SurReal: enhancing Surgical simulation Realism using style transfer

Surgical simulation is an increasingly important element of surgical education. Using simulation can be a means to address some of the significant challenges in developing surgical skills with limited time and resources. The photo-realistic fidelity of simulations is a key feature that can improve the experience and transfer ratio of trainees. In this paper, we demonstrate how we can enhance the visual fidelity of existing surgical simulation by performing style transfer of multi-class labels from real surgical video onto synthetic content. We demonstrate our approach on simulations of cataract surgery using real data labels from an existing public dataset. Our results highlight the feasibility of the approach and also the powerful possibility to extend this technique to incorporate additional temporal constraints and to different applications

Affordable Mobile-based Simulator for Robotic Surgery

Robotic surgery and novel surgical instrumentation present great potentials towards safer, more accurate and consistent minimally invasive surgery. However, their adoption is dependent to the access to training facilities and extensive surgical training. Robotic instruments require different dexterity skills compared to open or laparoscopic. Surgeons, therefore, are required to invest significant time by attending extensive training programs. Contrary, hands on experiences represent an additional operational cost for hospitals as the availability of robotic systems for training purposes is limited. All these technological and financial barriers for surgeons and hospitals hinder the adoption of robotic surgery. In this paper, we present a mobile dexterity training kit to develop basic surgical techniques within an affordable setting. The system could be used to train basic surgical gestures and to develop the motor skills needed for manoeuvring robotic instruments. Our work presents the architecture and components needed to create a simulated environment for training sub-tasks as well as a design for portable mobile manipulators that can be used as master controllers of different instruments. A preliminary study results demonstrate usability and skills development with this system.Comment: Hamlyn Symposium on Medical Robotics 201

DeepPhase: Surgical Phase Recognition in CATARACTS Videos

Automated surgical workflow analysis and understanding can assist surgeons to standardize procedures and enhance post-surgical assessment and indexing, as well as, interventional monitoring. Computer-assisted interventional (CAI) systems based on video can perform workflow estimation through surgical instruments' recognition while linking them to an ontology of procedural phases. In this work, we adopt a deep learning paradigm to detect surgical instruments in cataract surgery videos which in turn feed a surgical phase inference recurrent network that encodes temporal aspects of phase steps within the phase classification. Our models present comparable to state-of-the-art results for surgical tool detection and phase recognition with accuracies of 99 and 78% respectively.Comment: 8 pages, 3 figures, 1 table, MICCAI 201

Immunohistochemical study of the phenotypic change of the mesenchymal cells during portal tract maturation in normal and fibrous (ductal plate malformation) fetal liver

International audienceBACKGROUND: In adult liver, the mesenchymal cells, portal fibroblasts and vascular smooth muscle cells can transdifferentiate into myofibroblasts, and are involved in portal fibrosis. Differential expression of markers, such as alpha-smooth muscle actin (ASMA), h-caldesmon and cellular retinol-binding protein-1 allows their phenotypic discrimination. The aim of our study was to explore the phenotypic evolution of the mesenchymal cells during fetal development in normal liver and in liver with portal fibrosis secondary to ductal plate malformation in a series of Meckel-Gruber syndrome, autosomal recessive polycystic kidney disease and Ivemark's syndrome. RESULTS: At the early steps of the portal tract maturation, portal mesenchymal cells expressed only ASMA. During the maturation process, these cells were found condensed around the biliary and vascular structures. At the end of maturation process, only cells around vessels expressed ASMA and cells of the artery tunica media also expressed h-caldesmon. In contrast, ASMA positive cells persisted around the abnormal biliary ducts in fibrous livers. CONCLUSION: As in adult liver, there is a phenotypic heterogeneity of the mesenchymal cells during fetal liver development. During portal tract maturation, myofibroblastic cells disappear in normal development but persist in fibrosis following ductal plate malformation

Evolution of Polyphenols during Syrah Grapes Maceration: Time versus Temperature Effect

The effect of maceration time and temperature on the phenolic compounds of Syrah grape musts was studied. Pre-fermentation cold (10 °C) and heat maceration (60, 70 and 80 °C) were applied and compared to traditional maceration (control, 25 °C). The macerations were monitored and the kinetic profile of the maceration was studied by taking samples at 0, 2, 4, 8, 24 and 48 h. The results showed that heat treatment had the most significant effect on the extraction of total polyphenol. A significant loss of anthocyanin content was observed when the maceration was extended beyond eight hours at high temperatures, while longer maceration times seemed to favor the extraction of tannins. A principal component analysis showed that independently of the vinification technique, and for the same grape varieties, different winegrowing regions and harvest years affected the phenolic composition of the grape ski

Processamento auditivo em crianças e adolescentes em situação de risco e vulnerabilidade

CONTEXT AND OBJECTIVE: Children and adolescents who live in situations of social vulnerability present a series of health problems. Nonetheless, affirmations that sensory and cognitive abnormalities are present are a matter of controversy. The aim of this study was to investigate aspects to auditory processing, through applying the brainstem auditory evoked potential (BAEP) and behavioral auditory processing tests to children living on the streets, and comparison with a control group. DESIGN AND SETTING: Cross-sectional study in the Laboratory of Auditory Processing, School of Medicine, Universidade de São Paulo. METHODS: The auditory processing tests were applied to a group of 27 individuals, subdivided into 11 children (7 to 10 years old) and 16 adolescents (11 to 16 years old), of both sexes, in situations of social vulnerability, compared with an age-matched control group of 10 children and 11 adolescents without complaints. The BAEP test was also applied to investigate the integrity of the auditory pathway. RESULTS: For both children and adolescents, there were significant differences between the study and control groups in most of the tests applied, with significantly worse performance in the study group, except in the pediatric speech intelligibility test. Only one child had an abnormal result in the BAEP test. CONCLUSIONS: The results showed that the study group (children and adolescents) presented poor performance in the behavioral auditory processing tests, despite their unaltered auditory brainstem pathways, as shown by their normal results in the BAEP test

Analysis of the impact of fining agents types, oenological tannins and mannoproteins and their concentrations on the phenolic composition of red wine

This paper aimed to evaluate and analyze the effect of five fining agents, commercial tannins and mannoproteins on the pigment, color and tannins composition of a Cabernet Sauvignon red wine. The wines were analyzed 2 d after treatment and immediately after separation of sedimentation. Color was evaluated by spectrophotometry and polyphenols were analyzed by spectrophotometry and HPLC-DAD. The results showed that all treatments affected the phenolic contents of the wine. The most remarkable effects on phenolic composition were produced by bentonite and Polyvinylpolypyrrolidone (PvPP) + potassium caseinate which significantly decreased anthocyanins and tannins concentrations, respectively. The use of vegetable protein and gelatin has a less impact on the color and phenolic contents of red wines. The antioxidant activity was little affected by treatments except the addition of tannins that increased it. Principal components analysis demonstrates the importance of a low concentration of agents for high total polyphenol levels

Reconstructing fluvial incision rates based upon palaeo‐water tables in Chalk karst networks along the Seine valley (Normandy, France)

Quantifying rates of river incision and continental uplift over Quaternary timescales offer the potential for modelling landscape change due to tectonic and climatic forcing. In many areas, river terraces form datable archives that help constrain the timing and rate of valley incision. However, old river terraces, with high‐level deposits, are prone to weathering and often lack datable material. Where valleys are incised through karst areas, caves and sediments can be used to reconstruct the landscape evolution because they can record the elevation of palaeo‐water tables and contain preserved datable material. In Normandy (N. France), the Seine River is entrenched into an extensive karstic chalk plateau. Previous estimates of valley incision were hampered by the lack of preserved datable fluvial terraces. A stack of abandoned phreatic cave passages preserved in the sides of the Seine valley can be used to reconstruct the landscape evolution of the region. Combining geomorphological observations, palaeomagnetic and U/Th dating of speleothem and sediments in eight caves along the Lower Seine valley, we have constructed a new age model for cave development and valley incision. Six identified cave levels up to ∼100 m a.s.l. were formed during the last ~1 Ma, coeval with the incision of the Seine River. Passage morphologies indicate that the caves formed in a shallow phreatic/epiphreatic setting, modified by sediment influxes. The valley's maximum age is constrained by the occurrence of late Pliocene marine sand. Palaeomagnetic dating of cave infills indicates that the highest‐level caves were being infilled prior to 1.1 Ma. The evidence from the studied caves, complemented by fluvial terrace sequences, indicates that rapid river incision occurred during marine isotope stage (MIS) 28 to 20 (0.8–1 Ma), with maximal rates of ~0.30 m ka−1, dropping to ~0.08 m ka−1 between MIS 20–11 (0.8–0.4 Ma) and 0.05 m ka−1 from MIS 5 to the present time

The pandemic toll and post-acute sequelae of SARS-CoV-2 in healthcare workers at a Swiss University Hospital.

Healthcare workers have potentially been among the most exposed to SARS-CoV-2 infection as well as the deleterious toll of the pandemic. This study has the objective to differentiate the pandemic toll from post-acute sequelae of SARS-CoV-2 infection in healthcare workers compared to the general population. The study was conducted between April and July 2021 at the Geneva University Hospitals, Switzerland. Eligible participants were all tested staff, and outpatient individuals tested for SARS-CoV-2 at the same hospital. The primary outcome was the prevalence of symptoms in healthcare workers compared to the general population, with measures of COVID-related symptoms and functional impairment, using prevalence estimates and multivariable logistic regression models. Healthcare workers (n=3,083) suffered mostly from fatigue (25.5%), headache (10.0%), difficulty concentrating (7.9%), exhaustion/burnout (7.1%), insomnia (6.2%), myalgia (6.7%) and arthralgia (6.3%). Regardless of SARS-CoV-2 infection, all symptoms were significantly higher in healthcare workers than the general population (n=3,556). SARS-CoV-2 infection in healthcare workers was associated with loss or change in smell, loss or change in taste, palpitations, dyspnea, difficulty concentrating, fatigue, and headache. Functional impairment was more significant in healthcare workers compared to the general population (aOR 2.28; 1.76-2.96), with a positive association with SARS-CoV-2 infection (aOR 3.81; 2.59-5.60). Symptoms and functional impairment in healthcare workers were increased compared to the general population, and potentially related to the pandemic toll as well as post-acute sequelae of SARS-CoV-2 infection. These findings are of concern, considering the essential role of healthcare workers in caring for all patients including and beyond COVID-19

Outcomes in newly diagnosed elderly glioblastoma patients after concomitant temozolomide administration and hypofractionated radiotherapy

This study aimed to analyze the treatment and outcomes of older glioblastoma patients. Forty-four patients older than 70 years of age were referred to the Paul Strauss Center for chemotherapy and radiotherapy. The median age was 75.5 years old (range: 70-84), and the patients included 18 females and 26 males. The median Karnofsky index (KI) was 70%. The Charlson indices varied from 4 to 6. All of the patients underwent surgery. O6-methylguanine-DNA methyltransferase (MGMT) methylation status was determined in 25 patients. All of the patients received radiation therapy. Thirty-eight patients adhered to a hypofractionated radiation therapy schedule and six patients to a normofractionated schedule. Neoadjuvant, concomitant and adjuvant chemotherapy regimens were administered to 12, 35 and 20 patients, respectively. At the time of this analysis, 41 patients had died. The median time to relapse was 6.7 months. Twenty-nine patients relapsed, and 10 patients received chemotherapy upon relapse. The median overall survival (OS) was 7.2 months and the one- and two-year OS rates were 32% and 12%, respectively. In a multivariate analysis, only the Karnofsky index was a prognostic factor. Hypofractionated radiotherapy and chemotherapy with temozolomide are feasible and acceptably tolerated in older patients. However, relevant prognostic factors are needed to optimize treatment proposals