Percutaneous puncture during PCNL: new perspective for the future with virtual imaging guidance.

CONTEXT: Large and complex renal stones are usually treated with percutaneous nephrolithotomy (PCNL). One of the crucial steps in this procedure is the access to the collecting system with the percutaneous puncture and this maneuver leads to a risk of vascular and neighboring organs' injury. In the last years, the application of virtual image-guided surgery has gained wide diffusion even in this specific field. OBJECTIVES: To provide a short overview of the most recent evidence on current applications of virtual imaging guidance for PCNL. EVIDENCE ACQUISITION: A non-systematic review of the literature was performed. Medline, PubMed, the Cochrane Database and Embase were screened for studies regarding the use virtual imaging guidance for PCNL. EVIDENCE SYNTHESIS: 3D virtual navigation technology for PCNL was first used in urology with the purpose of surgical training and surgical planning; subsequently, the field of surgical navigation with different modalities (from cognitive to augmented reality or mixed reality) had been explored. Finally, anecdotal preliminary experiences explored the potential application of artificial intelligence guidance for percutaneous puncture. CONCLUSION: Nowadays, many experiences proved the potential benefit of virtual guidance for surgical simulation and training. Focusing on surgery, this tool revealed to be useful both for surgical planning, allowed to achieve a better surgical performance, and for surgical navigation by using augmented reality and mixed reality systems aimed to assist the surgeon in real time during the intervention.

Toward a mathematical theory of living systems focusing on developmental biology and evolution: a review and perspectives.

This review paper is devoted to present a personal perspective, based on a critical analysis of the existing literature, about the conceptual difficulties that mathematics meets when attempting to describe the complexity of living matter focusing on the challenging goal of developing a mathematical theory for living systems. The authors propose a personal path, starting from the identification of a number of common features of living systems that can be viewed as sources of complexity, firstly in general, and subsequently focusing specifically on evolution problems. Further, three key questions are posed addressing to a mathematical theory. Finally, the tools of the kinetic theory of active particles are critically analyzed to understand how far this approach still is from the achievement of the afore said ambitious objective.