48 research outputs found

    Towards realistic laparoscopic image generation using image-domain translation

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    none5openMarzullo, Aldo; Moccia, Sara; Catellani, Michele; Calimeri, Francesco; Momi, Elena DeMarzullo, Aldo; Moccia, Sara; Catellani, Michele; Calimeri, Francesco; Momi, Elena D

    Using spatial-temporal ensembles of convolutional neural networks for lumen segmentation in ureteroscopy

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    Purpose: Ureteroscopy is an efficient endoscopic minimally invasive technique for the diagnosis and treatment of upper tract urothelial carcinoma (UTUC). During ureteroscopy, the automatic segmentation of the hollow lumen is of primary importance, since it indicates the path that the endoscope should follow. In order to obtain an accurate segmentation of the hollow lumen, this paper presents an automatic method based on Convolutional Neural Networks (CNNs). Methods: The proposed method is based on an ensemble of 4 parallel CNNs to simultaneously process single and multi-frame information. Of these, two architectures are taken as core-models, namely U-Net based in residual blocks(m1m_1) and Mask-RCNN(m2m_2), which are fed with single still-frames I(t)I(t). The other two models (M1M_1, M2M_2) are modifications of the former ones consisting on the addition of a stage which makes use of 3D Convolutions to process temporal information. M1M_1, M2M_2 are fed with triplets of frames (I(t‚ąí1)I(t-1), I(t)I(t), I(t+1)I(t+1)) to produce the segmentation for I(t)I(t). Results: The proposed method was evaluated using a custom dataset of 11 videos (2,673 frames) which were collected and manually annotated from 6 patients. We obtain a Dice similarity coefficient of 0.80, outperforming previous state-of-the-art methods. Conclusion: The obtained results show that spatial-temporal information can be effectively exploited by the ensemble model to improve hollow lumen segmentation in ureteroscopic images. The method is effective also in presence of poor visibility, occasional bleeding, or specular reflections

    Requirements elicitation for robotic and computer-assisted minimally invasive surgery

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    The robotic surgical systems and computer-assisted technologies market has seen impressive growth over the last decades, but uptake by end-users is still scarce. The purpose of this article is to provide a comprehensive and informed list of the end-user requirements for the development of new generation robot- and computer-assisted surgical systems and the methodology for eliciting them. The requirements were elicited, in the frame of the EU project SMARTsurg, by conducting interviews on use cases of chosen urology, cardiovascular and orthopaedics procedures, tailored to provide clinical foundations for scientific and technical developments. The structured interviews resulted in detailed requirement specifications which are ranked according to their priorities. Paradigmatic surgical scenarios support the use cases

    Three vs. Four Cycles of Neoadjuvant Chemotherapy for Localized Muscle Invasive Bladder Cancer Undergoing Radical Cystectomy: A Retrospective Multi-Institutional Analysis

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    Three or four cycles of cisplatin-based chemotherapy is the standard neoadjuvant treatment prior to cystectomy in patients with muscle-invasive bladder cancer. Although NCCN guidelines recommend 4 cycles of cisplatin-gemcitabine, three cycles are also commonly administered in clinical practice. In this multicenter retrospective study, we assessed a large and homogenous cohort of patients with urothelial bladder cancer (UBC) treated with three or four cycles of neoadjuvant cisplatin-gemcitabine followed by radical cystectomy, in order to explore whether three vs. four cycles were associated with different outcomes

    Changes in renal function after nephroureterectomy for upper urinary tract carcinoma: analysis of a large multicenter cohort (Radical Nephroureterectomy Outcomes (RaNeO) Research Consortium)

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    Purpose To investigate prevalence and predictors of renal function variation in a multicenter cohort treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods Patients from 17 tertiary centers were included. Renal function variation was evaluated at postoperative day (POD)-1, 6 and 12 months. Timepoints differences were Delta 1 = POD-1 eGFR - baseline eGFR; Delta 2 = 6 months eGFR - POD-1 eGFR; Delta 3 = 12 months eGFR - 6 months eGFR. We defined POD-1 acute kidney injury (AKI) as an increase in serum creatinine by >= 0.3 mg/dl or a 1.5 1.9-fold from baseline. Additionally, a cutoff of 60 ml/min in eGFR was considered to define renal function decline at 6 and 12 months. Logistic regression (LR) and linear mixed (LM) models were used to evaluate the association between clinical factors and eGFR decline and their interaction with follow-up. Results A total of 576 were included, of these 409(71.0%) and 403(70.0%) had an eGFR < 60 ml/min at 6 and 12 months, respectively, and 239(41.5%) developed POD-1 AKI. In multivariable LR analysis, age (Odds Ratio, OR 1.05, p < 0.001), male gender (OR 0.44, p = 0.003), POD-1 AKI (OR 2.88, p < 0.001) and preoperative eGFR < 60 ml/min (OR 7.58, p < 0.001) were predictors of renal function decline at 6 months. Age (OR 1.06, p < 0.001), coronary artery disease (OR 2.68, p = 0.007), POD-1 AKI (OR 1.83, p = 0.02), and preoperative eGFR < 60 ml/min (OR 7.80, p < 0.001) were predictors of renal function decline at 12 months. In LM models, age (p = 0.019), hydronephrosis (p < 0.001), POD-1 AKI (p < 0.001) and pT-stage (p = 0.001) influenced renal function variation (ss 9.2 +/- 0.7, p < 0.001) during follow-up. Conclusion Age, preoperative eGFR and POD-1 AKI are independent predictors of 6 and 12 months renal function decline after RNU for UTUC

    Attraversamenti ebraici. Progetto per il Museo Ebraico Didattico. Milano, 1999-2000

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    Il progetto si fonda sulla ricerca di un principio relazionale capace di generare la forma dello spazio espositivo, ovvero un attraversamento didattico, concettuale e spaziale dell\u2019ebraismo e della storia degli ebrei italiani. Ai valori della Diaspora corrisponde la metafora di un\u2019architettura d\u2019interni trasformabile, intesa come \u201csensore di spazi\u201d, luogo che attiva nei visitatori un\u2019esperienza cognitiva attraverso il confronto con la vita ebraica, i suoi riti, usi e costumi, mediante un racconto che utilizza simultaneamente l\u2019apparato documentario e la complessa multiformit\ue0 della cultura materiale espressa dagli oggetti esposti. Cos\uec, l\u2019excursus storico della sezione introduttiva trasmette lo spessore della dimensione memoriale dell\u2019attraversamento ebraico della storia, rendendo anche intelligibile l\u2019unicit\ue0 problematica della Shoah; mentre gli oggetti esposti ricostituiscono il senso di ritualit\ue0 che caratterizza l\u2019ebraismo, come specifica forma e modalit\ue0 di vita comunitaria. L\u2019assunto relazionale interpretato con la metafora dell\u2019attraversamento corrisponde ad un principio progettuale che rigenera lo spazio, modificandone la forma in funzione dell\u2019uso: museo didattico, estensione dell\u2019adiacente sinagoga, sala per conferenze e dibattiti, ma anche luogo di studio e ricerca, oltre che ambiente in grado di accogliere esposizioni e installazioni temporanee

    Museo Ebraico Didattico, Milano

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    Il progetto elaborato nel contesto di un concorso a inviti in due fasi promosso dalla Comunit\ue0 Ebraica di Milano, ha per oggetto la formazione di un Museo Ebraico didattico trasformabile in sala polivalente, collocato nello spazio esistente al di sotto della Sinagoga Centrale di Milano. Esso si fonda sulla ricerca di un principio relazionale capace di generare la forma dello spazio espositivo, ovvero un attraversamento didattico, concettuale e spaziale dell'Ebraismo e della storia degli ebrei italiani. Ai valori della Diaspora corrisponde la metafora di un'architettura d'interni trasformabile, intesa come "sensore di spazi", luogo che attiva nei visitatori un'esperienza cognitiva attraverso il confronto con la vita ebraica, i suoi riti, usi e costumi, mediante un racconto che utilizza simultaneamente l'apparato documentario e la complessa multiformit\ue0 della cultura materiale espressa dagli oggetti esposti

    Automating Endoscope Motion in Robotic Surgery: A Usability Study on da Vinci-Assisted Ex Vivo Neobladder Reconstruction

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    Robots for minimally invasive surgery introduce many advantages, but still require the surgeon to alternatively control the surgical instruments and the endoscope. This work aims at providing autonomous navigation of the endoscope during a surgical procedure. The autonomous endoscope motion was based on kinematic tracking of the surgical instruments and integrated with the da Vinci Research Kit. A preclinical usability study was conducted by 10 urologists. They carried out an ex vivo orthotopic neobladder reconstruction twice, using both traditional and autonomous endoscope control. The usability of the system was tested by asking participants to fill standard system usability scales. Moreover, the effectiveness of the method was assessed by analyzing the total procedure time and the time spent with the instruments out of the field of view. The average system usability score overcame the threshold usually identified as the limit to assess good usability (average score = 73.25 &gt; 68). The average total procedure time with the autonomous endoscope navigation was comparable with the classic control (p = 0.85 &gt; 0.05), yet it significantly reduced the time out of the field of view (p = 0.022 &lt; 0.05). Based on our findings, the autonomous endoscope improves the usability of the surgical system, and it has the potential to be an additional and customizable tool for the surgeon that can always take control of the endoscope or leave it to move autonomously

    Residue study of ivermectin in plasma, milk, and mozzarella cheese following subcutaneous administration to buffalo (Bubalus bubalis)

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    The distribution of ivermectin in buffalo plasma and milk after administration of a single subcutaneous dose (0.2 mg kg(-)(1) b.w.) was studied. Ivermectin reached the maximal concentration in plasma (28.5 +/- 1.7 ng mL(-)(1)) and milk (23.6 +/- 2.6 ng mL(-)(1)) after 2.4 +/- 0.32 and 2.8 +/- 0.44 days, respectively. The drug showed a parallel disposition in milk and plasma, with a ratio of 1.12 +/- 0.16. Ivermectin concentrations were detected in mozzarella cheese obtained from milk collected on days 1, 3, 4, and 20 following administration. The highest values (81.4 +/- 3.26 ng g(-)(1)) were found in the cheese produced on day 3 and were 4-fold higher than those present in the milk.[...
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