

The use of ultrasound is already routine in contraceptive procedures. One of the best examples is the transvaginal assessment of the IUD position. But ultrasound may improve safety and comfort to contraceptive procedures too, e. g. transabdominally guided IUD insertion may not only help avoiding perforation but also painful moments. In case of lost threads transabdominally guided IUD extraction might be completed successfully without any kind of anesthesia. Furthermore, a subcutaneous contraceptive implant, if not palpable, might be localized and extracted by transcutaneous ultrasound guidance during local anesthesia. Die Sonographie hat in der Unterstützung der Antikonzeption schon längst einen festen Platz eingenommen. Das wohl beste Beispiel dafür ist die Lagebeurteilung eines IUD mit der Transvaginalsonographie. Die Sonographie bringt heute aber weit mehr Komfort und Sicherheit in die Verhütung. So hilft z. B. eine transabdominalsonographisch geführte Spiralen-Einlage bei gut gefüllter Blase Perforationen zu vermeiden, aber auch der Patientin unnötige Schmerzen zu ersparen. Auch kann die IUD-Extraktion mit einer IUD-Fasszange bei nicht mehr sichtbaren Fäden durch die transabdominalsonographische Führung bis hoch ins Kavum ermöglicht werden. Weiter kann ein in die Subkutis eingebrachtes Verhütungsstäbchen, wenn es nicht mehr tastbar sein sollte, mittels Ultraschall meist exakt lokalisiert und auch dessen Extraktion in Lokalanästhesie sonographisch geleitet werden

Real-time Synthesis of Bleeding for Virtual

Abstract. Simulating bleeding in a virtual reality surgical simulator is an important task that still has not found a visually appealing solution. Bleeding in a simulator not only tests a surgeon to deal with critical issues, but also affects the environment by obscuring the view in which the surgeon has to operate. For any virtual reality surgical simulator, bleeding has to be treated, while at the same time the bleeding has to be responsive to any feedback that the surgeon may be conducing to the virtual reality environment. And all this has to be performed in real-time, i.e. at frame-rate. In this paper we present a methodology for solving this particular problem and show preliminary results of real-time visualization of bleeding in a dynamic virtual reality environment.