156 research outputs found
Improving Surgical Training Phantoms by Hyperrealism: Deep Unpaired Image-to-Image Translation from Real Surgeries
Current `dry lab' surgical phantom simulators are a valuable tool for
surgeons which allows them to improve their dexterity and skill with surgical
instruments. These phantoms mimic the haptic and shape of organs of interest,
but lack a realistic visual appearance. In this work, we present an innovative
application in which representations learned from real intraoperative
endoscopic sequences are transferred to a surgical phantom scenario. The term
hyperrealism is introduced in this field, which we regard as a novel subform of
surgical augmented reality for approaches that involve real-time object
transfigurations. For related tasks in the computer vision community, unpaired
cycle-consistent Generative Adversarial Networks (GANs) have shown excellent
results on still RGB images. Though, application of this approach to continuous
video frames can result in flickering, which turned out to be especially
prominent for this application. Therefore, we propose an extension of
cycle-consistent GANs, named tempCycleGAN, to improve temporal consistency.The
novel method is evaluated on captures of a silicone phantom for training
endoscopic reconstructive mitral valve procedures. Synthesized videos show
highly realistic results with regard to 1) replacement of the silicone
appearance of the phantom valve by intraoperative tissue texture, while 2)
explicitly keeping crucial features in the scene, such as instruments, sutures
and prostheses. Compared to the original CycleGAN approach, tempCycleGAN
efficiently removes flickering between frames. The overall approach is expected
to change the future design of surgical training simulators since the generated
sequences clearly demonstrate the feasibility to enable a considerably more
realistic training experience for minimally-invasive procedures.Comment: 8 pages, accepted at MICCAI 2018, supplemental material at
https://youtu.be/qugAYpK-Z4
Impella 5.0® as bridge-to-recovery short-term mechanical circulatory support after LVAD explantation
Mild Type 2 Diabetes Mellitus Reduces the Susceptibility of the Heart to Ischemia/Reperfusion Injury: Identification of Underlying Gene Expression Changes.
Despite clinical studies indicating that diabetic hearts are more sensitive to ischemia/reperfusion injury, experimental data is contradictory. Although mild diabetes prior to ischemia/reperfusion may induce a myocardial adaptation, further research is still needed. Nondiabetic Wistar (W) and type 2 diabetic Goto-Kakizaki (GK) rats (16-week-old) underwent 45 min occlusion of the left anterior descending coronary artery and 24 h reperfusion. The plasma glucose level was significantly higher in diabetic rats compared to the nondiabetics. Diabetes mellitus was associated with ventricular hypertrophy and increased interstitial fibrosis. Inducing myocardial infarction increased the glucose levels in diabetic compared to nondiabetic rats. Furthermore, the infarct size was smaller in GK rats than in the control group. Systolic and diastolic functions were impaired in W + MI and did not reach statistical significance in GK + MI animals compared to the corresponding controls. Among the 125 genes surveyed, 35 genes showed a significant change in expression in GK + MI compared to W + MI rats. Short-term diabetes promotes compensatory mechanisms that may provide cardioprotection against ischemia/reperfusion injury, at least in part, by increased antioxidants and the upregulation of the prosurvival PI3K/Akt pathway, by the downregulation of apoptotic genes, proinflammatory cytokine TNF-alpha, profibrogenic TGF-beta, and hypertrophic marker alpha-actin-1
Addition of vardenafil into storage solution protects the endothelium in a hypoxia-reoxygenation model
OBJECTIVE: Based upon the well known protective effect of intracellular cyclic guanosine monophosphate (cGMP) accumulation, we tested the hypothesis that storage solution enriched with optimal concentration of the phosphodiestherase-5 inhibitor vardenafil could provide better protection of vascular grafts against reperfusion injury after long-term cold ischaemic storage. METHODS: Isolated thoracic aorta obtained from rats underwent 24-h cold ischaemic preservation in physiological saline or vardenafil (10(-11) M)-supplemented saline solution. Reperfusion injury was simulated by hypochlorite (200 muM) exposure for 30 minutes. Endothelium-dependent vasorelaxation was assessed, and histopathological and molecular-biological examination of the aortic tissue were performed. RESULTS: Compared with the control group, the saline group showed significantly attenuated endothelium-dependent maximal relaxation (Rmax) to acetylcholine after hypoxia-reoxygenation, which was significantly improved by vardenafil supplementation (Rmax control: 98 +/- 1%; saline: 48 +/- 6%; vardenafil: 75 +/- 4%; p < .05). Vardenafil treatment significantly reduced DNA strand breaks (control: 10.6 +/- 6.2%; saline: 72.5 +/- 4.0%; vardenafil: 14.2 +/- 5.2%; p < .05) and increased cGMP score in the aortic wall (control: 8.2 +/- 0.6; saline: 4.5 +/- 0.3; vardenafil: 6.7 +/- 0.6; p < .05). CONCLUSIONS: Our results support the view that impairment of intracellular cGMP signalling plays a role in the pathogenesis of the endothelial dysfunction induced by cold storage warm reperfusion, which can be effectively reversed by pharmacological phosphodiesterase-5 inhibition
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