Patient-specific polyvinyl alcohol phantom fabrication with ultrasound and x-ray contrast for brain tumor surgery planning

Phantoms are essential tools for clinical training, surgical planning and the development of novel medical devices. However, it is challenging to create anatomically accurate head phantoms with realistic brain imaging properties because standard fabrication methods are not optimized to replicate any patient-specific anatomical detail and 3D printing materials are not optimized for imaging properties. In order to test and validate a novel navigation system for use during brain tumor surgery, an anatomically accurate phantom with realistic imaging and mechanical properties was required. Therefore, a phantom was developed using real patient data as input and 3D printing of molds to fabricate a patient-specific head phantom comprising the skull, brain and tumor with both ultrasound and X-ray contrast. The phantom also had mechanical properties that allowed the phantom tissue to be manipulated in a similar manner to how human brain tissue is handled during surgery. The phantom was successfully tested during a surgical simulation in a virtual operating room. The phantom fabrication method uses commercially available materials and is easy to reproduce. The 3D printing files can be readily shared, and the technique can be adapted to encompass many different types of tumor

Integrated multi-modality image-guided navigation for neurosurgery: open-source software platform using state-of-the-art clinical hardware.

PURPOSE: Image-guided surgery (IGS) is an integral part of modern neuro-oncology surgery. Navigated ultrasound provides the surgeon with reconstructed views of ultrasound data, but no commercial system presently permits its integration with other essential non-imaging-based intraoperative monitoring modalities such as intraoperative neuromonitoring. Such a system would be particularly useful in skull base neurosurgery. METHODS: We established functional and technical requirements of an integrated multi-modality IGS system tailored for skull base surgery with the ability to incorporate: (1) preoperative MRI data and associated 3D volume reconstructions, (2) real-time intraoperative neurophysiological data and (3) live reconstructed 3D ultrasound. We created an open-source software platform to integrate with readily available commercial hardware. We tested the accuracy of the system's ultrasound navigation and reconstruction using a polyvinyl alcohol phantom model and simulated the use of the complete navigation system in a clinical operating room using a patient-specific phantom model. RESULTS: Experimental validation of the system's navigated ultrasound component demonstrated accuracy of [Formula: see text] and a frame rate of 25 frames per second. Clinical simulation confirmed that system assembly was straightforward, could be achieved in a clinically acceptable time of [Formula: see text] and performed with a clinically acceptable level of accuracy. CONCLUSION: We present an integrated open-source research platform for multi-modality IGS. The present prototype system was tailored for neurosurgery and met all minimum design requirements focused on skull base surgery. Future work aims to optimise the system further by addressing the remaining target requirements

Protocol and statistical analysis plan for the mega randomised registry trial comparing conservative vs. liberal oxygenation targets in adults with nonhypoxic ischaemic acute brain injuries and conditions in the intensive care unit (Mega-ROX Brains)

Background: The effect of conservative vs. liberal oxygen therapy on 90-day in-hospital mortality in adults who have nonhypoxic ischaemic encephalopathy acute brain injuries and conditions and are receiving invasive mechanical ventilation in the intensive care unit (ICU) is uncertain. Objective: The objective of this study was to summarise the protocol and statistical analysis plan for the Mega-ROX Brains trial. Design, setting, and participants: Mega-ROX Brains is an international randomised clinical trial, which will be conducted within an overarching 40,000-participant, registry-embedded clinical trial comparing conservative and liberal ICU oxygen therapy regimens. We expect to enrol between 7500 and 9500 participants with nonhypoxic ischaemic encephalopathy acute brain injuries and conditions who are receiving unplanned invasive mechanical ventilation in the ICU. Main outcome measures: The primary outcome is in-hospital all-cause mortality up to 90 d from the date of randomisation. Secondary outcomes include duration of survival, duration of mechanical ventilation, ICU length of stay, hospital length of stay, and the proportion of participants discharged home. Results and conclusions: Mega-ROX Brains will compare the effect of conservative vs. liberal oxygen therapy regimens on 90-day in-hospital mortality in adults in the ICU with acute brain injuries and conditions. The protocol and planned analyses are reported here to mitigate analysis bias. Trial Registration: Australian and New Zealand Clinical Trials Registry (ACTRN 12620000391976)

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

The effects of cow genetic group on the density of raw whole milk

peer reviewedThe density of milk is dependent upon various factors including temperature, processing conditions, and animal breed. This study evaluated the effect of different cow genetic groups, Jersey, elite Holstein Friesians (EHF), and national average Holstein Friesians (NAHF) on the compositional and physicochemical properties of milk. Approximately 1,040 representative (morning and evening) milk samples (~115 per month during 9 mo) were collected once every 2 wk. Milk composition was determined with a Bentley Dairyspec instrument. Data were analysed with a mixed linear model that included the fixed effects of sampling month, genetic group, interaction between month and genetic group and the random effects of cow to account for repeated measures on the same animal. Milk density was determined using three different analytical approaches – a portable and a standard desktop density meter and 100 cm3 calibrated glass pycnometers. Milk density was analysed with the same mixed model as for milk composition but including the analytical method as a fixed effect. Jersey cows had the greatest mean for fat content (5.69 ± 0.13%), followed by EHF (4.81 ± 0.16%) and NAHF (4.30 ± 0.15%). Milk density was significantly higher (1.0313 g/cm³ ± 0.00026, P < 0.05) for the milk of Jersey breed when compared to the EHF (1.0304 ± 0.00026 g/cm³) and NAHF (1.0303 ± 0.00024 g/cm³) genetic groups. The results from this study can be used by farmers and dairy processors alike to enhance accuracy when calculating the quantity and value of milk solids depending upon the genetic merit of the animal/herd, and may also improve milk payment systems through relating milk solids content and density