Surgical navigation for guidewire placement from intraoperative fluoroscopy in orthopaedic surgery.

Objective. Surgical guidewires are commonly used in placing fixation implants to stabilize fractures. Accurate positioning of these instruments is challenged by difficulties in 3D reckoning from 2D fluoroscopy. This work aims to enhance the accuracy and reduce exposure times by providing 3D navigation for guidewire placement from as little as two fluoroscopic images.Approach. Our approach combines machine learning-based segmentation with the geometric model of the imager to determine the 3D poses of guidewires. Instrument tips are encoded as individual keypoints, and the segmentation masks are processed to estimate the trajectory. Correspondence between detections in multiple views is established using the pre-calibrated system geometry, and the corresponding features are backprojected to obtain the 3D pose. Guidewire 3D directions were computed using both an analytical and an optimization-based method. The complete approach was evaluated in cadaveric specimens with respect to potential confounding effects from the imaging geometry and radiographic scene clutter due to other instruments.Main results. The detection network identified the guidewire tips within 2.2 mm and guidewire directions within 1.1°, in 2D detector coordinates. Feature correspondence rejected false detections, particularly in images with other instruments, to achieve 83% precision and 90% recall. Estimating the 3D direction via numerical optimization showed added robustness to guidewires aligned with the gantry rotation plane. Guidewire tips and directions were localized in 3D world coordinates with a median accuracy of 1.8 mm and 2.7°, respectively.Significance. The paper reports a new method for automatic 2D detection and 3D localization of guidewires from pairs of fluoroscopic images. Localized guidewires can be virtually overlaid on the patient's pre-operative 3D scan during the intervention. Accurate pose determination for multiple guidewires from two images offers to reduce radiation dose by minimizing the need for repeated imaging and provides quantitative feedback prior to implant placement.

An outbreak of multiple genotypes of Listeria monocytogenes in New Zealand linked to contaminated ready-to-eat meats-a retrospective analysis using whole-genome sequencing.

Four cases of listeriosis in a hospital (A) in New Zealand were identified in 2012. Pulsed-field gel electrophoresis (PFGE) used at the time identified four pulsotypes amongst the clinical isolates. Two of the pulsotypes matched to Listeria monocytogenes isolates obtained from ready-to-eat (RTE) meat samples from a RTE producer tested during a nationwide microbiological survey the month prior. The outbreak investigation confirmed that the RTE producer had supplied product to the hospital and additional testing confirmed the presence of L.  monocytogenes in RTE meats from the hospital kitchen. Two further listeriosis cases presented in another hospital (B) with one clinical isolate identified as the same pulsotype as identified for one case in hospital A, but the epidemiology information concluded that the clinical cases from hospital B were not linked to the outbreak. Retrospective whole-genome sequencing confirmed that epidemiologically linked isolates belonging to three different genotypes for clinical cases from hospital A and RTE meats samples from the hospital kitchen differed by 0-1 core-genome locus or single nucleotide polymorphisms (SNP). The use of core-genome multilocus sequence typing and SNP analysis provided a greater degree of discrimination between isolates compared to PFGE. SIGNIFICANCE AND IMPACT OF THE STUDY: This study describes a listeriosis outbreak associated with a hospital in New Zealand and attributed to contaminated ready-to-eat (RTE) meat supplied to the hospital by a single producer. Retrospective whole-genome sequence analysis of outbreak isolates was found to provide a greater degree of discrimination between isolates compared to pulsed-field gel electrophoresis and supported the conclusions made at the time of the outbreak. The multiple genotypes identified from clinical cases and the RTE meats obtained during the outbreak highlight the importance of epidemiological concordance alongside genotyping.

[Prism adaptation test before strabismus surgery : Results of a survey and literature review]. / Prismenadaptationstest vor Schieloperationen : Ergebnisse einer Umfrage und Literaturreview.

BACKGROUND: Variable preoperative deviations and compensatory mechanisms may cause wrong dosage of strabismus surgery and result in over- or undercorrection. A long-lasting prism adaptation test (PAT) before surgery is supposed to reduce those difficulties and to improve the postoperative results. To date, the use of prism adaptation before surgery has not been systematically examined. METHODS: A total of 15 strabismologists and 28 orthoptists in Austria were interviewed about their approach to prism adaptation in 9 types of strabismus. They were also asked about the basis of their decision for a certain treatment regime. RESULTS: Of those interviewed, 28% performed preoperative prism adaptation for weeks to years. Of those, 7% based their decision on evidence from the literature, 54% decide on personal experience, 15% due to guidelines of their institution, and 23% follow the teaching of their medical school. DISCUSSION: Reports in the literature reveal inconsistent results on PAT. In published studies, PAT was rarely performed longer than 4 weeks and only shows significant improvements on outcome in particular pathologies as acquired esotropia. Long-term PAT appears questionable as to date there is no evidence for a better postoperative outcome. Before setting up guidelines, further controlled, prospective studies on PAT must be conducted.

Time-resolved investigation of coherently controlled electric currents at a metal surface.

Studies of current dynamics in solids have been hindered by insufficiently brief trigger signals and electronic detection speeds. By combining a coherent control scheme with photoelectron spectroscopy, we generated and detected lateral electron currents at a metal surface on a femtosecond time scale with a contact-free experimental setup. We used coherent optical excitation at the light frequencies omega(a) and omega(a)/2 to induce the current, whose direction was controlled by the relative phase between the phase-locked laser excitation pulses. Time- and angle-resolved photoelectron spectroscopy afforded a direct image of the momentum distribution of the excited electrons as a function of time. For the first (n = 1) image-potential state of Cu(100), we found a decay time of 10 femtoseconds, attributable to electron scattering with steps and surface defects.

[The primary objective in macular hole surgery. Ultrastructural features of the vitreomacular interface]. / Operative Zielvorgabe in der Makulaforamenchirurgie. Neue Aspekte zur Feinstruktur der vitreomakulären Grenzfläche.

We compared the ultrastructure of the inner limiting membrane (ILM) and epiretinal tissue in closed and non-closed, idiopathic macular holes (MH). Peeling of ILM and epimacular tissue during vitrectomy was successfully performed on 77 eyes with stage III MH and on 19 eyes with stage IV MH. In 16 additional eyes with non-closed MH, we performed a second vitrectomy with extended ILM removal. The specimens were processed for transmission electron microscopy. Fibrocellular proliferation at the vitreal side of the ILM was found in 57% of MH that were closed by one operation, and in 100% of non-closed MH. Mono- and multilayered cellular membranes as well as native vitreous collagen at the ILM were significantly more frequent in eyes with stage IV MH than in eyes with stage III MH. In non-closed MH, cellular proliferation was mostly seen as irregular cell accumulation, and masses of newly formed collagen were found. Since ILM remnants and collagen represent a stimulus for the early formation of tangential traction preventing successful MH closure, it appears mandatory to create a complete vitreoretinal separation and to remove the ILM and collagen thoroughly during MH surgery.

Time-resolved two-photon photoemission of buried interface states in Ar/Cu(100).

We demonstrate the existence of buried image-potential states at the interface between thick Ar films and a Cu(100) substrate. The electron dynamics of these solid-solid interface states, energetically located above the vacuum level in the band gaps of both materials, could be investigated with time-resolved two-photon photoemission for an Ar layer thickness up to 200 A. Relaxation on time scales between 40 and 200 fs occurs via two distinct channels, resonant tunneling through the insulating layer into the vacuum and electron-hole pair decay in the metal.

Ultrastructure of vitreomacular traction syndrome associated with persistent hyaloid artery.

AIM: To demonstrate the ultrastructure of vitreomacular traction associated with persistent hyaloid artery. METHODS: Pars plana vitrectomy was performed in a 66-year-old man with progressive vitreomacular traction associated with a persistent hyaloid artery. Epimacular tissue was peeled and processed for transmission electron microscopy. RESULTS: Ultrastructural analysis revealed multiple sheets of cellular and collagenous components. Myofibroblasts and newly formed collagen were the predominant features. Fibrous astrocytes, fibroblasts, macrophages, and basement membrane were also present. CONCLUSION: The cellular composition of the epimacular tissue and high cellular activity suggest that persistence of the hyaloid artery may contribute to the development of vitreomacular traction.

Epiretinal pathology of vitreomacular traction syndrome.

AIMS: To investigate the ultrastructure of the vitreoretinal interface in patients with vitreomacular traction syndrome. METHODS: 14 patients with vitreomacular traction syndrome underwent standard pars plana vitrectomy. After induction of posterior vitreous detachment, epiretinal tissue and the inner limiting membrane (ILM) of the retina were removed, and processed for transmission electron microscopy. RESULTS: Ultrastructural analysis revealed two basic patterns of vitreoretinal pathology in eyes with vitreomacular traction syndrome. Seven specimens showed mostly single cells or a cellular monolayer covering closely the vitreal side of the ILM, not resulting in a biomicroscopically detectable epiretinal fibrocellular proliferation. The other seven specimens revealed premacular fibrocellular tissue which was separated from the ILM by a layer of native collagen, resembling the clinical features of idiopathic epiretinal membranes. In both groups of eyes, the myofibroblast was the predominant cell type. Fibrous astrocytes and fibrocytes were less frequent. Retinal pigment epithelial cells and macrophages were absent. Deposits of newly formed collagen were present only adjacent to fibrocellular multilayers. CONCLUSIONS: There are two distinct clinicopathological features of vitreomacular traction syndrome which suggest different forms of epiretinal fibrocellular proliferation: (1) epiretinal membranes interposed in native vitreous collagen and (2) single cells or a cellular monolayer proliferating directly on the ILM. The presence of remnants of the cortical vitreous which remain attached to the ILM following posterior vitreous separation may determine the clinicopathological feature of the disease. The predominance of myofibroblasts may help to explain the high prevalence of cystoid macular oedema and progressive vitreomacular traction characteristic for this disorder.

Application of an enzyme-immunoassay (EIA) for rapid screening of 5 alpha-pregnane-3,20-dione (DHP) in blood plasma of the Asian elephant, Elephas maximus.

Populations of African (Loxodonta Africana) and Asian Elephants (Elephas maximus) in zoos and safari parks are at risk due to their low reproductive success. To extend the limited knowledge of their reproductive physiology, the development of easy and practical methods for the analysis of the relevant reproductive hormones is essential to support e.g. assisted reproduction. For the measurement of 5 alpha-pregnane-3,20-dione (DHP), the predominant ovarian gestagen in both species, an enzyme-immunoassay (EIA) based on commercial reagents was applied. Advantages of this EIA are the small volume of plasma needed for evaluation (5 microliters) and the possibility of direct processing without an extraction stage. The lower limit of detection was 0.16 ng/ml, the mean recovery was 101% and the mean coefficients of variation were 7.3% (intra-assay) and 9.9% (inter-assay). In Asian elephants, DHP levels reached 15 ng/ml during the luteal phase and up to 21 ng/ml during pregnancy. Estrous cycle lengths based on the lowest DHP concentrations varied from 12 to 20 weeks (mean 15.4 +/- 2.3). In two Asian elephant cows a calf was still-borne. Thereafter, the animals reassumed ovarian activity after approximately 8 and 13 weeks, respectively. In one animal estradiol implants for hormonal contraception caused a down regulation of the ovarian function as demonstrated by an irregular pattern of DHP secretion over a period of 48 weeks. We propose the direct DHP-EIA as a suitable method for reproductive monitoring in elephants, as it can be easily established in laboratories.

Differences between antigenic determinants of pig and cat zona pellucida proteins.

Despite many efforts, the control of reproduction in feral cat populations is still a problem in urban regions around the world. Immunocontraception is a promising approach; thus the present study examined the suitability of the widely used pig zona pellucida proteins (pZP) for contraception in feral domestic cats. Purified zona pellucida proteins obtained from pig and cat ovaries were used to produce highly specific antisera in rabbits. Antibodies against pZP raised in rabbits or lions were not effective inhibitors of either in vitro sperm binding (cat spermatozoa to cat oocytes) or in vitro fertilization in cats, whereas antibodies against feline zona pellucida proteins (fZP) raised in rabbits showed a dose-dependent inhibition of in vitro fertilization. Immunoelectrophoresis, ELISA and immunohistology of ovaries confirmed these results, showing crossreactivity of anti-fZP sera to fZP and to a lesser extent to pZP, but no interaction of anti-pZP sera with fZP. It is concluded that cat and pig zonae pellucidae express a very small number of shared antigenic determinants, making the use of pZP vaccine in cats questionable. A contraceptive vaccine based on feline zona pellucida determinants will be a better choice for the control of reproduction in feral cats if immunogenity can be achieved.

[Sex steroid profiles and ovarian activities of the female panda Yan Yan in the Berlin Zoo]. / Sexualsteroidprofile und Ovaraktivitäten des Pandaweibchens YAN YAN im Berliner Zoo.

The nine years old giant panda YAN YAN was received in April 1995 on loan for 5 years to the Berlin Zoo. Urine samples were collected daily or every second day from April 1995 to June 1996 in order to follow up sex hormone secretions and ovarian activities. Conjugated steroids were hydrolysed, extracted and measured with two enzyme immuno assays (EIA) being specific for either total oestrogenes or pregnandiol. The evaluation of the hormone secretion pattern yielded the following results: There is a significant synchronous cross correlation between estrogen and progestin metabolites secretion indicating its simultaneous synthesis. In addition, we found a regular increase and decrease of both hormones with a 13 days interval. This secretory pattern indicates repeating development and atresia of follicle cohorts with a cycle length of about 13 days. Only a single period of slightly elevated oestrogen synthesis was monitored in Feb. 96 without any signs of oestrus. Obviously the stimulation of ovarian function was insufficient for complete ovulation and corpus luteum formation.