RESUMEN
Augmented Reality (AR) has been utilized in multiple applications in the medical field, such as augmenting Computed Tomography (CT) images onto the patient's body during surgery. However, one of the challenges in its utilization is to register the pre-operative CT images to the patient's body accurately. The current registration process requires prior attachment of tracking markers, and their localization within the body and CT images. This process can be cumbersome, error-prone, and dependent on the surgeon's experience. Moreover, there are cases where medical instruments, drapes, or the body may occlude the markers. In light of these limitations, markerless registration algorithms have the potential to aid the registration process in the clinical setting. While those algorithms have been successfully used in other sectors, such as multimedia, they have not yet been thoroughly investigated in a clinical setting, especially in surgery, where there are more challenging cases with different positions of the patients in the image and the surgical environment. In this paper, we benchmarked and evaluated the performance of 6 state-of-the-art markerless registration algorithms from the multimedia sector by registering a CT image onto the whole-body phantom dataset acquired from a simulated surgical environment. We also analyzed the suitability of these algorithms for use in the surgical setting and discussed their potential for the advancement of AR-assisted surgery.Clinical Relevance-Our study provides insight into the potential of AR-assisted surgery and helps practitioners in choosing the most suitable registration algorithm for their needs to improve patient outcomes, reduce the risk of surgical errors and shorten the time of preoperative planning.
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Realidad Aumentada , Cirugía Asistida por Computador , Humanos , Imagenología Tridimensional/métodos , Algoritmos , Tomografía Computarizada por Rayos X/métodosRESUMEN
We present a unique case of bowel obstruction with a hiatus hernia causing atypical chest pain with dynamic ST-segment elevation in a regional Australian emergency department. The ST elevation only resolved after nasogastric decompression of the bowel obstruction. Early thrombolysis of presumed myocardial infarction led to upper gastrointestinal tract bleeding that could have been avoided with timely diagnosis. An extensive review of literature, in addition to our case report, suggests bowel obstruction is a differential diagnosis for patients who have inferior pattern ST elevation but normal troponin presenting with atypical chest pain, nausea, vomiting and previous abdominal surgery.
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BACKGROUND: Paediatric age-adjusted shock index (SIPA) has emerged as a predictor of morbidity and mortality in trauma. Poor sensitivity and low generalisability demonstrated in previous studies have limited its use. We evaluate the use of SIPA in the general Australian paediatric trauma population and the combination of SIPA with GCS. METHODS: All patients from January 2015 to August 2020 at a major Australian paediatric trauma centre were reviewed. Pre-arrival SIPA (pSIPA) and arrival SIPA (aSIPA) were calculated. If SIPA was elevated or the Glasgow Coma Scale ≤ 13, SIPA with mental state (SIPAms) was marked positive for pre-arrival (pSIPAms) and arrival (aSIPAms) respectively. RESULTS/DISCUSSION: Data from 480 patients were analysed. pSIPA and aSIPA poorly predicted outcomes of morbidity. Only aSIPA predicted mortality. However, both pre-arrival and arrival SIPAms variables predict mortality, major trauma (ISS≥12), hospital LOS, need for ICU admission, and major surgery. Furthermore, median ISS and lactate were significantly higher in positive pSIPA, aSIPA, pSIPAms, and aSIPAms groups than negative. aSIPAms has a sensitivity of 76% and specificity of 70% for major trauma. CONCLUSION: Broad inclusion criteria reduce SIPA's ability to predict morbidity. Combining it with GCS improves this and is most valuable when calculated at arrival. In addition, the score is more reliable for major trauma (ISS≥12). Future studies should evaluate the use of SIPAms in activation criteria.
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Heridas y Lesiones , Australia/epidemiología , Niño , Escala de Coma de Glasgow , Humanos , Puntaje de Gravedad del Traumatismo , Morbilidad , Estudios Retrospectivos , Heridas y Lesiones/terapiaRESUMEN
There are multiple approaches described for the repair of stenosed branch pulmonary arteries. Regardless of the technique used, restenosis is common. We describe a case of severe left pulmonary artery stenosis repaired with a novel technique using the native main pulmonary artery which was transected and turned down to create a direct anastomosis with the left pulmonary artery. This tension-free tissue to tissue anastomosis resulted in hemodynamically gratifying results with the potential for growth.
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Arteria Pulmonar , Estenosis de Arteria Pulmonar , Anastomosis Quirúrgica , Humanos , Pulmón , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía , Estenosis de Arteria Pulmonar/diagnóstico por imagen , Estenosis de Arteria Pulmonar/cirugía , Procedimientos Quirúrgicos VascularesRESUMEN
We present an unusual case of atrial septal defect and ventricular septal defect with a vascular ring formed by a right-sided aortic arch with an aberrant left subclavian artery that gave rise to a patent ductus arteriosus connecting to the main pulmonary artery. We performed a single-stage repair of the intracardiac defects and division of vascular ring with a sternotomy instead of the traditionally practiced dual approach. This included division and reimplantation of the aberrant left subclavian artery to the left carotid artery after transection. This approach has not been described so far.
Asunto(s)
Defectos del Tabique Interventricular , Anillo Vascular , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Defectos del Tabique Interventricular/diagnóstico por imagen , Defectos del Tabique Interventricular/cirugía , Humanos , Esternotomía , Arteria Subclavia/diagnóstico por imagen , Arteria Subclavia/cirugíaRESUMEN
BACKGROUND: Epigenetic aging is associated with higher risk of cardiovascular disease, cancer, and all-cause mortality and may be a mechanistic link between early-life exposures, such as maternal dietary characteristics during pregnancy, and risk of adult disease. OBJECTIVES: We sought to determine the early-life risk factors for newborn epigenetic aging, specifically maternal dietary macronutrient intake, and whether epigenetic aging is associated with cardiovascular health markers in the newborn. METHODS: Epigenetic age acceleration of 169 newborns was measured from saliva using the Horvath age calculator. Maternal diet during pregnancy was assessed using food-frequency questionnaires. RESULTS: Newborns with positive age acceleration were more likely to be female and have greater body fatness. Maternal intakes of saturated fat [6.2 wk epigenetic age acceleration (95% CI: 1.0, 11.3) per 5% of energy; P = 0.02] and monounsaturated fat [12.4 wk (95% CI: 4.2, 20.5) per 5% of energy; P = 0.003] were associated with higher epigenetic age acceleration in the newborn. The strongest association of individual fatty acids were for palmitoleic acid (25.3 wk; 95% CI: 11.4, 39.2; P = 0.0004), oleic acid (2.2 wk; 95% CI: 0.8, 3.6; P = 0.002), and palmitic acid (2.9 wk; 95% CI: 1.0, 4.9; P = 0.004) per 1% of energy intake. Vitamin D supplementation was associated with lower epigenetic age acceleration (-8.1 wk; 95% CI: -14.5, -1.7; P = 0.01). Epigenetic age acceleration was associated with aortic intima-media thickness in preterm infants [1.0 µm (95% CI: 0.2, 1.8) per week of epigenetic age acceleration; P = 0.01], but not among those born at term (P = 0.78). Epigenetic age acceleration was not associated with heart rate variability in either preterm or term born infants (both P > 0.2). CONCLUSIONS: This study provides evidence of maternal dietary characteristics that are associated with epigenetic aging in the offspring. Prospective intervention studies are required to determine whether such associations are causal.