Automatic image analysis of C-arm Computed Tomography images for ankle joint surgeries

Open reduction and internal fixation is a standard procedure in ankle surgery for treating a fractured fibula. Since fibula fractures are often accompanied by an injury of the syndesmosis complex, it is essential to restore the correct relative pose of the fibula relative to the adjoining tibia for the ligaments to heal. Otherwise, the patient might experience instability of the ankle leading to arthritis and ankle pain and ultimately revision surgery. Incorrect positioning referred to as malreduction of the fibula is assumed to be one of the major causes of unsuccessful ankle surgery. 3D C-arm imaging is the current standard procedure for revealing malreduction of fractures in the operating room. However, intra-operative visual inspection of the reduction result is complicated due to high inter-individual variation of the ankle anatomy and rather based on the subjective experience of the surgeon. A contralateral side comparison with the patient’s uninjured ankle is recommended but has not been integrated into clinical routine due to the high level of radiation exposure it incurs. This thesis presents the first approach towards a computer-assisted intra-operative contralateral side comparison of the ankle joint. The focus of this thesis was the design, development and validation of a software-based prototype for a fully automatic intra-operative assistance system for orthopedic surgeons. The implementation does not require an additional 3D C-arm scan of the uninjured ankle, thus reducing time consumption and cumulative radiation dose. A 3D statistical shape model (SSM) is used to reconstruct a 3D surface model from three 2D fluoroscopic projections representing the uninjured ankle. To this end, a 3D SSM segmentation is performed on the 3D image of the injured ankle to gain prior knowledge of the ankle. A 3D convolutional neural network (CNN) based initialization method was developed and its outcome was incorporated into the SSM adaption step. Segmentation quality was shown to be improved in terms of accuracy and robustness compared to the pure intensity-based SSM. This allows us to overcome the limitations of the previously proposed methods, namely inaccuracy due to metal artifacts and the lack of device-to-patient orientation of the C-arm. A 2D-CNN is employed to extract semantic knowledge from all fluoroscopic projection images. This step of the pipeline both creates features for the subsequent reconstruction and also helps to pre-initialize the 3D-SSM without user interaction. A 2D-3D multi-bone reconstruction method has been developed which uses distance maps of the 2D features for fast and accurate correspondence optimization and SSM adaption. This is the central and most crucial component of the workflow. This is the first time that a bone reconstruction method has been applied to the complex ankle joint and the first reconstruction method using CNN based segmentations as features. The reconstructed 3D-SSM of the uninjured ankle can be back-projected and visualized in a workflow-oriented manner to procure clear visualization of the region of interest, which is essential for the evaluation of the reduction result. The surgeon can thus directly compare an overlay of the contralateral ankle with the injured ankle. The developed methods were evaluated individually using data sets acquired during a cadaver study and representative clinical data acquired during fibular reduction. A hierarchical evaluation was designed to assess the inaccuracies of the system on different levels and to identify major sources of error. The overall evaluation performed on eleven challenging clinical datasets acquired for manual contralateral side comparison showed that the system is capable of accurately reconstructing 3D surface models of the uninjured ankle solely using three projection images. A mean Hausdorff distance of 1.72 mm was measured when comparing the reconstruction result to the ground truth segmentation and almost achieved the high required clinical accuracy of 1-2 mm. The overall error of the pipeline was mainly attributed to inaccuracies in the 2D-CNN segmentation. The consistency of these results requires further validation on a larger dataset. The workflow proposed in this thesis establishes the first approach to enable automatic computer-assisted contralateral side comparison in ankle surgery. The feasibility of the proposed approach was proven on a limited amount of clinical cases and has already yielded good results. The next important step is to alleviate the identified bottlenecks in the approach by providing more training data in order to further improve the accuracy. In conclusion, the new approach presented gives the chance to guide the surgeon during the reduction process, improve the surgical outcome while avoiding additional radiation exposure and reduce the number of revision surgeries in the long term

355— Topographical Individualized Neuromarkers in the Analysis of the Brain Functioning of Social-Emotional Development

Topographical Individualized Neuromarkers (TIN) are spatially arranged patterns of brain function used to develop novel brain markers of social-emotional functioning and development. The current study focuses on developing markers of risk for psychological problems in children. We are expanding on previous research that indicates the brains of shy children differ from the brains of non-shy children, where shy children present with a topographical pattern of brain function that may be considered an internally hypervigilant neuromarker (Taber-Thomas et al., 2016). Using the online software, Neurosynth, we will extend our research into neuromarkers for other disorders using publicly available data. This program allows for the examination of internally hypervigilant neuromarkers in several regions of the brain. The regions we will be specifically examining are the insula, cingulate gyrus, hippocampus, and amygdala. This model will be explored further by calculating topographical maps from fMRI data and examining how differences in the maps are related to social-emotional functioning and development

Influence of pretreatments on microtensile bond strength to eroded dentin using a universal adhesive in self-etch mode

Purpose To evaluate the influence of pretreatments on microtensile bond strength (μTBS) to eroded dentin when using a universal adhesive in self-etch mode. Materials and methods Forty-eight human molars were randomly assigned to six groups (G1–G6, n = 8) and ground down until dentin exposure. G2–G6 were eroded with citric acid (pH 2.6) for 10 × 2 min (within 12 h) on 5 consecutive days. G1 and G2 served as uneroded and eroded controls and were not pretreated. G3 and G4 were pretreated for 60 s with NaOCl (10% and 5%, respectively). G5 was airborne-particle abraded using Al2O3 for 15 s, and G6 was roughened with a diamond bur. The universal adhesive Scotchbond Universal was applied in self-etch mode. After composite build-up, μTBS was determined. Results Control group G1 (uneroded) showed higher μTBS than G2 (eroded). The μTBS (mean MPa ±SD) of G5 (airborne-particle abrasion; 11.6 ± 4.6) and G6 (bur-roughening; 11.0 ± 3.3) did not differ significantly from the μTBS of G1 (12.4 ± 4.2). Significantly higher μTBS compared to all other groups was observed in G3 (NaOCl 10%; 17.6 ± 7.6). Pretreatment with NaOCl 5% (G4) achieved significantly lower μTBS (3.5 ± 2.6) than the other groups, except for G2 (8.8 ± 2.0). Conclusions Pretreatment with 10% NaOCl, diamond bur roughening or airborne-particle abrasion can increase bond strength of the tested adhesive to eroded dentine. Pre-treatment with 5% NaOCl is not recommended

351— Social Attention Bias in the Real World - Pilot Study

Attention bias is defined as the elevated processing of certain stimuli over others. Past research has discovered that attention bias is related to anxiety through behavioral experiments. Studies found that in a lab setting those who are more anxious are more vigilant towards a threat. Previous research is however limited in the study of examining how these behavioral experiments relate to a real-world context since most of the experiments that have been done occurred in a lab setting. To address this phenomenon, two Empatica E4 Wristbands were utilized in order to measure a participant’s anxiety through skin conductance, electrodermal activity, and heart rate. The current study is pilot work done to test the equipment’s accuracy and reliability as well as create a protocol for data collection. To assess the equipment, SED lab members have been following safe covid practices in order to minimize the risk of contracting or spreading the virus. Based on data collected by the Empatica E4 wristbands, we hypothesize that when put in a real-world situation, a more anxious person will focus their attention on threatening stimuli rather than non-threatening stimuli

The IMS Toucan System for the Blizzard Challenge 2023

For our contribution to the Blizzard Challenge 2023, we improved on the system we submitted to the Blizzard Challenge 2021. Our approach entails a rule-based text-to-phoneme processing system that includes rule-based disambiguation of homographs in the French language. It then transforms the phonemes to spectrograms as intermediate representations using a fast and efficient non-autoregressive synthesis architecture based on Conformer and Glow. A GAN based neural vocoder that combines recent state-of-the-art approaches converts the spectrogram to the final wave. We carefully designed the data processing, training, and inference procedures for the challenge data. Our system identifier is G. Open source code and demo are available.Comment: Published at the Blizzard Challenge Workshop 2023, colocated with the Speech Synthesis Workshop 2023, a sattelite event of the Interspeech 202

Neuromelanin, neurotransmitter status and brainstem location determine the differential vulnerability of catecholaminergic neurons to mitochondrial DNA deletions

<p>Abstract</p> <p>Background</p> <p>Deletions of the mitochondrial DNA (mtDNA) accumulate to high levels in dopaminergic neurons of the substantia nigra pars compacta (SNc) in normal aging and in patients with Parkinson's disease (PD). Human nigral neurons characteristically contain the pigment neuromelanin (NM), which is believed to alter the cellular redox-status. The impact of neuronal pigmentation, neurotransmitter status and brainstem location on the susceptibility to mtDNA damage remains unclear. We quantified mtDNA deletions (ΔmtDNA) in single pigmented and non-pigmented catecholaminergic, as well as non-catecholaminergic neurons of the human SNc, the ventral tegmental area (VTA) and the locus coeruleus (LC), using laser capture microdissection and single-cell real-time PCR.</p> <p>Results</p> <p>In healthy aged individuals, ΔmtDNA levels were highest in pigmented catecholaminergic neurons (25.2 ± 14.9%), followed by non-pigmented catecholamergic (18.0 ± 11.2%) and non-catecholaminergic neurons (12.3 ± 12.3%; p < 0.001). Within the catecholaminergic population, ΔmtDNA levels were highest in dopaminergic neurons of the SNc (33.9 ± 21.6%) followed by dopaminergic neurons of the VTA (21.9 ± 12.3%) and noradrenergic neurons of the LC (11.1 ± 11.4%; p < 0.001). In PD patients, there was a trend to an elevated mutation load in surviving non-pigmented nigral neurons (27.13 ± 16.73) compared to age-matched controls (19.15 ± 11.06; p = 0.052), but levels where similar in pigmented nigral neurons of PD patients (41.62 ± 19.61) and controls (41.80 ± 22.62).</p> <p>Conclusions</p> <p>Catecholaminergic brainstem neurons are differentially susceptible to mtDNA damage. Pigmented dopaminergic neurons of the SNc show the highest ΔmtDNA levels, possibly explaining the exceptional vulnerability of the nigro-striatal system in PD and aging. Although loss of pigmented noradrenergic LC neurons also is an early feature of PD pathology, mtDNA levels are not elevated in this nucleus in healthy controls. Thus, ΔmtDNA are neither an inevitable consequence of catecholamine metabolism nor a universal explanation for the regional vulnerability seen in PD.</p

Brain perfusion patterns are altered in chronic knee pain:a spatial covariance analysis of arterial spin labelling MRI

Chronic musculoskeletal pain is a common problem globally. Current evidence suggests that maladapted central pain pathways are associated with pain chronicity, for example, in postoperative pain after knee replacement. Other factors such as low mood, anxiety, and tendency to catastrophize are also important contributors. We aimed to investigate brain imaging features that underpin pain chronicity based on multivariate pattern analysis of cerebral blood flow (CBF), as a marker of maladaptive brain changes. This was achieved by identifying CBF patterns that discriminate chronic pain from pain-free conditions and by exploring their explanatory power for factors thought to drive pain chronification. In 44 chronic knee pain and 29 pain-free participants, we acquired both CBF and T1-weighted data. Participants completed questionnaires related to affective processes and pressure and cuff algometry to assess pain sensitization. Two factor scores were extracted from these scores representing negative affect and pain sensitization. A spatial covariance principal component analysis of CBF identified 5 components that significantly discriminated chronic pain participants from controls, with the unified network achieving 0.83 discriminatory accuracy (area under the curve). In chronic knee pain, significant patterns of relative hypoperfusion were evident in anterior default-mode and salience network hubs, while hyperperfusion was seen in posterior default mode, thalamus, and sensory regions. One component correlated positively with the pain sensitization score (r = 0.43, P = 0.006), suggesting that this CBF pattern reflects neural activity changes encoding pain sensitization. Here, we report a distinct chronic knee pain-related representation of CBF, pointing toward a brain signature underpinning central aspects of pain sensitization

Peripheral Blood Stem Cells versus Bone Marrow for T Cell-Replete Haploidentical Transplantation with Post-Transplant Cyclophosphamide in Hodgkin Lymphoma.

Abstract Haploidentical stem cell transplantation (haplo-SCT) with post-transplant cyclophosphamide (PT-Cy) represents a potential curative strategy for patients with Hodgkin lymphoma (HL) when a matched related or unrelated donor is not available. The role of graft source, either bone marrow (BM) or peripheral blood stem cells (PBSCs), in this setting has not been fully elucidated. We performed a retrospective study on 91 patients with HL to compare the outcome after BM (n = 53) or PBSC (n = 38) transplant. Eighty-nine patients engrafted with no difference between BM and PBSCs in terms of median time for neutrophil (20 versus 20 days, P = .405) and platelet (26 versus 26.5 days, P = .994) engraftment. With a median follow-up of 40.2 months, 100-day cumulative incidences of grades II to IV acute graft-versus host disease (GVHD) and grades II to IV acute GVHD were 24% and 4%, respectively. Graft source was not associated with a different risk of acute GVHD both by univariate and multivariate analyses. Consistently, 1-year cumulative incidence of chronic GVHD was 7% with no differences between the 2 graft types (P = .761). Two-year rates of overall survival (OS), progression-free survival (PFS), nonrelapse mortality, and GVHD/relapse-free survival (GRFS) were 67%, 58%, 20%, and 52%, respectively. By univariate analysis, pretransplant disease status was the main variable affecting all outcomes. By multivariate analysis, PBSCs resulted in a protective factor for OS (hazard ratio [HR], .29; P = .006), PFS (HR, .38; P = .001), and GRFS (HR, .44; P = .020). The other independent variables affecting the final outcome were pretransplant disease status and hematopoietic cell transplant–specific comorbidity index. In conclusion, when planning a haplo-SCT with PT-Cy for patients with poor-risk HL, graft type is an important variable to take into account when selecting the best available donor