Determination of the effective dose of remimazolam combined with sufentanil for inhibiting body movement during surgical abortion: An up-and-down sequential allocation trial.

BACKGROUND: Remimazolam, a recently developed anesthetic characterized by its rapid and ultra-short-acting properties, exhibits pharmacological attributes that make it potentially suitable for painless surgical abortion procedures. The objective of this study was to determine the effective dose of remimazolam when administered in combination with sufentanil, with the intention of inhibiting body movement during surgical abortion. Additionally, a secondary objective was to assess the recovery profile from general anesthesia. METHODS: The study enrolled a total of 25 healthy women aged 20 to 40, with a body mass index between 18 and 28 kg/m2, in their first trimester of pregnancy (up to 12 weeks), and American Society of Anesthesiologists status I and II. Anesthesia induction was initiated by administering sufentanil at a dose of 0.1 µg/kg. The modified Dixon up-and-down method was employed to determine the induction dose of remimazolam for each patient. RESULTS: The 50% and 95% effective dose of remimazolam for inhibitory effects of body movement was estimated using centered isotonic regression to be 0.145 mg/kg (95% CI: 0.115, 0.207), and 0.242 mg/kg (95% CI: 0.232, 0.620), respectively. Five out of 25 (20%) experienced hiccups, with 1 patient having persistent hiccups until the end of the surgery. The mean time to first eye-opening was 51.4 ±â€…20.5 seconds, and the time to obey verbal command was 54.5 ±â€…20.6 seconds. Upon arrival at the postanesthesia care unit, 95.7% of the patients achieved a Modified Aldrete score ≥ 9. CONCLUSIONS: The 50% and 95% effective dose of remimazolam for inhibiting body movement during surgical abortion when used in combination with 0.1 µg/kg of sufentanil were 0.145 mg/kg and 0.242 mg/kg, respectively.

Dynamic reconstruction for digital tomosynthesis: a phantom proof of concept for breast care.

Objective. Digital tomosynthesis (DTS) is a type of limited-angle Computed Tomography (CT) used in orthopedic and oncology care to provide a pseudo-3D reconstructed volume of a body part from multiple x-ray projections. Patient motion during acquisitions results in artifacts which affect screening and diagnostic performances. Hence, accurate reconstruction of moving body parts from a tomosynthesis projection series is addressed in this paper, with a particular focus on the breast. The aim of this paper is to assess the feasibility of a novel dynamic reconstruction technique for DTS and evaluate its accuracy compared to an available ground truth.Approach. The proposed method is a combination of a 4D dynamic tomography strategy leveraging the formalism of Projection-based Digital Volume Correlation (P-DVC) with a multiscale approach to estimate and correct patient motion. Iterations of two operations are performed: (i) a motion-corrected reconstruction based on the Simultaneous Iterative Reconstruction Technique (SIRT) algorithm and (ii) a motion estimation from projection residuals, to obtain motion-free volumes. Performance is evaluated on a synthetic Digital Breast Tomosynthesis (DBT) case. Three slabs of a CIRS breast phantom are imaged on a Senographe PristinaTM, under plate-wise rigid body motions with amplitudes ranging up to 10 mm so that an independent measurement of the motion can be accessed.Results. Results show a motion estimation average precision down to 0.183 mm (1.83 voxels), when compared to the independent measurement. Moreover, an 84.2% improvement on the mean residual error and a 59.9% improvement on the root mean square error (RMSE) with the original static reconstruction are obtained.Significance. Visual and quantitative assessments of the dynamically reconstructed volumes show that the proposed method fully restores conspicuity for important clinical features contained in the phantom.

Exploring the association between haematological markers of iron and general movements in 4-month-old infants exposed to anaemia in-utero.

BACKGROUND: Iron is a vital micronutrient for brain development, influencing myelination, neurotransmitter balance, and the maturation of specific brain cells. Hence iron insufficiency in the foetal, neonatal and infancy period has the potential to influence the neuromotor development. AIMS: We aimed to describe haematological markers of iron at 4 months of age in infants exposed to prenatal anaemia and explore the association with their quality of general movements. STUDY DESIGN: Cross sectional study nested within the RAPIDIRON-KIDS trial. SUBJECTS: All infants whose mothers were part of RAPIDIRON-KIDS trial, were eligible to participate in this study when the infants were 4 months old. Children suffering from fever or acute illness on the day of assessment, or with a history of either surgery, or admission to hospital in the first month were excluded. OUTCOME MEASURES: Haematological markers of iron (Haemoglobin and Ferritin level) and quality of general movements in infants at 4 months of age. RESULTS: 120 infants were assessed with mean birth weight of 2685.5 g (±384.5) and median gestational age of 39 weeks [Q1, Q3:38,40]. There was no significant association between haemoglobin or ferritin levels with fidgety movements (p = 0.18 and p = 0.27, respectively). The combined effect of haemoglobin and ferritin estimates also did not show any significant association with the study groups (p = 0.21). CONCLUSION: A majority of infants still had low iron indices at 4 months of age and this was not associated with the quality of general movements. A prospective longitudinal study needs to be considered in infants exposed to prenatal anaemia rather than assessing the outcomes at a single time point.

Intrafractional motion and dosimetric analysis in prostate stereotactic body radiation therapy with auto beam hold technique.

Objective: To summarize our institutional prostate stereotactic body radiation therapy (SBRT) experience using auto beam hold (ABH) technique for intrafractional prostate motion and assess ABH tolerance of 10-millimeter (mm) diameter.Approach: Thirty-two patients (160 fractions) treated using ABH technique between 01/2018 and 03/2021 were analyzed. During treatment, kV images were acquired every 20-degree gantry rotation to visualize 3-4 gold fiducials within prostate to track target motion. If the fiducial center fell outside the tolerance circle (diameter = 10 mm), beam was automatically turned off for reimaging and repositioning. Number of beam holds and couch translational movement magnitudes were recorded. Dosimetric differences from intrafractional motion were calculated by shifting planned isocenter.Main Results: Couch movement magnitude (mean ± SD) in vertical, longitudinal and lateral directions were -0.7 ± 2.5, 1.4 ± 2.9 and -0.1 ± 0.9 mm, respectively. For most fractions (77.5%), no correction was necessary. Number of fractions requiring one, two, or three corrections were 15.6%, 5.6% and 1.3%, respectively. Of the 49 corrections, couch shifts greater than 3 mm were seen primarily in the vertical (31%) and longitudinal (39%) directions; corresponding couch shifts greater than 5 mm occurred in 2% and 6% of cases. Dosimetrically, 100% coverage decreased less than 2% for clinical target volume (CTV) (-1 ± 2%) and less than 10% for PTV (-10 ± 6%). Dose to bladder, bowel and urethra tended to increase (Bladder: ΔD10%:184 ± 466 cGy, ΔD40%:139 ± 241 cGy, Bowel: ΔD1 cm3:54 ± 129 cGy; ΔD5 cm3:44 ± 116 cGy, Urethra: ΔD0.03 cm3:1 ± 1%). Doses to the rectum tended to decrease (Rectum: ΔD1 cm3:-206 ± 564 cGy, ΔD10%:-97 ± 426 cGy; ΔD20%:-50 ± 251 cGy).Significance: With the transition from conventionally fractionated intensity modulated radiation therapy to SBRT for localized prostate cancer treatment, it is imperative to ensure that dose delivery is spatially accurate for appropriate coverage to target volumes and limiting dose to surrounding organs. Intrafractional motion monitoring can be achieved using triggered imaging to image fiducial markers and ABH to allow for reimaging and repositioning for excessive motion.

Impact of setup and geometric uncertainties on the robustness of free-breathing photon radiotherapy of small lung tumors.

PURPOSE: Respiratory motion and patient setup error both contribute to the dosimetric uncertainty in radiotherapy of lung tumors. Managing these uncertainties for free-breathing treatments is usually done by margin-based approaches or robust optimization. However, breathing motion can be irregular and concerns have been raised for the robustness of the treatment plans. We have previously reported the dosimetric effects of the respiratory motion, without setup uncertainties, in lung tumor photon radiotherapy using free-breathing images. In this study, we include setup uncertainty. METHODS: Tumor positions from cine-CT images acquired in free-breathing were combined with per-fraction patient shifts to simulate treatment scenarios. A total of 14 patients with 300 tumor positions were used to evaluate treatment plans based on 4DCT. Four planning methods aiming at delivering 54 Gy as median tumor dose in three fractions were compared. The planning methods were denoted robust 4D (RB4), isodose to the PTV with a central higher dose (ISD), the ISD method normalized to the intended median tumor dose (IRN) and homogeneous fluence to the PTV (FLU). RESULTS: For all planning methods 95% of the intended dose was achieved with at least 90% probability with RB4 and FLU having equal CTV D50% values at this probability. FLU gave the most consistent results in terms of CTV D50% spread and dose homogeneity. CONCLUSIONS: Despite the simulated patient shifts and tumor motions being larger than observed in the 4DCTs the dosimetric impact was suggested to be small. RB4 or FLU are recommended for the planning of free-breathing treatments.

Validation of OpenCap: A low-cost markerless motion capture system for lower-extremity kinematics during return-to-sport tasks.

Low-cost markerless motion capture systems offer the potential for 3D measurement of joint angles during human movement. This study aimed to validate a smartphone-based markerless motion capture system's (OpenCap) derived lower extremity kinematics during common return-to-sport tasks, comparing it to an established optoelectronic motion capture system. Athletes with prior anterior cruciate ligament reconstruction (12-18 months post-surgery) performed three movements: a jump-landing-rebound, single-leg hop, and lateral-vertical hop. Kinematics were recorded concurrently with two smartphones running OpenCap's software and with a 10-camera, marker-based motion capture system. Validity of lower extremity joint kinematics was assessed across 437 recorded trials using measures of agreement (coefficient of multiple correlation: CMC) and error (mean absolute error: MAE, root mean squared error: RMSE) across the time series of movement. Agreement was best in the sagittal plane for the knee and hip in all movements (CMC > 0.94), followed by the ankle (CMC = 0.84-0.93). Lower agreement was observed for frontal (CMC = 0.47-0.78) and transverse (CMC = 0.51-0.6) plane motion. OpenCap presented a grand mean error of 3.85° (MAE) and 4.34° (RMSE) across all joint angles and movements. These results were comparable to other available markerless systems. Most notably, OpenCap's user-friendly interface, free software, and small physical footprint have the potential to extend motion analysis applications beyond conventional biomechanics labs, thus enhancing the accessibility for a diverse range of users.

Intrafraction organ movement in adaptive MR-guided radiotherapy of abdominal lesions - dosimetric impact and how to detect its extent in advance.

INTRODUCTION: Magnetic resonance guided radiotherapy (MRgRT) allows daily adaptation of treatment plans to compensate for positional changes of target volumes and organs at risk (OARs). However, current adaptation times are relatively long and organ movement occurring during the adaptation process might offset the benefit gained by adaptation. The aim of this study was to evaluate the dosimetric impact of these intrafractional changes. Additionally, a method to predict the extent of organ movement before the first treatment was evaluated in order to have the possibility to compensate for them, for example by adding additional margins to OARs. MATERIALS & METHODS: Twenty patients receiving adaptive MRgRT for treatment of abdominal lesions were retrospectively analyzed. Magnetic resonance (MR) images acquired at the start of adaptation and immediately before irradiation were used to calculate adapted and pre-irradiation dose in OARs directly next to the planning target volume. The extent of organ movement was determined on MR images acquired during simulation sessions and adaptive treatments, and their agreement was evaluated. Correlation between the magnitude of organ movement during simulation and the duration of simulation session was analyzed in order to assess whether organ movement might be relevant even if the adaptation process could be accelerated in the future. RESULTS: A significant increase in dose constraint violations was observed from adapted (6.9%) to pre-irradiation (30.2%) dose distributions. Overall, OAR dose increased significantly by 4.3% due to intrafractional organ movement. Median changes in organ position of 7.5 mm (range 1.5-10.5 mm) were detected within a median time of 17.1 min (range 1.6-28.7 min). Good agreement was found between the range of organ movement during simulation and adaptation (66.8%), especially if simulation sessions were longer and multiple MR images were acquired. No correlation was determined between duration of simulation sessions and magnitude of organ movement. CONCLUSION: Intrafractional organ movement can impact dose distributions and lead to violations of OAR tolerance doses, which impairs the benefit of daily on-table plan adaptation. By application of simulation images, the extent of intrafractional organ movement can be predicted, which possibly allows to compensate for them.

Preliminary Experience with Three Alternative Motion Sensors for 0.55 Tesla MR Imaging.

Due to limitations in current motion tracking technologies and increasing interest in alternative sensors for motion tracking both inside and outside the MRI system, in this study we share our preliminary experience with three alternative sensors utilizing diverse technologies and interactions with tissue to monitor motion of the body surface, respiratory-related motion of major organs, and non-respiratory motion of deep-seated organs. These consist of (1) a Pilot-Tone RF transmitter combined with deep learning algorithms for tracking liver motion, (2) a single-channel ultrasound transducer with deep learning for monitoring bladder motion, and (3) a 3D Time-of-Flight camera for observing the motion of the anterior torso surface. Additionally, we demonstrate the capability of these sensors to simultaneously capture motion data outside the MRI environment, which is particularly relevant for procedures like radiation therapy, where motion status could be related to previously characterized cyclical anatomical data. Our findings indicate that the ultrasound sensor can track motion in deep-seated organs (bladder) as well as respiratory-related motion. The Time-of-Flight camera offers ease of interpretation and performs well in detecting surface motion (respiration). The Pilot-Tone demonstrates efficacy in tracking bulk respiratory motion and motion of major organs (liver). Simultaneous use of all three sensors could provide complementary motion information outside the MRI bore, providing potential value for motion tracking during position-sensitive treatments such as radiation therapy.

Upper-Limb Movement Quality before and after Surgery in Women with Breast Cancer: An Exploratory Study.

(1) Background: This study aimed to describe upper-limb (UL) movement quality parameters in women after breast cancer surgery and to explore their clinical relevance in relation to post-surgical pain and disability. (2) Methods: UL movement quality was assessed in 30 women before and 3 weeks after surgery for breast cancer. Via accelerometer data captured from a sensor located at the distal end of the forearm on the operated side, various movement quality parameters (local dynamic stability, movement predictability, movement smoothness, movement symmetry, and movement variability) were investigated while women performed a cyclic, weighted reaching task. At both test moments, the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire was filled out to assess UL disability and pain severity. (3) Results: No significant differences in movement quality parameters were found between the pre-surgical and post-surgical time points. No significant correlations between post-operative UL disability or pain severity and movement quality were found. (4) Conclusions: From this study sample, no apparent clinically relevant movement quality parameters could be derived for a cyclic, weighted reaching task. This suggests that the search for an easy-to-use, quantitative analysis tool for UL qualitative functioning to be used in research and clinical practice should continue.

Flexible Strain Sensor Based on Nickel Microparticles/Carbon Black Microspheres/Polydimethylsiloxane Conductive Composites for Human Motion Detection.

Herein, we report a dual-functional flexible sensor (DFFS) using a magnetic conductive polymer composed of nickel (Ni), carbon black (CB), and polydimethylsiloxane (PDMS). The material selection for the DFFS utilizes the excellent elasticity of the PDMS matrix and the synergistic interaction between Ni and CB. The DFFS has a wide strain range of 0-170%, a high sensitivity of 74.13 (140-170%), and a low detection limit of 0.3% strain. The DFFS based on superior performance can accurately detect microstrain/microvibration, oncoming/contacting objects, and bicycle riding speed. Additionally, the DFFS can be used for comprehensive monitoring of human movements. Therefore, the DFFS of this work shows significant value for implementation in intelligent wearable devices and noncontact intelligent control.

A back propagation neural network based respiratory motion modelling method.

BACKGROUND: This study presents the development of a backpropagation neural network-based respiratory motion modelling method (BP-RMM) for precisely tracking arbitrary points within lung tissue throughout free respiration, encompassing deep inspiration and expiration phases. METHODS: Internal and external respiratory data from four-dimensional computed tomography (4DCT) are processed using various artificial intelligence algorithms. Data augmentation through polynomial interpolation is employed to enhance dataset robustness. A BP neural network is then constructed to comprehensively track lung tissue movement. RESULTS: The BP-RMM demonstrates promising accuracy. In cases from the public 4DCT dataset, the average target registration error (TRE) between authentic deep respiration phases and those forecasted by BP-RMM for 75 marked points is 1.819 mm. Notably, TRE for normal respiration phases is significantly lower, with a minimum error of 0.511 mm. CONCLUSIONS: The proposed method is validated for its high accuracy and robustness, establishing it as a promising tool for surgical navigation within the lung.

Ankle movement alterations during gait in children with acute lymphoblastic leukemia with suspected peripheral mononeuropathy. A cross-sectional study.

BACKGROUND: Peripheral neuropathy due to chemotherapeutic drugs causes alterations in ankle movement during gait. This study aimed to describe the spatiotemporal parameters and ankle kinematics during gait in schoolchildren with acute lymphoblastic leukemia with clinically suspected peripheral neuropathy. METHODS: In children with acute lymphoblastic leukemia in the maintenance phase, we calculated spatiotemporal and kinematic parameters of the ankle during gait using Kinovea® software. Furthermore, we identified alterations in the parameters obtained considering the values of the normality data from a stereophotogrammetry system as the reference values. Finally, we represented the kinematic parameters of the ankles calculated with Kinovea® compared to the normality values of the stereophotogrammetry. FINDINGS: We evaluated 25 schoolchildren; 13 were male (52.0%) with a median age of 88.0months and a median of 60.0 weeks in the maintenance phase, and 54.8% were classified as standard risk. Spatiotemporal parameters: cadence (steps/min), bilateral step length (m), and average gait speed (m/s) in ALL children were significantly lower than reference values (p < 0.001). Except for right mid-stance and bilateral foot strike, initial swing showed that both ankles maintained plantar flexion values during gait, significantly lower in ALL patients (p < 0.05). INTERPRETATION: We identified spatiotemporal and kinematics alterations in schoolchildren with acute lymphoblastic leukemia during all phases of the gait suggestive of alteration in ankle muscles during movement, probably due to peripheral neuropathy; nevertheless, our results should be taken with caution until the accuracy and reliability of Kinovea® software as a diagnostic test compared to the stereophotogrammetric system in children with ALL and healthy peers is proven.

Inter-fractional error and intra-fractional motion of prostate and dosimetry comparisons of patient position registrations with versus without fiducial markers during treatment with carbon-ion radiotherapy.

A few reports have discussed the influence of inter-fractional position error and intra-fractional motion on dose distribution, particularly regarding a spread-out Bragg peak. We investigated inter-fractional and intra-fractional prostate position error by monitoring fiducial marker positions. In 2020, data from 15 patients with prostate cancer who received carbon-ion beam radiotherapy (CIRT) with gold markers were investigated. We checked marker positions before and during irradiation to calculate the inter-fractional positioning and intra-fractional movement and evaluated the CIRT dose distribution by adjusting the planning beam isocenter and clinical target volume (CTV) position. We compared the CTV dose coverages (CTV receiving 95% [V95%] or 98% [V98%] of the prescribed dose) between skeletal and fiducial matching irradiation on the treatment planning system. For inter-fractional error, the mean distance between the marker position in the planning images and that in a patient starting irradiation with skeletal matching was 1.49 ± 1.11 mm (95th percentile = 1.85 mm). The 95th percentile (maximum) values of the intra-fractional movement were 0.79 mm (2.31 mm), 1.17 mm (2.48 mm), 1.88 mm (4.01 mm), 1.23 mm (3.00 mm), and 2.09 mm (8.46 mm) along the lateral, inferior, superior, dorsal, and ventral axes, respectively. The mean V95% and V98% were 98.2% and 96.2% for the skeletal matching plan and 99.5% and 96.8% for the fiducial matching plan, respectively. Fiducial matching irradiation improved the CTV dose coverage compared with skeletal matching irradiation for CIRT for prostate cancer.

Three-dimensional motion analysis of pre- and postoperative thumb movement in trapeziometacarpal joint osteoarthritis-Comparison of arthrodesis and trapeziectomy with suspensionplasty.

Trapeziometacarpal osteoarthritis (TMC-OA) reduces the range of motion (ROM) of the thumb. However, the kinematic change achieved through surgical treatment remains unclear. Therefore, to quantify the kinematic change following TMC-OA surgery, we performed a three-dimensional motion analysis of the thumb using an optical motion capture system preoperatively and 1 year postoperatively in 23 patients with TMC-OA scheduled for arthrodesis (AD) or trapeziectomy with suspensionplasty (TS). Eighteen hands of nine healthy volunteers were also included as controls. Both procedures improved postoperative pain and Disability of the Arm, Shoulder and Hand scores, and AD increased pinch strength. The ROM of the base of the thumb was preserved in AD, which was thought to be due to the appearance of compensatory movements of adjacent joints even if the ROM of the TMC joint was lost. TS did not improve ROM. Quantifying thumb kinematic changes following TMC-OA surgery can improve our understanding of TMC-OA treatment and help select surgical procedures and postoperative assessment.

Prostate intra-fraction motion recorded by transperineal ultrasound.

Infra-fraction motion of the prostate was recorded during 3.423 fractions of image guided radiotherapy (IGRT) in 191 patients, 14 of which were treated by intensity modulated radiation therapy (IMRT), and 177 of which were treated by volumetric arc therapy (VMAT). The prostate was imaged by three-dimensional and time-resolved transperineal ultrasound (4D-US) of type Clarity by Elekta AB, Stockholm, Sweden. The prostate volume was registered and the prostate position (center of volume) was recorded at a frequency of 2.0 samples per second. This raw data set contains a total of 1.985.392 prostate and patient couch positions over a time span of 272 hours, 52 minutes and 34 seconds of life radiotherapy as exported by the instrument software. This data set has been used for the validation of models of prostate intra-fraction motion and for the estimation of the dosimetric impact of actual intra-fraction motion on treatment quality and side effects. We hope that this data set may be reused by other groups for similar purposes.

A modular motion compensation pipeline for prospective respiratory motion correction of multi-nuclear MR spectroscopy.

Magnetic resonance (MR) acquisitions of the torso are frequently affected by respiratory motion with detrimental effects on signal quality. The motion of organs inside the body is typically decoupled from surface motion and is best captured using rapid MR imaging (MRI). We propose a pipeline for prospective motion correction of the target organ using MR image navigators providing absolute motion estimates in millimeters. Our method is designed to feature multi-nuclear interleaving for non-proton MR acquisitions and to tolerate local transmit coils with inhomogeneous field and sensitivity distributions. OpenCV object tracking was introduced for rapid estimation of in-plane displacements in 2D MR images. A full three-dimensional translation vector was derived by combining displacements from slices of multiple and arbitrary orientations. The pipeline was implemented on 3 T and 7 T MR scanners and tested in phantoms and volunteers. Fast motion handling was achieved with low-resolution 2D MR image navigators and direct implementation of OpenCV into the MR scanner's reconstruction pipeline. Motion-phantom measurements demonstrate high tracking precision and accuracy with minor processing latency. The feasibility of the pipeline for reliable in-vivo motion extraction was shown on heart and kidney data. Organ motion was manually assessed by independent operators to quantify tracking performance. Object tracking performed convincingly on 7774 navigator images from phantom scans and different organs in volunteers. In particular the kernelized correlation filter (KCF) achieved similar accuracy (74%) as scored from inter-operator comparison (82%) while processing at a rate of over 100 frames per second. We conclude that fast 2D MR navigator images and computer vision object tracking can be used for accurate and rapid prospective motion correction. This and the modular structure of the pipeline allows for the proposed method to be used in imaging of moving organs and in challenging applications like cardiac magnetic resonance spectroscopy (MRS) or magnetic resonance imaging (MRI) guided radiotherapy.

Multimodal convergence in the pedunculopontine tegmental nucleus: Motor, sensory and theta-frequency inputs influence activity of single neurons.

The pedunculopontine tegmental nucleus of the brainstem (PPTg) has extensive interconnections and neuronal-behavioural correlates. It is implicated in movement control and sensorimotor integration. We investigated whether single neuron activity in freely moving rats is correlated with components of skilled forelimb movement, and whether individual neurons respond to both motor and sensory events. We found that individual PPTg neurons showed changes in firing rate at different times during the reach. This type of temporally specific modulation is like activity seen elsewhere in voluntary movement control circuits, such as the motor cortex, and suggests that PPTg neural activity is related to different specific events occurring during the reach. In particular, many neuronal modulations were time-locked to the end of the extension phase of the reach, when fine distal movements related to food grasping occur, indicating strong engagement of PPTg in this phase of skilled individual forelimb movements. In addition, some neurons showed brief periods of apparent oscillatory firing in the theta range at specific phases of the reach-to-grasp movement. When movement-related neurons were tested with tone stimuli, many also responded to this auditory input, allowing for sensorimotor integration at the cellular level. Together, these data extend the concept of the PPTg as an integrative structure in generation of complex movements, by showing that this function extends to the highly coordinated control of the forelimb during skilled reach to grasp movement, and that sensory and motor-related information converges on single neurons, allowing for direct integration at the cellular level.

Accuracy of robotic radiosurgery in renal cell carcinoma.

PURPOSE: Although emerging clinical evidence supports robotic radiosurgery as a highly effective treatment option for renal cell carcinoma (RCC) less than 4 cm in diameter, delivery uncertainties and associated target volume margins have not been studied in detail. We assess intrafraction tumor motion patterns and accuracy of robotic radiosurgery in renal tumors with real-time respiratory tracking to optimize treatment margins. METHODS: Delivery log files from 165 consecutive treatments of RCC were retrospectively analyzed. Five components were considered for planning target volume (PTV) margin estimation: (a) The model error from the correlation model between patient breath and tumor motion, (b) the prediction error from an algorithm predicting the patient breathing pattern, (c) the targeting error from the treatment robot, (d) the inherent total accuracy of the system for respiratory motion tracking, and (e) the margin required to cover potential target rotation, simulated with PTV rotations up to 10°. RESULTS: The median tumor motion was 10.5 mm, 2.4 mm and 4.4 mm in the superior-inferior, left-right, and anterior-posterior directions, respectively. The root of the sum of squares of all contributions to the system's inaccuracy results in a minimum PTV margin of 4.3 mm, 2.6 mm and 3.0 mm in the superior-inferior, left-right and anterior-posterior directions, respectively, assuming optimal fiducial position and neglecting target deformation. CONCLUSIONS: We have assessed kidney motion and derived PTV margins for the treatment of RCC with robotic radiosurgery, which helps to deliver renal treatments in a more consistent manner and potentially further improve outcomes.

Quality of life, craniomandibular function, and psychosocial factors related to pain and movement in patients with head and neck cancer.

PURPOSE: To describe the characteristics of and the associations between health-related quality of life, pain, craniomandibular function, and psychosocial factors related to pain and fear of movement in patients with head and neck cancer. METHODS: Seventy-eight patients diagnosed with HNC were recruited. Measurements of the maximum mouth opening range and pressure pain thresholds on the masseter muscle and the distal phalanx of the thumb were conducted, as well as a battery of self-report questionnaires were administrated, including the QoL Questionnaire (EORT QLQ-H&N35), Numeric Rating Scale (NRS), Pain Catastrophizing Scale (PCS), the Spanish translation of the Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD), and the short version of the Craniofacial Pain and Disability Inventory (CF-PDI-11). RESULTS: The study sample (66.7% men, mean age 60.12 [11.95] years) experienced a moderate impact on their QoL levels (57.68 [18.25] EORT QLQ-H&N35) and high kinesiophobia values (20.49 [9.11] TSK-TMD). Pain was present in 41% of the patients, but only 3.8% reported severe pain. 26.4% had a restricted mouth opening range, and 34.62% showed significant catastrophism levels. There were strong positive correlations between EORT QLQ-H&N35 and CF-PDI-11 (r = 0.81), between NRS and CF-PDI-11 (r = 0.74), and between PCS and CF-PDI-11 (r = 0.66). CONCLUSION: Patients with HNC experience negative effects in their QoL, related to their impairment in craniomandibular function. Fear of movement, pain intensity, and catastrophism are associated with poorer functionality; relationships that should be considered when attempting to improve health care.

Unsupervised MRI motion artifact disentanglement: introducing MAUDGAN.

Objective.This study developed an unsupervised motion artifact reduction method for magnetic resonance imaging (MRI) images of patients with brain tumors. The proposed novel design uses multi-parametric multicenter contrast-enhanced T1W (ceT1W) and T2-FLAIR MRI images.Approach.The proposed framework included two generators, two discriminators, and two feature extractor networks. A 3-fold cross-validation was used to train and fine-tune the hyperparameters of the proposed model using 230 brain MRI images with tumors, which were then tested on 148 patients'in-vivodatasets. An ablation was performed to evaluate the model's compartments. Our model was compared with Pix2pix and CycleGAN. Six evaluation metrics were reported, including normalized mean squared error (NMSE), structural similarity index (SSIM), multi-scale-SSIM (MS-SSIM), peak signal-to-noise ratio (PSNR), visual information fidelity (VIF), and multi-scale gradient magnitude similarity deviation (MS-GMSD). Artifact reduction and consistency of tumor regions, image contrast, and sharpness were evaluated by three evaluators using Likert scales and compared with ANOVA and Tukey's HSD tests.Main results.On average, our method outperforms comparative models to remove heavy motion artifacts with the lowest NMSE (18.34±5.07%) and MS-GMSD (0.07 ± 0.03) for heavy motion artifact level. Additionally, our method creates motion-free images with the highest SSIM (0.93 ± 0.04), PSNR (30.63 ± 4.96), and VIF (0.45 ± 0.05) values, along with comparable MS-SSIM (0.96 ± 0.31). Similarly, our method outperformed comparative models in removingin-vivomotion artifacts for different distortion levels except for MS- SSIM and VIF, which have comparable performance with CycleGAN. Moreover, our method had a consistent performance for different artifact levels. For the heavy level of motion artifacts, our method got the highest Likert scores of 2.82 ± 0.52, 1.88 ± 0.71, and 1.02 ± 0.14 (p-values≪0.0001) for our method, CycleGAN, and Pix2pix respectively. Similar trends were also found for other motion artifact levels.Significance.Our proposed unsupervised method was demonstrated to reduce motion artifacts from the ceT1W brain images under a multi-parametric framework.