Actuation and Control of a Steerable Catheter for Mitral Valve Repair

In the field of Structural Heart Diseases, Mitral Regurgitation's incidence is rising because of an aging population worldwide, and it has reached an annual mortality rate near 34%. The procedures of Structural Intervention Cardiology have enlarged the number of treated patients, since their minimally invasive and trans-catheter approach. To provide a forward step-change in this procedure, the aim of this work is to improve the use of the commercially available MitraClip system®, suggesting an innovative robot-assisted platform with autonomous control for the aforementioned system. The presented methodology is constituted of two phases: in the first one, we design, in the Solidworks® environment, 3D print and integrate the mechanical support with electrical motors and micro-controller devoted to catheter's steering. In the second phase, we develop the closed-loop position control to improve the accuracy in the autonomous positioning of the catheter. The described approach was tested to demonstrate its feasibility and dexterity: a position accuracy of 1.1±0.54 mm in following a given optimal trajectory was obtained

Defining neurotrauma in administrative data using the International Classification of Diseases Tenth Revision

Abstract Background It is essential to use a definition that is precise and accurate for the surveillance of traumatic brain injuries (TBI) and spinal cord injuries (SCI). This paper reviews the International Classification of Diseases 10th revision (ICD-10) definitions used internationally to inform the definition for neurotrauma surveillance using administrative data in Ontario, Canada. Methods PubMed, Web of Science, Medline and the grey literature were searched for keywords "spinal cord injuries" or "brain injuries" and "international classification of diseases". All papers and reports that used an ICD-10 definition were included. To determine the ICD-10 codes for inclusion consensus across papers and additional evidence were sought to look at the correlation between the condition and brain or spinal injuries. Results Twenty-four articles and reports were identified; 15 unique definitions for TBI and 7 for SCI were found. The definitions recommended for use in Ontario by this paper are F07.2, S02.0, S02.1, S02.3, S02.7, S02.8, S02.9, S06, S07.1, T90.2, and T90.5 for traumatic brain injuries and S14.0, S14.1, S24.0, S24.1, S34.1, S34.0, S34.3, T06.0, T06.1 and T91.3 for spinal cord injuries. Conclusions Internationally, inconsistent definitions are used to define brain and spinal cord injuries. An abstraction study of data would be an asset in understanding the effects of inclusion and exclusion of codes in the definition. This paper offers a definition of neurotrauma for surveillance in Ontario, but the definition could be applied to other countries that have mandated administrative data collection

Fifth European Dirofilaria and Angiostrongylus Days (FiEDAD) 2016

Peer reviewe

Rare and low-frequency coding variants alter human adult height

Height is a highly heritable, classic polygenic trait with ~700 common associated variants identified so far through genome - wide association studies . Here , we report 83 height - associated coding variants with lower minor allele frequenc ies ( range of 0.1 - 4.8% ) and effects of up to 2 16 cm /allele ( e.g. in IHH , STC2 , AR and CRISPLD2 ) , >10 times the average effect of common variants . In functional follow - up studies, rare height - increasing alleles of STC2 (+1 - 2 cm/allele) compromise d proteolytic inhibition of PAPP - A and increased cleavage of IGFBP - 4 in vitro , resulting in higher bioavailability of insulin - like growth factors . The se 83 height - associated variants overlap genes mutated in monogenic growth disorders and highlight new biological candidates ( e.g. ADAMTS3, IL11RA, NOX4 ) and pathways ( e.g . proteoglycan/ glycosaminoglycan synthesis ) involved in growth . Our results demonstrate that sufficiently large sample sizes can uncover rare and low - frequency variants of moderate to large effect associated with polygenic human phenotypes , and that these variants implicate relevant genes and pathways

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Gaia Early Data Release 3: Structure and properties of the Magellanic Clouds

We compare the Gaia DR2 and Gaia EDR3 performances in the study of the Magellanic Clouds and show the clear improvements in precision and accuracy in the new release. We also show that the systematics still present in the data make the determination of the 3D geometry of the LMC a difficult endeavour; this is at the very limit of the usefulness of the Gaia EDR3 astrometry, but it may become feasible with the use of additional external data. We derive radial and tangential velocity maps and global profiles for the LMC for the several subsamples we defined. To our knowledge, this is the first time that the two planar components of the ordered and random motions are derived for multiple stellar evolutionary phases in a galactic disc outside the Milky Way, showing the differences between younger and older phases. We also analyse the spatial structure and motions in the central region, the bar, and the disc, providing new insights into features and kinematics. Finally, we show that the Gaia EDR3 data allows clearly resolving the Magellanic Bridge, and we trace the density and velocity flow of the stars from the SMC towards the LMC not only globally, but also separately for young and evolved populations. This allows us to confirm an evolved population in the Bridge that is slightly shift from the younger population. Additionally, we were able to study the outskirts of both Magellanic Clouds, in which we detected some well-known features and indications of new ones

Inverse Reinforcement Learning algorithm for intra-vascular and intra-cardiac catheter’s navigation in Minimally Invasive Surgery

Structural Intervention Cardiology (SIC) is a miniinvasive intervention with a catheter based approach for cardiac surgery. Although SIC procedures are becoming increasingly popular, procedures are not ergonomic and technically demanding and, at the same time, high precision and accuracy in reaching target locations inside the human body are necessary for the success these procedures. Thus, there is therefore a need to develop a robust path planner framework to improve the accuracy in target reaching while minimizing interaction with anatomical structures. In this work a pre-operative path-planning method able to guide the catheter from the peripheral access to the desired target position with the needed orientation is proposed. The method exploits an Inverse Reinforcement Learning algorithm based on a combination of Behavioral Cloning (BC) and Generative Adversarial Imitation Learning (GAIL). The method was in-silico tested performing 50 intra-vascular and 70 intra-cardiac paths where the ratio between attempts in which the catheter reaches the target and total number of attempts, computation time, the difference between desired pose and the reached one were considered as validation metrics. Results show that the proposed method computes optimal path enabling the catheter to reach the target with an average error in position below 2 mm in the intra-vascular phase and below 1 mm in position and 6° in orientation in the intra-cardiac phas

Cortical lesions at diagnosis predict long-term cognitive impairment in multiple sclerosis: a 20-year study

Background: Although cognitive impairment (CI) is frequent in multiple sclerosis (MS) patients, only few studies (and with conflicting results) evaluated early predictors of CI in the long-term. We aimed at determining associations between early clinical/neuroradiological variables with reference to CI after 20 years of MS. Methods: We investigated in 170 MS patients the relationship between clinical/MRI data at diagnosis and cognitive status after almost 20 years from MS onset. Among others, number/volume of both white matter lesions (WML) and cortical lesions (CL) were evaluated at diagnosis and after 2 years. All MS patients were followed over time and underwent a comprehensive neuropsychological assessment at the end of study. Advanced statistical methods (unsupervised cluster analysis and random forest model) were conducted. Results: CI patients showed at diagnosis higher focal cortical pathology compared to cognitively normal (p&lt;0.001). Volumes of both WML and CL emerged as the MRI metrics most associated with long-term CI. Moreover, CL number (especially ≥3) was also strongly associated with long-term CI (≥3 CL: OR=3.7, 95% CI 1.8-7.5; p&lt;0.001), more than WML number: the optimal cut-off of 3 CL (AUC=0.67, specificity=75%, sensitivity=55%) was estimated according to the risk of developing CI. Conclusions: These results highlighted the importance of considering both white and grey matter focal damage since early MS stages. Given the low predictive value of WM lesion number and the poor clinical applicability of lesion volume estimation in the daily clinical context, the evaluation of CL number could represent a reliable prognostic marker of CI