Twin-S: A Digital Twin for Skull-base Surgery

Purpose: Digital twins are virtual interactive models of the real world, exhibiting identical behavior and properties. In surgical applications, computational analysis from digital twins can be used, for example, to enhance situational awareness. Methods: We present a digital twin framework for skull-base surgeries, named Twin-S, which can be integrated within various image-guided interventions seamlessly. Twin-S combines high-precision optical tracking and real-time simulation. We rely on rigorous calibration routines to ensure that the digital twin representation precisely mimics all real-world processes. Twin-S models and tracks the critical components of skull-base surgery, including the surgical tool, patient anatomy, and surgical camera. Significantly, Twin-S updates and reflects real-world drilling of the anatomical model in frame rate. Results: We extensively evaluate the accuracy of Twin-S, which achieves an average 1.39 mm error during the drilling process. We further illustrate how segmentation masks derived from the continuously updated digital twin can augment the surgical microscope view in a mixed reality setting, where bone requiring ablation is highlighted to provide surgeons additional situational awareness. Conclusion: We present Twin-S, a digital twin environment for skull-base surgery. Twin-S tracks and updates the virtual model in real-time given measurements from modern tracking technologies. Future research on complementing optical tracking with higher-precision vision-based approaches may further increase the accuracy of Twin-S

The Anterior Cingulate Cortex Predicts Future States to Mediate Model-Based Action Selection

Behavioral control is not unitary. It comprises parallel systems, model based and model free, that respectively generate flexible and habitual behaviors. Model-based decisions use predictions of the specific consequences of actions, but how these are implemented in the brain is poorly understood. We used calcium imaging and optogenetics in a sequential decision task for mice to show that the anterior cingulate cortex (ACC) predicts the state that actions will lead to, not simply whether they are good or bad, and monitors whether outcomes match these predictions. ACC represents the complete state space of the task, with reward signals that depend strongly on the state where reward is obtained but minimally on the preceding choice. Accordingly, ACC is necessary only for updating model-based strategies, not for basic reward-driven action reinforcement. These results reveal that ACC is a critical node in model-based control, with a specific role in predicting future states given chosen actions.Akam et al. investigate mouse anterior cingulate cortex (ACC) in a sequential decision-making task, finding that ACC predicts future states given chosen actions and indicates when these predictions are violated. Transiently inhibiting ACC prevents mice from using observed state transitions to guide subsequent choices, impairing model-based reinforcement learning

Characterizing Acupuncture Stimuli Using Brain Imaging with fMRI - A Systematic Review and Meta-Analysis of the Literature

Background The mechanisms of action underlying acupuncture, including acupuncture point specificity, are not well understood. In the previous decade, an increasing number of studies have applied fMRI to investigate brain response to acupuncture stimulation. Our aim was to provide a systematic overview of acupuncture fMRI research considering the following aspects: 1) differences between verum and sham acupuncture, 2) differences due to various methods of acupuncture manipulation, 3) differences between patients and healthy volunteers, 4) differences between different acupuncture points. Methodology/Principal Findings We systematically searched English, Chinese, Korean and Japanese databases for literature published from the earliest available up until September 2009, without any language restrictions. We included all studies using fMRI to investigate the effect of acupuncture on the human brain (at least one group that received needle-based acupuncture). 779 papers were identified, 149 met the inclusion criteria for the descriptive analysis, and 34 were eligible for the meta-analyses. From a descriptive perspective, multiple studies reported that acupuncture modulates activity within specific brain areas, including somatosensory cortices, limbic system, basal ganglia, brain stem, and cerebellum. Meta-analyses for verum acupuncture stimuli confirmed brain activity within many of the regions mentioned above. Differences between verum and sham acupuncture were noted in brain response in middle cingulate, while some heterogeneity was noted for other regions depending on how such meta-analyses were performed, such as sensorimotor cortices, limbic regions, and cerebellum. Conclusions Brain response to acupuncture stimuli encompasses a broad network of regions consistent with not just somatosensory, but also affective and cognitive processing. While the results were heterogeneous, from a descriptive perspective most studies suggest that acupuncture can modulate the activity within specific brain areas, and the evidence based on meta-analyses confirmed some of these results. More high quality studies with more transparent methodology are needed to improve the consistency amongst different studies

Fluid challenges in intensive care: the FENICE study A global inception cohort study

Fluid challenges (FCs) are one of the most commonly used therapies in critically ill patients and represent the cornerstone of hemodynamic management in intensive care units. There are clear benefits and harms from fluid therapy. Limited data on the indication, type, amount and rate of an FC in critically ill patients exist in the literature. The primary aim was to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid; the secondary aim was to evaluate variables used to trigger an FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC.This was an observational study conducted in ICUs around the world. Each participating unit entered a maximum of 20 patients with one FC.2213 patients were enrolled and analyzed in the study. The median [interquartile range] amount of fluid given during an FC was 500 ml (500-1000). The median time was 24 min (40-60 min), and the median rate of FC was 1000 [500-1333] ml/h. The main indication for FC was hypotension in 1211 (59 %, CI 57-61 %). In 43 % (CI 41-45 %) of the cases no hemodynamic variable was used. Static markers of preload were used in 785 of 2213 cases (36 %, CI 34-37 %). Dynamic indices of preload responsiveness were used in 483 of 2213 cases (22 %, CI 20-24 %). No safety variable for the FC was used in 72 % (CI 70-74 %) of the cases. There was no statistically significant difference in the proportion of patients who received further fluids after the FC between those with a positive, with an uncertain or with a negatively judged response.The current practice and evaluation of FC in critically ill patients are highly variable. Prediction of fluid responsiveness is not used routinely, safety limits are rarely used, and information from previous failed FCs is not always taken into account

Coal seam water infusion for dust control: a technical review

Coal mine dust continues to be a health and safety issue in underground coal mines. Coal seam water infusion was developed and widely applied in European coal mines for dust control, and was also a common practice in most Chinese coal mines. This method typically involves the infusion of water into the coal seam to increase its moisture content, and therefore reduce dust generation during mining operations. With the availability of other dust control methods such as water spraying systems, the water infusion method has not been considered as a viable means for dust mitigation in modern mines. However, the increase in production output and the deployment of more powerful equipment for coal cutting and transport and intensive gas drainage practices mean that workers could be exposed to more dust contaminations. Whilst the mine operators are committed to suppress and dilute airborne dust particles using these passive measures, there is a need to critically examine and subsequently develop this proactive dust control technology for practical applications in Chinese coal mines. The paper provides a critical review of the water infusion technologies in view of its technological advances and practical application limitations. The methods of water infusion, mechanism of water flow in coal, the role of surfactants and the key parameters influencing the effect of water infusion on dust control are identified and discussed. Existing problems and prospects for water infusion are analysed

Machine-learning-aided prediction of flexural strength and asr expansion for waste glass cementitious composite

Waste glass (WG) is unsustainable due to its nonbiodegradable property. However, its main ingredient is silicon dioxide, which can be utilised as a supplementary cementitious material. Before reusing WG, the flexural strength (FS) and alkali–silica reaction (ASR) expansion of WG concrete are two essential properties that must be investigated. This study produced mortar containing activated glass powder using mechanical, chemical, and mechanical–chemical (combined) approaches. The results showed that mortar containing 30% WG powder using the combined method was optimal for improving the FS and mitigating the ASR expansion. The microstructure analysis was implemented to explore the activation effect on the glass powder and mortar. Moreover, a random forest (RF) model was proposed with hyperparameters tuned by beetle antennae search (BAS), aiming at predicting FS and ASR expansion precisely. A large database was established from the experimental results based on 549 samples prepared for the FS test and 183 samples produced for the expansion test. The BAS-RF model presented high correlation coefficients for both FS (0.9545) and ASR (0.9416) data sets, showing much higher accuracy than multiple linear regression and logistic regression. Finally, a sensitivity analysis was conducted to rank the variables based on importance. Apart from the curing time, the particle granularity and content of WG were demonstrated to be the most sensitive variable for FS and expansion, respectively