Usability assessment of an intraoperative planning software

Usability is a crucial aspect of medical device safety. The brand-new European Regulation requires the manufacturer to assess the usability of the new medical devices. In this study, we evaluate the usability of a new medical device intended to assist the intraoperative planning with the visualization of 3d patient-specific organ models. The usability study started from the early stage of the device design and iterated through an early formative, completed with desk-based activities, late formative, completed with a focus group, and summative phase, that comprised a user test, and questionnaire filling. The identified usability issues are mitigated, the safety of the device user interface is confirmed and the training contents are defined and confirmed. Additional information regarding the user experience is collected and analyzed to identify further improvements of the device

Molecular Characterization of Three Cultivars of Tomato (Lycopersicon Esculentum L.) in South-West Nigeria Using SSR Markers

Molecular characterisation of local tomato cultivars – Ibadan Local (IbL), Ife and JM94/46 (JM) were assessed using simple sequence repeat (SSR) markers. Out of ten SSR primer pairs used, three primer pairs were able to differentiate amplified genomic DNA of the cultivars. Unweighted Pair Group Method Using Arithmetic Average (UPGMA) cluster analysis of the data showed a close relationship between IbL and Ife with a genetic distance (GD) of 0.067; Ife and JM had GD of 0.2 and JM and Ife had GD of 0.25

Delamination technique together with longitudinal incisions for treatment of Chiari I/syringomyelia complex: a prospective clinical study

<p>Abstract</p> <p>Background</p> <p>Treatment modalities in Chiari malformation type 1(CMI) accompanied by syringomyelia have not yet been standardized. Pathologies such as a small posterior fossa and thickened dura mater have been discussed previously. Various techniques have been explored to enlarge the foramen magnum and to expand the dura. The aim of this clinical study was to explore a new technique of excision of the external dura accompanied by widening the cisterna magna and making longitudinal incisions in the internal dura, without disturbing the arachnoid.</p> <p>Methods</p> <p>Ten patients with CMI and syringomyelia, operated between 2004 and 2006, formed this prospective series. All cases underwent foramen magnum decompression of 3 × 3 cm area with C1–C2 (partial) laminectomy, resection of foramen magnum fibrous band, excision of external dura, delamination and widening of internal dura with longitudinal incisions.</p> <p>Results</p> <p>Patients were aged between 25 and 58 years and occipital headache was the most common complaint. The mean duration of preoperative symptoms was 4 years and the follow-up time was 25 months. Clinical progression was halted for all patients; eight patients completely recovered and two reported no change. In one patient, there was a transient cerebrospinal fluid (CSF) fistula that was treated with tissue adhesive. While syringomyelia persisted radiologically with radiological stability in five patients; for three patients the syringomyelic cavity decreased in size, and for the remaining two it regressed completely.</p> <p>Conclusion</p> <p>Removal of the fibrous band and the outer dural layer, at level of foramen magnum, together with the incision of inner dural layer appears to be good technique in adult CMI patients. The advantages are short operation time, no need for duraplasty, sufficient posterior fossa decompression, absence of CSF fistulas as a result of extra arachnoidal surgery, and short duration of hospitalization. Hence this surgical technique has advantages compared to other techniques.</p

Direction-dependent excitatory and inhibitory ocular vestibular-evoked myogenic potentials (oVEMPs) produced by oppositely directed accelerations along the midsagittal axis of the head

Oppositely directed displacements of the head need oppositely directed vestibulo-ocular reflexes (VOR), i.e. compensatory responses. Ocular vestibular-evoked myogenic potentials (oVEMPs) mainly reflect the synchronous extraocular muscle activity involved in the process of generating the VOR. The oVEMPs recorded beneath the eyes when looking up represent electro-myographic responses mainly of the inferior oblique muscle. We aimed: (1) to study the properties of these responses as they were produced by head acceleration impulses to the forehead and to the back of the head; (2) to investigate the relationships between these responses and the 3-D linear head accelerations that might reflect the true stimulus that acts on the vestibular hair cells. We produced backward- and forward-directed acceleration stimuli in four conditions (positive and negative head acceleration impulses to the hairline and to the inion) in 16 normal subjects. The oVEMPs produced by backward- and forward-directed accelerations of the head showed consistent differences. They were opposite in the phase. The responses produced by backward accelerations of the head began with an initial negativity, n11; conversely, those produced by accelerations directed forward showed initially a positive response, p11. There was a high inter-subject correlation of head accelerations along the head anteroposterior and transverse axes, but almost no correlation of accelerations along the vertical axis of the head. We concluded that backward-directed head accelerations produced an initial excitatory response, and forward-directed accelerations of the head were accompanied by an initial inhibitory response. These responses showed dependence on acceleration direction in the horizontal plane of the head. This could be consistent with activation of the utricle

Cervical intramedullary schwannoma: a case report and review of the literature

Intramedullary schwannomas unrelated with neurofibromatosis are uncommon tumors, but if correctly diagnosed and properly treated they may have a good prognosis

Increased pre-therapeutic serum vascular endothelial growth factor in patients with early clinical relapse of osteosarcoma

To investigate the clinical significance of circulating angiogenic factors, especially in association with early relapse of osteosarcoma, we quantified pre-therapeutic levels of vascular endothelial growth factor, basic fibroblast growth factor and placenta growth factor in the sera of 16 patients with osteosarcoma using an enzyme-linked immunosorbent assay. After a 1-year follow-up, the serum level of angiogenic factors was analysed with respect to microvessel density of the biopsy specimen and clinical disease relapse. The serum vascular endothelial growth factor levels were positively correlated with the microvessel density with statistical significance (P=0.004; Spearman rank correlation) and also significantly higher in seven patients who developed pulmonary metastasis than the remaining nine patients without detectable disease relapse (P=0.0009; The Mann–Whitney U-test). In contrast, the serum levels of basic fibroblast growth factor or placenta growth factor failed to show significant correlation with the microvessel density or relapse of the disease. Although there was no significant correlation between serum vascular endothelial growth factor levels and the tumour volume, the serum vascular endothelial growth factor levels were significantly higher in patients with a vascular endothelial growth factor-positive tumour than those with a vascular endothelial growth factor-negative tumour. These findings suggest that the pre-therapeutic serum vascular endothelial growth factor level reflects the angiogenic property of primary tumour and may have a predictive value on early disease relapse of osteosarcoma

Physical Habitat and Fish Assemblage Relationships with Landscape Variables at Multiple Spatial Scales in Wadeable Iowa Streams

Landscapes in Iowa and other midwestern states have been profoundly altered by conversion of native prairies to agriculture. We analyzed landscape data collected at multiple spatial scales to explore relationships with reach-scale physical habitat and fish assemblage data from 93 randomly selected sites on second- through fifth-order wadeable Iowa streams. Ordination of sites by physical habitat showed significant gradients of channel shape, habitat complexity, substrate composition, and stream size. Several landscape variables were significantly associated with the physical habitat ordination. Row crop land use was associated with fine substrates and steep bank angles, whereas wetland land cover and greater sinuosity and catchment land area were associated with complex channel and bank morphology and greater residual pool volume, woody debris, and canopy cover. Thirteen landscape variables were significant predictors of physical habitat variables in multiple linear regressions, with adjusted R 2 values ranging from 0.07 to 0.74. Inclusion of landscape variables with physical habitat variables in multiple regression models predicting fish assemblage metrics and a fish index of biotic integrity resulted in negligible improvements over models based on only physical habitat variables. Physical habitat in wadeable Iowa streams is strongly associated with landscape characteristics. Results of this study and previous studies suggest that (1) landscape factors directly influence physical habitat, (2) physical habitat directly influences fish assemblages, and (3) the influence of landscape factors on fish assemblages is primarily indirect. Understanding how landscape factors, such as human land use, influence physical habitat and fish assemblages will help managers make more informed decisions for improving Iowa\u27s wadeable streams

Comparison of anticoagulation quality between acenocoumarol and warfarin in patients with mechanical prosthetic heart valves: Insights from the nationwide PLECTRUM study

Vitamin K antagonists are indicated for the thromboprophylaxis in patients with mechanical prosthetic heart valves (MPHV). However, it is unclear whether some differences between acenocoumarol and warfarin in terms of anticoagulation quality do exist. We included 2111 MPHV patients included in the nationwide PLECTRUM registry. We evaluated anticoagulation quality by the time in therapeutic range (TiTR). Factors associated with acenocoumarol use and with low TiTR were investigated by multivariable logistic regression analysis. Mean age was 56.8 ± 12.3 years; 44.6% of patients were women and 395 patients were on acenocoumarol. A multivariable logistic regression analysis showed that patients on acenocoumarol had more comorbidities (i.e., ≥3, odds ratio (OR) 1.443, 95% confidence interval (CI) 1.081-1.927, p = 0.013). The mean TiTR was lower in the acenocoumarol than in the warfarin group (56.1 ± 19.2% vs. 61.6 ± 19.4%, p &lt; 0.001). A higher prevalence of TiTR (&lt;60%, &lt;65%, or &lt;70%) was found in acenocoumarol users than in warfarin ones (p &lt; 0.001 for all comparisons). Acenocoumarol use was associated with low TiTR regardless of the cutoff used at multivariable analysis. A lower TiTR on acenocoumarol was found in all subgroups of patients analyzed according to sex, hypertension, diabetes, age, valve site, atrial fibrillation, and INR range. In conclusion, anticoagulation quality was consistently lower in MPHV patients on acenocoumarol compared to those on warfarin