A Touchless system for image visualization during surgery: preliminary experience in clinical settings.

Today clinicians may access large medical datasets, but very few systems have been designed to allow a practical and efficient exploration of data directly in critical medical environments such as operating rooms (OR). This work aims to assess during tests in laboratory and clinical settings a Surgery Touchless System (STS). This system allows clinicians to interact with medical images by using two different approaches: a gesture recognition and a voice recognition based system. These two methods are based on the use of a Microsoft Kinect and of a selective microphone, respectively. The STS allows navigating in a specifically designed interface, to perform several tasks, among others, to manipulate biomedical images. In this article, we assessed both the recognitions approaches in laboratory with 5 users. In addition, the STS was tested using only the voice-based recognition approach in clinical settings. The assessment was performed during three procedures by two interventionalradiologists. The five volunteers and the 2 radiologists filled two questionnaires to assess the system. The system usability was positively evaluated in laboratory tests. From clinical trials emerged that the STS was considered safe and useful by both the radiologists: they used the system an averaged number of times of 10 and 15 for patients, and found the system useful. These promising results allow considering this system useful for providing information not otherwise accessible and limiting the impact of human error during the operation. Future work will be focused on the use of the STS on a high number and different types of procedure.

Ex vivo animal-model assessment of a non-invasive system for loss of resistance detection during epidural blockade.

During recent decades epidural analgesia has gained widespread recognition in many applications. In this complex procedure, anaesthetist uses a specific needle to inject anesthetic into the epidural space. It is crucial the appropriate insertion of the needle through inhomogeneous tissues placed between the skin and the epidural space to minimize anesthetic-related complications (e.g., nausea, headache, and dural puncture). Usually, anaesthetists perform the procedure without any supporting tools, and stop pushing the syringe when they sense a loss of resistance (LOR). This phenomenon is caused by the physical properties of the epidural space: the needle breaks the ligamentum flavum and reaches the epidural space, in this stage the anaesthetist perceives a LOR because the epidural space is much softer than the ligamentum flavum. To support the clinician in this maneuver we designed a non-invasive system able to detect the LOR by measuring the pressure exerted on the syringe plunger to push the needle up to the epidural space. In a previous work we described the system and its assessment during in vitro tests. This work aims at assessing the feasibility of the system for LOR detection on a more realistic model (ex vivo pig model). The system was assessed by analyzing: its ability to hold a constant value (saturation condition) during the insertion of the needle, and its ability to detect the entrance within the epidural space by a decrease of the system's output. Lastly, the anaesthetist was asked to assess how the ex vivo procedure mimics a clinical scenario. The system reached the saturation condition during the needle insertion; this feature is critical to avoid false positive during the procedure. However, it was not easy to detect the entrance within the epidural space due to its small volume in the animal model. Lastly, the practitioner found real the model, and performed the procedures in a conventional manner because the system did not influence his actions.

A cost-effective, non-invasive system for pressure monitoring during epidural needle insertion: Design, development and bench tests.

Epidural blockade procedures have gained large acceptance during last decades. However, the insertion of the needle during epidural blockade procedures is challenging, and there is an increasing alarming risk in accidental dural puncture. One of the most popular approaches to minimize the mentioned risk is to detect the epidural space on the base of the loss of resistance (LOR) during the epidural needle insertion. The aim of this paper is to illustrate an innovative and non-invasive system able to monitor the pressure exerted during the epidural blockade procedure in order to detect the LOR. The system is based on a Force Sensing Resistor (FSR) sensor arranged on the top of the syringe's plunger. Such a sensor is able to register the resistance opposed to the needle by the different tissues transducing the pressure exerted on the plunger into a change of an electrical resistance. Hence, on the base of a peculiar algorithm, the system automatically detects LOR providing visual and acoustic feedbacks to the operator improving the safety of the procedure. Experiments have been performed to characterize the measurement device and to validate the whole system. Notice that the proposed solution is able to perform an effective detection of the LOR.

Lymphocyte dysmetabolism: an immunocytochemical comparative approach in IDDM and control subjects.

We have investigated by immuno-electron microscopy the presence of phosphotyrosine in cells as a whole and in different cell districts (nucleus, cytoplasm, plasma membrane, and mitochondria) in peripheral blood lymphocytes of IDDM (insulin-dependent diabetes mellitus) patients and age-matched controls. Immuno-gold particle density was highest in mitochondria and decreased in cytoplasm, nucleus and plasma membrane. The time dependence of phosphotyrosine labelling after cell isolation was very strong in all subcellular populations, with a fall in immunogold staining after 30 min. Staining levels at zero time were similar in controls and IDDM patients; the loss of phosphotyrosine labelling was much stronger in controls, except in the plasma membrane. Plasma membrane NADH oxidoreductase activity, studied using cytosolic NADH as substrate and assayed with DCIP as acceptor, was significantly increased in IDDM patients, suggesting a response to a deficient mitochondrial energetic activity. The fact that NADH oxidoreductase is a growth factor related to tyrosine phosphorylation pathways raises intriguing questions on the cellular derangement occurring in peripheral lymphocytes in IDDM, although the relationships among the immunocytochemical and biochemical changes is still obscure.

Tyrosine phosphorylation in type-1 diabetes by immunogold detection: an in vitro human aortic endothelial cell (HAEC) study in the presence of diabetic low density lipoproteins (LDL).

An immunomorphometric study of tyrosine phosphorylation was performed by the immunogold technique on cultured human aortic endothelial cells (HAEC) with a view to demonstrating their impaired signal transduction status, induced in vitro by incubation with low-density lipoproteins from the plasma of Type-1 diabetic patients. The results seem to sustain the hypothesis that extranuclear bioenergetic derangement induced by low-density lipoproteins from Type-1 diabetic patients may be associated with an up-regulation of the nuclear energetic machinery aimed at maintaining intracellular metabolic equilibrium. Our data demonstrate that phosphorylated tyrosine is a useful marker to monitor this metabolic condition.

Increased susceptibility to peroxidation of VLDL from non-insulin-dependent diabetic patients: a possible correlation with fatty acid composition.

Recent studies suggested that both oxidized very low density lipoproteins (VLDL) and oxidized high density lipoproteins (HDL) might play a role in the pathogenesis of atherosclerosis. The aim of the present work was to analyse the susceptibility to in vitro peroxidation of VLDL and HDL from apparently normolipidemic subjects affected by insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) in good metabolic control and to examine the possible relations between oxidisability and lipoprotein fatty acid composition. VLDL and HDL were isolated from 13 IDDM patients, 12 NIDDM patients and 18 healthy subjects. The degree of lipoprotein oxidation was determined by the measurement of hydroperoxide levels and thiobarbituric acid-reactive substances (TBARS) before and after in vitro peroxidative stress with CuSO4. Fatty acid analysis was performed by gas chromatography. VLDL and HDL from NIDDM patients showed a decrease in the saturated fatty acid content with a concomitant increase in unsaturated fatty acids and higher basal peroxide levels compared with healthy subjects. Oxidisability of VLDL from NIDDM subjects was higher than in controls and was significantly related with the unsaturated fatty acid content. The present work suggests that alterations in the composition and functions of both VLDL and HDL able to produce more atherogenic lipoproteins are present in NIDDM.

Osteoblast behaviour in the presence of bisphosphonates: ultrastructural and biochemical in vitro studies.

OBJECTIVE: A positive balance in bone remodelling is an important goal of bone metabolism both in the presence of the osteoporotic processes characteristic of ageing and, especially, of prosthetic implants. The aim of the present work was to obtain new information about the initial steps of osteoblastic growth in an in vitro osteoblastic model in the presence of two bisphosphonates. METHODS: Experiments were performed with Alendronate and Neridronate, two molecules used in the therapy of osteoporosis. Since differentiating features into osteoblastic cells are known to parallel the presence in the cytoplasm of alkaline phosphatase and osteocalcin, we also carried out immunohistochemical typing. RESULTS: Good differentiation and osteoblastic activity were generally observed in the cells in contact with these compounds, except for 10(-4) Neridronate, where biochemical data clearly indicated its toxic effect on the cells. CONCLUSION: The detection of osteoblastic markers associated with an ultrastructural picture of correct organellar morphology in our cultures further supports the hypothesis of a metabolically positive action of these molecules on osteoblasts.

Histomorphometric studies in rat cerebral cortex: normal aging and cell loss.

One characteristic feature of the aged central nervous system (CNS) is neuron loss. Programmed cell death (PCD) has been implicated in neuronal death during development and may be involved in a number of age-related neurodegenerative diseases of the CNS. Cell death in the aging cerebral cortex was investigated in the present morphometric and immunohistochemical study of rat frontal cortex by detection of bcl-2 as the factor preventing PCD. The results were interpreted in the light of the bioenergetic features of aged motoneuron cells. Our results showed that 1) bcl-2 does not influence neuronal survival, and ii) the presence in aging frontal cortex of minor cellular morphometric and bioenergetic modifications, confirming the difference between normal aging and neurodegenerative disease.

Diabetes mellitus and subjects' ageing: a study on the ATP content and ATP-related enzyme activities in human erythrocytes.

Na+/K(+)- and Ca(2+)-ATPase are the major ATP-dependent membrane-bound enzymes that regulate the cation transmembrane gradient which is altered both in red blood cell (RBC) senescence and in RBCs of diabetic patients. In an attempt to clarify the possible connection between diabetes mellitus and ageing, we investigated the relationship between RBC ATP content, Na+/K(+)-ATPase, Ca(2+)-ATPase activities and ageing in healthy, insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) subjects. A significant correlation was found (r = -0.82; P < 0.001) between RBC ATP content and subject's age only in the control group. A significant reduction in Na+/K(+)-ATPase activity was observed in the older group (C2) of control subjects, in comparison with the younger (C1) one. In both IDDM and NIDDM subjects, the enzymatic activity was significantly decreased when compared with health subjects of similar age (P < 0.001). A significant negative correlation was found between age and enzymatic activity in healthy subjects (r = -0.60; P < 0.001). No difference was observed in the RBC membrane Ca(2+)-ATPase activity between younger (C1) and older (C2) healthy subjects. Ca(2+)-ATPase activity was significantly increased both in IDDM patients compared with C1 (P < 0.001) and in NIDDM patients compared with C2 (P < 0.001). The present data indicate that ageing causes a reduction in the erythrocyte ATP content in both healthy and diabetic subjects. In diabetic patients Na+/K(+)-ATPase activity decreases independently of age.

Sialic acid, diabetes, and aging: a study on the erythrocyte membrane.

Sialic acid (SA) content and Na+/K+-ATPase activity of red blood cell (RBC) membranes were studied in 26 normoalbuminuric patients with insulin-dependent diabetes mellitus (IDDM), 25 normoalbuminuric patients with non-insulin-dependent diabetes mellitus (NIDDM), and 40 healthy nondiabetic subjects with a negative family history for diabetes. A decrease in RBC membrane SA content and Na+/K+-ATPase activity was observed in older control subjects compared with younger controls. A significant correlation between age, Na+/K+-ATPase activity, and SA content was also found. No difference was observed in RBC membrane SA content between IDDM and NIDDM subjects, but Na+/K+-ATPase activity was significantly lower in IDDM patients. SA content was increased in NIDDM subjects compared with healthy subjects of similar age, whereas Na+/K+-ATPase activity was significantly lower in both IDDM and NIDDM subjects compared with controls. In NIDDM, Na+/K+-ATPase activity was significantly correlated with age, whereas both Na+/K+-ATPase activity and SA content were significantly correlated in IDDM and NIDDM patients. Hemoglobin A1c, (HbA1c) levels did not show any significant correlation either with Na+/K+-ATPase or with SA content in diabetic patients. The modified SA content and Na+/K+-ATPase activity in elderly subjects described in the present study indicate a similar behavior of the erythrocyte membrane during both RBC senescence and aging of subjects.

Modifications of functional and physico-chemical properties of rat ileal plasma membranes.

A membrane fraction enriched with plasma membranes was isolated from rat ileal brush-border cells before and after five-day starvation of the animals. Cholesterol/phospholipid ratio of the standard cell membranes decreased highly significantly (0.42 to 0.18), as did the microviscosity of the membranes determined by polarization of fluorescence (0.187 to 0.142). Concomitantly, the specific activity of Na,K-ATPase in the basolateral membranes significantly increased (59 to 83 mumol ATP hydrolyzed per mg protein per min).