Quality control in treating patients with patent foramen ovale: 7-year-experience of the Heart and Brain team of the Careggi University Hospital.

BACKGROUND: The right comprehension of ischemic stroke pathogenesis guarantees the best prevention therapy. The term "patent foramen ovale (PFO) related stroke" has been proposed for those events where PFO is supposed to be pathogenetic, but their definition is challenging. A multidisciplinary evaluation in a "Heart & Brain" team (HBteam) including stroke neurologists and interventional cardiologists was therefore highly recommended in the recent guidelines of secondary stroke prevention. OBJECTIVE: We aimed at describing the organization of the HBteam of Careggi-University-Hospital of Florence (Italy), and the results of the first seven years of activity. METHODS: In 2016 Interventional Cardiologists and Stroke Neurologists set up an outpatient clinic for the joined evaluation of patients with PFO and other cardio/neurological conditions. A specific diagnostic-therapeutic hospital plan was produced for PFO patients. Patient empowerment was guaranteed by a hospital explicative webpage, a booklet regarding risks/benefits of PFO closure and a 3D heartmodel to simulate the intervention. Data were collected in a dedicated registry. RESULTS: We evaluated 594 patients for PFO, 40 for left atrial appendage closure and 38 for other conditions. In 20% of PFO-patients, HBteam diagnosis was discordant from that of referring physicians, 14% were stroke misdiagnoses. We advised against closure in 53% of patients. At follow-up 94% of closed patients had no/minimum residual shunt; 3 patients had a cerebral ischemic event. CONCLUSIONS: A dedicated HBteam represents a unique opportunity to share decisions with patients after a thorough empowerment process. The joining of cardioneurological skills allows a better classification of PFO-patients, reducing futile interventions.

Modelling and fabrication procedure for a 3D printed cardiac model - surgical planning of Left Ventricular Aneurysm.

The present paper describes a procedure for the development and production of a physical model for surgical planning of a Left Ventricular Aneurysm. The method is based on the general approach provided in Otton et al. (2017) and was customized to seek a reliable and fast procedure for the production of a specific type of cardiac model - i.e. chambers of the left side of the heart. The paper covers all the steps: processing of the data, segmentation, modelling and 3D printing; details are provided for all the phases, in order to allow the reproduction of the achieved results. The procedure relies on Computed Tomography - CT imaging as data source for the identification and modelling of the anatomy. Materialise Mimics was used as segmentation software to process the CT data. While its usefulness for the surgical needs was verified on a single clinical case (provided by the Careggi Hospital of Florence, Italy), the modelling procedure was tested twice, to produce a physical replica both ex-ante and ex-post surgical intervention.•The tools used for segmentation and generation of the printable model were customized to reduce modelling time for the specific type of desired model.•Detailed information on the use of modeling tools, not available in the literature, will be provided.•The procedure allows fabrication of a physical model representing the heart chambers in a short time.

Machine Learning for Renal Pathologies: An Updated Survey.

Within the literature concerning modern machine learning techniques applied to the medical field, there is a growing interest in the application of these technologies to the nephrological area, especially regarding the study of renal pathologies, because they are very common and widespread in our society, afflicting a high percentage of the population and leading to various complications, up to death in some cases. For these reasons, the authors have considered it appropriate to collect, using one of the major bibliographic databases available, and analyze the studies carried out until February 2022 on the use of machine learning techniques in the nephrological field, grouping them according to the addressed pathologies: renal masses, acute kidney injury, chronic kidney disease, kidney stone, glomerular disease, kidney transplant, and others less widespread. Of a total of 224 studies, 59 were analyzed according to inclusion and exclusion criteria in this review, considering the method used and the type of data available. Based on the study conducted, it is possible to see a growing trend and interest in the use of machine learning applications in nephrology, becoming an additional tool for physicians, which can enable them to make more accurate and faster diagnoses, although there remains a major limitation given the difficulty in creating public databases that can be used by the scientific community to corroborate and eventually make a positive contribution in this area.

Case Report: Three-Dimensional Printing Model for Surgical Planning of Left Ventricular Aneurysm: Evolution Toward Tailoring Surgery.

A 59-year-old woman was admitted to the emergency department for heart failure (HF), New York Heart Association (NYHA) IV, showing an anterior, evolved myocardial infarction (MI) with a wide apical left ventricular aneurysm (LVA), ejection fraction (EF) 24%, and global longitudinal strain (GLS) -5. 5% by echo. Cardiac magnetic resonance imaging (MRI) confirmed an apical LVA without thrombus, EF 20%, and a transmural delayed enhancement in the myocardium wall. Coronarography showed a three-vessel disease with occluded proximal left anterior descending (LAD) and proximal right coronary artery (RCA). Based on the cardiac CT scan, we decided to generate a three-dimensional (3D) print model of the heart, for better prediction of residual LV volumes. After LVA surgery plus complete functional revascularization, an optimal agreement was found between predicted and surgical residual LV end-diastolic (24.7 vs. 31.8 ml/m2) and end-systolic (54.1 vs. 69.4 ml/m2) volumes, with an improvement of NYHA class, from IV to I. The patient was discharged uneventfully and at 6- and 12-month follow-up, the NYHA class, and LV volumes were found unchanged. This is a second report describing the use of the 3D print model for the preoperative planning of surgical management of LVA; the first report was described by Jacobs et al. among three patients, one with a malignant tumor and the remaining two patients with LVA. This article focused on the use of the 3D print model to optimize surgical planning and individualize treatment of LVA associated with complete functional revascularization, leading to complete recovery of LV function with a favorable outcome.

Wearable Robots: An Original Mechatronic Design of a Hand Exoskeleton for Assistive and Rehabilitative Purposes.

Robotic devices are being employed in more and more sectors to enhance, streamline, and augment the outcomes of a wide variety of human activities. Wearable robots arise indeed as of-vital-importance tools for telerehabilitation or home assistance targeting people affected by motor disabilities. In particular, the field of "Robotics for Medicine and Healthcare" is attracting growing interest. The development of such devices is a primarily addressed topic since the increasing number of people in need of rehabilitation or assistive therapies (due to population aging) growingly weighs on the healthcare systems of the nation. Besides, the necessity to move to clinics represents an additional logistic burden for patients and their families. Among the various body parts, the hand is specially investigated since it most ensures the independence of an individual, and thus, the restoration of its dexterity is considered a high priority. In this study, the authors present the development of a fully wearable, portable, and tailor-made hand exoskeleton designed for both home assistance and telerehabilitation. Its purpose is either to assist patients during activities of daily living by running a real-time intention detection algorithm or to be used for remotely supervised or unsupervised rehabilitation sessions by performing exercises preset by therapists. Throughout the mechatronic design process, special attention has been paid to the complete wearability and comfort of the system to produce a user-friendly device capable of assisting people in their daily life or enabling recorded home rehabilitation sessions allowing the therapist to monitor the state evolution of the patient. Such a hand exoskeleton system has been designed, manufactured, and preliminarily tested on a subject affected by spinal muscular atrophy, and some results are reported at the end of the article.

Metrological Characterization and Comparison of D415, D455, L515 RealSense Devices in the Close Range.

RGB-D cameras are employed in several research fields and application scenarios. Choosing the most appropriate sensor has been made more difficult by the increasing offer of available products. Due to the novelty of RGB-D technologies, there was a lack of tools to measure and compare performances of this type of sensor from a metrological perspective. The recent ISO 10360-13:2021 represents the most advanced international standard regulating metrological characterization of coordinate measuring systems. Part 13, specifically, considers 3D optical sensors. This paper applies the methodology of ISO 10360-13 for the characterization and comparison of three RGB-D cameras produced by Intel® RealSense™ (D415, D455, L515) in the close range (100-1500 mm). ISO 10360-13 procedures, which focus on metrological performances, are integrated with additional tests to evaluate systematic errors (acquisition of flat objects, 3D reconstruction of objects). The present paper proposes an off-the-shelf comparison which considers the performance of the sensors throughout their acquisition volume. Results have exposed the strengths and weaknesses of each device. The D415 device showed better reconstruction quality on tests strictly related to the short range. The L515 device performed better on systematic depth errors; finally, the D455 device achieved better results on tests related to the standard.

CAD-based automatic modelling of customized cutting templates for Pectus Arcuatum surgical correction.

Pectus Arcuatum (PA) is a congenital chest wall deformity which produces a superior manubrial and sternal protrusion, particularly at the sternal angle. PA surgical correction to reduce the angle of the sternum always includes the removal of bone portion by means of horizontal sternal osteotomies, resection of deformed rib cartilage and finally stabilization of the anterior thoracic wall. Within this process an incorrect assessment of the sternotomy angle during the procedure may lead to the need for bone or cartilage grafts to fill the left voids. This problem has been addressed with a patient-specific cutting template, realized with Reverse Engineering and Additive Manufacturing techniques, which proved to be a key element to simplify the procedure and avoid the occurrence of this type of complications. In this work is presented and validated a procedure that, through common CAD operations, realizes in a completely automatic way the CAD model of the custom cutting template, so as to make non-expert users independent in the realization of the medical device.

Scene Acquisition with Multiple 2D and 3D Optical Sensors: A PSO-Based Visibility Optimization.

Designing an acquisition system for 2D or 3D information, based on the integration of data provided by different sensors is a task that requires a labor-intensive initial design phase. Indeed, the definition of the architecture of such acquisition systems needs to start from the identification of the position and orientation of the sensors observing the scene. Their placement is carefully studied to enhance the efficacy of the system. This often coincides with the need to maximize the surfaces observed by the sensors or some other metric. An automatic optimization procedure based on the Particle Swarm Optimization (PSO) algorithm, to seek the most convenient setting of multiple optical sensors observing a 3D scene, is proposed. The procedure has been developed to provide a fast and efficient tool for 2D and 3D data acquisition. Three different objective functions of general validity, to be used in future applications, are proposed and described in the text. Various filters are introduced to reduce computational times of the whole procedure. The method is capable of handling occlusions from undesired obstacle in the scene. Finally, the entire method is discussed with reference to 1) the development of a body scanner for the arm-wrist-hand district and 2) the acquisition of an internal environment as case studies.

Pectus Carinatum: a non-invasive and objective measurement of severity.

To date, standard methods for assessing the severity of chest wall deformities are mostly linked to X-ray and CT scans. However, the use of radiations limits their use when there is a need to monitor the development of the pathology over time. This is particularly important when dealing with patients suffering from Pectus Carinatum, whose treatment mainly requires the use of corrective braces and a systematic supervision. In recent years, the assessment of severity of chest deformities by means of radiation-free devices became increasingly popular but not yet adopted as standard clinical practice. The present study aims to define an objective measure by defining a severity index (named External Pectus Carinatum Index) used to monitor the course of the disease during treatment. Computed on the optical acquisition of the patients' chest by means of an appositely devised, fast and easy-to-use, body scanner, the proposed index has been validated on a sample composed of a control group and a group of Pectus Carinatum patients. The index proved to be reliable and accurate in the characterization of the pathology, enabling the definition of a threshold that allows to distinguish the cases of patients with PC from those of healthy subjects. Graphical abstract.

Are We Ready to Build a System for Assisting Blind People in Tactile Exploration of Bas-Reliefs?

Nowadays, the creation of methodologies and tools for facilitating the 3D reproduction of artworks and, contextually, to make their exploration possible and more meaningful for blind users is becoming increasingly relevant in society. Accordingly, the creation of integrated systems including both tactile media (e.g., bas-reliefs) and interfaces capable of providing the users with an experience cognitively comparable to the one originally envisioned by the artist, may be considered the next step for enhancing artworks exploration. In light of this, the present work provides a description of a first-attempt system designed to aid blind people (BP) in the tactile exploration of bas-reliefs. In detail, consistent hardware layout, comprising a hand-tracking system based on Kinect(®) sensor and an audio device, together with a number of methodologies, algorithms and information related to physical design are proposed. Moreover, according to experimental test on the developed system related to the device position, some design alternatives are suggested so as to discuss pros and cons.