Soft liver phantom with a hollow biliary system

Einleitung: Die flexible Endoskopie bietet eine ständig wachsende Zahl innovativer diagnostischer und therapeutischer Möglichkeiten bei hepatobiliären Erkrankungen. Diese fortschrittlichen Verfahren, die mitunter komplex und gar nicht so selten mit relevanten Komplikationen verbunden sind, erfordern spezielle technische Fertigkeiten, ein profundes anatomisches Wissen und eine lange Lernkurve, die praktisch trainiert werden muss. Für ein patientenunabhängiges Training endoskopischer und endosonographischer Eingriffe sollte ein weiches, naturgetreues und langlebiges Leberorganmodell mit detaillierter Morphologie zur Verfügung stehen. In dieser Arbeit wird ein praktikables und kostengünstiges selbst hergestelltes weiches Lebermodell mit anatomisch korrektem Gallensystem vorgestellt. Methode: Mit Hilfe von 3D-Druck- und Weichstoffformungstechnologien wurde ein nahezu realistisches Lebermodell mit einem komplexen, hohlen Gallensystem hergestellt. Die Anatomie des Lebermodells wurde mittels Computertomographie (CT), Ultraschall und Endoskopie validiert. Nach Aufbereitung und Auswertung der Bildgebung wurden interventionelle transhepatische Eingriffe eingeleitet. Zur Validierung der Trainingseffekte und der individuellen Kompetenz wurde ein genaues Bewertungssystem für den transhepatischen Zugang etabliert. Ergebnisse: Ein realistisches Lebermodell wurde erfolgreich entwickelt und hergestellt. Die CT-Ergebnisse zeigen, dass das Lebermodell die detaillierte Anatomie wiedergibt, mit einem räumlichen Root Mean Square Error (RMSE) von 0,9 ± 0,2 mm und 1,7 ± 0,7 mm für die äußere Form bzw. den Gallengang. Das endosonographische Bild des Modells ist realistisch und die Dimension der Gallengänge ist konsistent. Die transhepatische Punktion der Gallengänge war durchführbar und ein elektronisches Abtastsystem zur quantitativen Lokalisierung der transhepatischen Nadel in Echtzeit war erfolgreich möglich. Schlussfolgerung: Das vorgestellte künstliche Lebermodell für das endoskopische und endosonografische Training kommt der Realität einer normalen Leber sehr nahe, ist kostengünstig, einfach zu reproduzieren und für die Serienproduktion geeignet. Mit dem elektronischen Sensormodul lässt sich der Trainingserfolg objektiv kontrollieren. Neben der transhepatischen Punktion könnten an diesem Modell weitere Eingriffe trainiert werden, wie z. B. endoskpischen retrograden Cholangiopankreatographie (ERCP), perkutane transhepatische Cholangiographie oder choliangiographische Drainage (PTC/PTCD), perkutane holedochofiberoskopie (POC), endoskopische ultraschallgeführte biliäre Drainage (EUS-BD)

Proceedings of IC-NIDC2010

Abstract In Web 2.0 applications, users always label digital images using textual descriptions, which are also called tags. As a result, a web image usually carries both tag and visual content information. In order to improve the retrieval performance of web images, in this paper, we propose an error-driven fusion co-clustering algorithm, which combines images' tags, visual contents together for analysis. Experimental results demonstrate that our algorithm outperforms other simple clustering methods

Impact of Salvage Surgery following Colonic Endoscopic Polypectomy for Patients with Invasive Neoplasia

Background: Invasive neoplasia (Tis-T1) are increasingly being encountered in the daily routine of endoscopic polypectomy. However, the need for salvage surgery following endoscopic therapy for invasive neoplasia is controversially discussed. Patients and Methods: Patients with endoscopic removal of invasive neoplasia were identified from the national Surveillance Epidemiology and End Results (SEER) Database 2005 to 2015. Survival analysis and Cox proportional hazard regression analysis in cancer-specific mortality and overall survival rate was used, which were stratified by T stage and polyp size. Results: A total of 5805 patients with endoscopic removal of invasive neoplasia were included in the analysis, of whom 1214 (20.9%) underwent endoscopic treatment alone and 4591 (79.1%) underwent endoscopic resection plus surgery. The survival analysis revealed that patients undergoing salvage surgery had a significantly better cancer-specific survival (97.4% vs. 95.8%, p-value = 0.017). In patients with T1 stage, additional salvage surgery led to a significantly higher cancer-specific survival (92.1% vs. 95.0%, p value = 0.047). Conclusion: Salvage surgery following endoscopic polypectomy may improve the oncological survival of patients with invasive neoplasia, especially in patients with T1 stage. Furthermore, the T stage, size, and localization of polyps, as well as the level of CEA, could be identified as significant predictors for lymphonodal and distant metastases

A High-Fidelity Artificial Urological System for the Quantitative Assessment of Endoscopic Skills

Minimally-invasive surgery is rapidly growing and has become a standard approach for many operations. However, it requires intensive practice to achieve competency. The current training often relies on animal organ models or physical organ phantoms, which do not offer realistic surgical scenes or useful real-time feedback for surgeons to improve their skills. Furthermore, the objective quantitative assessment of endoscopic skills is also lacking. Here, we report a high-fidelity artificial urological system that allows realistic simulation of endourological procedures and offers a quantitative assessment of the surgical performance. The physical organ model was fabricated by 3D printing and two-step polymer molding with the use of human CT data. The system resembles the human upper urinary tract with a high-resolution anatomical shape and vascular patterns. During surgical simulation, endoscopic videos are acquired and analyzed to quantitatively evaluate performance skills by a customized computer algorithm. Experimental results show significant differences in the performance between professional surgeons and trainees. The surgical simulator offers a unique chance to train endourological procedures in a realistic and safe environment, and it may also lead to a quantitative standard to evaluate endoscopic skills

Sinomenine Suppresses Osteoclast Formation and <i>Mycobacterium tuberculosis</i> H37Ra-Induced Bone Loss by Modulating RANKL Signaling Pathways

<div><p>Receptor activator of NF-κB ligand (RANKL) is essential for osteoclastogenesis. Targeting RANKL signaling pathways has been an encouraging strategy for treating lytic bone diseases such as osteoporosis and rheumatoid arthritis (RA). Sinomenine (SIN), derived from Chinese medicinal plant <i>Sinomenioum</i><i>acutum</i>, is an active compound to treat RA, but its effect on osteoclasts has been hitherto unknown. In the present study, SIN was found to ameliorate <i>M. tuberculosis</i> H37Ra (Mt)-induced bone loss in rats with a decreased serum level of TRACP5b and RANKL, and an increased level of osteoprotegerin (OPG). <i>In vitro</i> study also showed that SIN could inhibit RANKL-induced osteoclast formation and bone resorption. The osteoclastic specific marker genes induced by RANKL including c-Src, MMP-9, TRACP were inhibited by SIN in a dose dependent manner. Signal transduction studies showed that SIN could obviously reduce the expression of RANK adaptor molecule TRAF6 and down-regulate RANKL-induced NF-κB activation. It decreased the RANKL-induced p38, JNK posphorylation but not ERK1/2 posphorylation. SIN could also reduce RANKL-mediated calcium influx which is associated with TRAF6/c-Src complex. Finally, SIN suppressed RANKL induced AP-1 and NFAT transcription, as well as the gene expression of NFATc1 and AP-1 components (Fra-1, Fra-2, c-Fos). The protein expression of c-Fos and TRAF6 were also inhibited by SIN after RANKL stimulation. Taken together, SIN could attenuate osteoclast formation and Mt-induced bone loss by mediating RANKL signaling pathways.</p> </div