Disease associations between honeybees and bumblebees as a threat to wild pollinators.

Emerging infectious diseases (EIDs) pose a risk to human welfare, both directly and indirectly, by affecting managed livestock and wildlife that provide valuable resources and ecosystem services, such as the pollination of crops. Honeybees (Apis mellifera), the prevailing managed insect crop pollinator, suffer from a range of emerging and exotic high-impact pathogens, and population maintenance requires active management by beekeepers to control them. Wild pollinators such as bumblebees (Bombus spp.) are in global decline, one cause of which may be pathogen spillover from managed pollinators like honeybees or commercial colonies of bumblebees. Here we use a combination of infection experiments and landscape-scale field data to show that honeybee EIDs are indeed widespread infectious agents within the pollinator assemblage. The prevalence of deformed wing virus (DWV) and the exotic parasite Nosema ceranae in honeybees and bumblebees is linked; as honeybees have higher DWV prevalence, and sympatric bumblebees and honeybees are infected by the same DWV strains, Apis is the likely source of at least one major EID in wild pollinators. Lessons learned from vertebrates highlight the need for increased pathogen control in managed bee species to maintain wild pollinators, as declines in native pollinators may be caused by interspecies pathogen transmission originating from managed pollinators.

Comparison of diflunisal and an aspirin-codeine combination in the management of patients having one-visit endodontic therapy.

One hundred seventy-nine patients with asymptomatic or mildly symptomatic endodontic disease had single-visit therapy and were given either diflunisal (n = 94) or aspirin with codeine (n = 85) to control posttreatment pain. In this open-label, randomized study, diflunisal was judged superior to the aspirin-codeine combination in all major categories evaluated. Of patients receiving diflunisal, 93.6% needed the medication for only one day. In contrast, 77.7% of patients receiving aspirin with codeine needed the medication for only one day. Almost 64% of patients receiving diflunisal needed only one dose, while 32.9% of patients using aspirin with codeine needed only one dose. Four or more doses were required by 5.3% of patients receiving diflunisal and by 23.5% of patients receiving the aspirin-codeine combination. In patients receiving diflunisal, 20.2% experienced side effects. In contrast, 29.4% of patients receiving aspirin with codeine reported side effects. Thirty-five percent of patients receiving diflunisal rated the analgesic as excellent; 5.3% rated it as fair or poor. In contrast, 12.9% of patients receiving aspirin with codeine rated the analgesic combination as excellent; another 12.9% rated it as fair or poor. Diflunisal was found to be generally effective and well-tolerated, and superior to aspirin with codeine in the management of pain from endodontic treatment.

Effect of hypoxemia and ethacrynic acid on ABR and distortion product emission thresholds.

Various studies have shown that induction of hypoxemia in animals such that arterial blood oxygen tensions reach 20-30 mm Hg is accompanied by reversible threshold elevations of the auditory nerve-brain-stem evoked response (ABR). In this state, the endocochlear potential (EP) is depressed, causing a smaller potential difference across the hair cells and/or reduced activity of the cochlear amplifier of the outer hair cells. In order to test these possibilities, ABR threshold (an expression of the overall sensitivity of the cochlea) and changes in threshold of the cubic (2f1-f2) distortion product emissions (DPE) (an expression of activity of the cochlear amplifier) were measured in the same cats while the EP was depressed by hypoxemia or by ethacrynic acid. During the episodes of hypoxemia, DPE thresholds were elevated by 10 dB while ABR thresholds were elevated by 22.8 dB. Therefore, it seems that a normal EP is necessary both for normal cochlear transduction (inner hair cells) and for normal cochlear amplification (outer hair cells). The human fetus in utero is relatively hypoxic and there is evidence that its auditory threshold is also similarly elevated. Therefore the threshold elevation in the fetus in utero, estimated to be about 20 dB, is a consequence of both reduced transduction current through the inner hair cells (about 10 dB) and an additional 10 dB reduction in the activity of the cochlear amplifier of the outer hair cells.

Differences of CT (2f1 - f2) phase in psychophysical and physiological experiments.

Neural and psychophysical studies of combination tones (CT) give highly correlated evidence for the existence of stimulus-like intracochlear distortion products. However, a large systematic difference was found between psychophysical and neural measurements of the phase of the cubic CT, 2f1 - f2. The psychophysical phase, as measured by monaural concellation, decreases typically at 6-12 degrees per decibel increase in stimulus amplitudes, while the physiological phase, measured both by neural phase locking or by cancellation of the locking, is nearly independent of stimulus amplitudes. Through new psychophysical studies of combination tone interactions monaurally as well as their lateralization binaurally, we examined whether the phase of the psychophysical cancellation tone directly measures the phase of the intracochlear CT. We found evidence for amplitude dependent biases in the cancellation measurement, but the biases were generally far too small to account for the amplitude dependence of the cancellation phase. On the other hand, binaural lateralization of the CT showed a similar amplitude dependence of CT phase as found in monaural cancellation. No evidence exists in neural data either for an amplitude dependent bias of the cancellation measurement or for systematic amplitude dependence of the neural phase. Therefore, we conclude that a real difference exists in the intracochlear nonlinearity for alert human subjects and anaesthetized laboratory animals. We model the human cochlea nonlinearities by modifying Hall's nonlinear transmission line model through the addition of nonlinear stiffness in the nonlinear mechanical loading of the basilar membrane.

Prediction of binaural click lateralization by brainstem auditory evoked potentials.

A previous study by Furst et al. (1985) has shown that in healthy subjects brainstem responses evoked by binaural auditory stimuli with interaural time difference (ITD) and interaural level difference (ILD) include information about the integration of data received by both ears. A correlation was found between the first major peak of the binaural difference waveform and perception of click lateralization and fusion. We have now tested whether a similar correlation exists in patients with multiple sclerosis (MS). The ability to lateralize dichotic clicks was tested in MS patients with normal audiograms. Two kinds of psychoacoustical experiments were employed: (1) A matching experiment in which the subject was asked to match the perceived positions of two click trains, one of which consisted of dichotic clicks with ILD and the other dichotic clicks with ITD; and (2) A positional JND experiment in which the subject was asked to determine the difference in perceived position of two successive click trains. Two reference positions were tested, the head center and the side of the head near the ear, while the control was either on ITD or on ILD. According to the psychoacoustical performances, three groups of patients were identified. Group I consisted of patients who performed normally in all the psychoacoustical experiments. Group II patients were able to lateralize binaural clicks but performed abnormally in the matching experiment and in the position discrimination experiment when the control was on ITD and the reference position was the head center. The patients in Group II performed normally in the discrimination experiments when the control was on ILD, and when the control was on ITD but the reference position was the head side. Group III consisted of those who were not able to perform either one of the psychoacoustical experiments. They perceived the same binaural clicks in different positions in different times. Brainstem auditory potentials evoked by dichotic clicks with different ILDs and ITDs were measured in all the MS patients, and the corresponding binaural difference (BD) waveforms were calculated. Whenever beta, the first major peak of BD, was identified it was used to obtain a physiological matching curve. It was derived by matching an ILD on the basis of similar beta latencies. For every patient, in either Group I or II, the physiological matching curve was very similar to his psychoacoustical matching curve.

Brainstem lesions and click lateralization in patients with multiple sclerosis.

The ability to lateralize dichotic clicks with either interaural time delays (ITD) or interaural level differences (ILD) was tested in seven multiple sclerosis (MS) subjects who had normal audiograms. Along with the psychoacoustical tests, magnetic resonance images (MRI) of the subjects' brainstem were obtained. After matching each MRI section with the corresponding section of a computerized atlas of the brainstem, the parts of the auditory pathway affected by each MS lesion were determined. Of the seven subjects two performed normally with both types of interaural asymmetry and had no brainstem lesions involving the auditory pathway. Two subjects performed normally only with level differences, but perceived all the dichotic clicks with different ITDs in the center of the head; both had lesions involving the trapezoid body. Three subjects could not perform normally with either task, perceiving the clicks to the sides and never in the center for both ITDs and ILDs; all three had unilateral lesions of the lateral lemniscus. A multi-level decision making model is proposed to account for these results.

Binaural auditory processing in multiple sclerosis subjects.

In order to relate human auditory processing to physiological and anatomical experimental animal data, we have examined the interrelationships between behavioral, electrophysiological and anatomical data obtained from human subjects with focal brainstem lesions. Thirty-eight subjects with multiple sclerosis were studied with tests of interaural time and level discrimination (just noticeable differences or jnds), brainstem auditory evoked potentials and magnetic resonance (MR) imaging. Interaural testing used two types of stimuli, high-pass (> 4000 Hz) and low-pass (< 1000 Hz) noise bursts. Abnormal time jnds (Tjnd) were far more common than abnormal level jnds (70% vs 11%); especially for the high-pass (Hp) noise (70% abnormal vs 40% abnormal for low-pass (Lp) noise). The HpTjnd could be abnormal with no other abnormalities; however, whenever the BAEPs, LpTjnd and/or level jnds were abnormal HpTjnd was always abnormal. Abnormal wave III amplitude was associated with abnormalities in both time jnds, but abnormal wave III latency with only abnormal HpTjnds. Abnormal wave V amplitude, when unilateral, was associated with a major HpTjnd abnormality, and, when bilateral, with both HpTjnd and LpTjnd major abnormalities. Sixteen of the subjects had their MR scans obtained with a uniform protocol and could be analyzed with objective criteria. In all four subjects with lesions involving the pontine auditory pathway, the BAEPs and both time jnds were abnormal. Of the twelve subjects with no lesions involving the pontine auditory pathway, all had normal BAEPs and level jnds, ten had normal LpTjnds, but only five had normal HpTjnds. We conclude that interaural time discrimination is closely related to the BAEPs and is dependent upon the stimulus spectrum. Redundant encoding of low-frequency sounds in the discharge patterns of auditory neurons, may explain why the HpTjnd is a better indicator of neural desynchrony than the LpTjnd. Encroachment of MS lesions upon the pontine auditory pathway always is associated with abnormal BAEPs and abnormal interaural time discrimination but may have normal interaural level discrimination. Our data provide one of the most direct demonstrations in humans of relationships among auditory performance, evoked potentials and anatomy. We present a model showing that many of these interrelationships can be readily interpreted using ideas developed from work on animals, even though these relationships could not have been predicted with confidence beforehand. This work provides a clear advance in our understanding of human auditory processing and should serve as a basis for future studies.

Effects of multiple sclerosis brainstem lesions on sound lateralization and brainstem auditory evoked potentials.

Magnetic resonance (MR) imaging, brainstem auditory evoked potentials (BAEPs), and tests of interaural time and level discrimination were performed on sixteen subjects with multiple sclerosis (MS). Objective criteria were used to define MR lesions. Of the eleven subjects in whom no pontine lesions were detected and the one subject who had pontine lesions that did not encroach upon the auditory pathways, all had normal BAEPs and interaural level discrimination, although a few had abnormal interaural time discrimination. Of four subjects with lesions involving the pontine auditory pathway, all had both abnormal BAEPs and abnormal interaural time discrimination; one also had abnormal interaural level discrimination. Analysis of the data suggest the following: waves I and II are generated peripheral to the middle of the ventral acoustic stria (VAS); wave III is generated ipsilaterally in the region of the rostral VAS, caudal superior olivary complex (SOC) and trapezoid body (TB); and waves V and L are generated contralaterally, rostral to the SOC-TB. The region of the ipsilateral rostral SOC-TB is implicated as part of the pathway involved in the generation of waves V and L. Interaural time discrimination of both high and low frequency stimuli were affected by all brainstem lesions that encroached on auditory pathways. A unilateral lesion in the region of the LL affected interaural time discrimination for low-frequency stimuli less severely than bilateral lesions of the LL or a unilateral lesion of the VAS. The only interaural level discrimination abnormality occurred for a subject with a unilateral lesion involving the entire rostral VAS. It appears that detailed analysis of lesion locations coupled with electrophysiological and psychophysical data holds promise for testing hypotheses concerning the function of various human auditory brainstem structures.

Sound lateralization and interaural discrimination. Effects of brainstem infarcts and multiple sclerosis lesions.

Subjects with brainstem lesions due to either an infarct or multiple sclerosis (MS) underwent two types of binaural testing (lateralization testing and interaural discrimination) for three types of sounds (clicks and high and low frequency narrow-band noise) with two kinds of interaural differences (level and time). Two major types of abnormalities were revealed in the lateralization performances: perception of all stimuli, regardless of interaural differences (time and/or level) in the center of the head (center-oriented), or lateralization of all stimuli to one side or the other of the head (side-oriented). Similar patterns of abnormal lateralization (center-oriented and side-oriented) occurred for MS and stroke patients. A subject's pattern of abnormal lateralization testing was the same regardless of the type of stimulus or type of interaural disparity. Lateralization testing was a more sensitive test than interaural discrimination testing for both types of subjects. Magnetic resonance image (MRI) scanning in three orthogonal planes of the brainstem was used to detect lesions. A semi-automated algorithm superimposed the auditory pathway onto each MRI section. Whenever a lesion overlapped the auditory pathway, some binaural performance was abnormal and vice versa. Given a lateralization test abnormality, whether the pattern was center-oriented or side-oriented was mainly determined by lesion site. Center-oriented performance was principally associated with caudal pontine lesions and side-oriented performance with lesions rostral to the superior olivary complex. For lesions restricted to the lateral lemniscus and/or inferior colliculus, whether unilateral or bilateral, just noticeable differences (JNDs) were nearly always abnormal, but for caudal pontine lesions JNDs could be normal or abnormal. MS subjects were more sensitive to interaural time delays than interaural level differences particularly for caudal pontine lesions, while stroke patients showed no differential sensitivity to the two kinds of interaural differences. These results suggest that neural processing of binaural stimuli is multilevel and begins with independent interaural time and level analyzers in the caudal pons.

Optimal a posteriori time domain filter for average evoked potentials.

Evoked potentials measured with scalp electrodes are often described as a deterministic process corrupted by unrelated noise. The common procedure to determine the signal is to average N repetitive measurements. By obtaining additional information from the N measurements, signal detection can be improved. An algorithm that estimates the signal autocorrelation from N given measurements is proposed. The estimator is consistent and unbiased, and its variance tends to 0 as o(N). Two filters that are applied to the average response are introduced. Both depend on the estimation of the signal and the noise autocorrelations. One filter is based on the assumption that the average response is a stationary process. The second filter coefficients are obtained by minimizing the mean squared error (MSE) of an optimal filter of a nonstationary process applied on a single sweep. When a small number of sweeps are averaged, the stationary assumption is adequate, and the MSE of the stationary optimal filter is two to five times less than the MSE of the average response. When a large number of measurements are considered, the error in estimating the autocorrelations decreases. In this case, applying the optimal filter for a nonstationary process leads to a significant improvement in the signal estimation.

An evaluation of tricalcium phosphate as a treatment for endodontic perforations.

In the rat, perforations of maxillary molars were created and treated with either tricalcium phosphate (Synthograft) or Cavit. At four time intervals (1 day, 1 wk, 2 wk, and 1 month), four evaluative factors (inflammation, bone resorption, cementum and dentin resorption, and epithelial proliferation) were analyzed and compared for the two materials. For the individual time periods, there were no statistically significant differences between the two materials. However, when all four time periods were combined, there was a statistically significant better result for tricalcium phosphate than for Cavit with respect to decreased inflammation (p less than 0.05).

Survival analysis of hips treated with flexion osteotomy for femoral head necrosis.

The treatment of osteonecrosis of the femoral head (FHN) is controversial. It mainly occurs in young patients in whom total hip replacement is best avoided because of an increased risk of revision. The objective of this long-term follow-up study was to evaluate the outcome of intertrochanteric flexion osteotomy as a hip joint preserving operation for FHN. Over a 19-year period we carried out 70 intertrochanteric flexion osteotomies for FHN in 64 patients. The mean follow-up was 10.4 years (3.0 to 20.3). The overall mean Harris hip score increased from 51 points preoperatively to 71 points postoperatively. Six patients (9%) developed early postoperative complications. A total of 19 hips (27%) underwent total hip arthroplasty at a mean of 8.7 years after osteotomy. The five-year survival rate was 90%. Survival rates of hips in Ficat stage 2 were higher than those in stages 3 or 4. Hips with a preoperative necrotic angle of <200 degrees had a better survival probability than those with a necrotic angle >200 degrees. Our findings suggest that flexion osteotomy is a safe and effective procedure in Ficat stage 2 and 3 FHN, preferably with a necrotic angle of <200 degrees.

Oxaceprol is a well-tolerated therapy for osteoarthritis with efficacy equivalent to diclofenac.

The therapeutic equivalence and safety of treatment for 21 days with 400 mg t.i.d. oxaceprol (n = 132) and 50 mg t.i.d. diclofenac (n = 131) were assessed in a multicentre, randomised, double-blind study of a mixed population of patients with osteoarthritis of the knee and/or hip. In a per-protocol analysis of efficacy, the mean Lequesne index decreased by 2.5 points in the oxaceprol group (n = 109) and by 2.8 points in the diclofenac group (n = 109). The 95% confidence interval for the end-point difference revealed therapeutic equivalence. This was confirmed by assessments (visual analogue scale) of pain at rest, weight-bearing pain, pain on standing and pain on movement, all of which decreased to a similar extent under both treatments. The pain-free walking time increased in both groups from 10 min to 25 min by the end of the treatment period. Mobility was also increased to a similar extent by both drugs. The physicians assessed treatment as good or very good in 45-46% of patients in both groups. In all patients who received treatment, 28 and 37 adverse events were reported by 25 out of 132 (18.9%) and 33 out of 131 (25.2%) patients treated with oxaceprol and diclofenac, respectively. In 15 patients (11.4%) with 15 adverse events in the oxaceprol group and 25 patients (19.1%) with 27 adverse events in the diclofenac group, a relation to the medication was considered probable. The difference between the groups was statistically significant (p = 0.04106) for the number of these adverse events. Oxaceprol is therapeutically equivalent to diclofenac, but better tolerated than diclofenac in the treatment of osteoarthritis.

Correlation of lesion volume and brain swelling from a focal brain trauma.

Brain edema and secondary growth of a traumatic brain tissue necrosis are important manifestations of secondary brain damage and of prognostic significance in severe head injury. Aim of the current study was to analyze the interdependency of the resulting brain swelling from the size of the focal traumatic lesion. Male Sprague-Dawley rats were intubated and mechanically ventilated. A trephination was made over the left parietal cortex for induction of a cold lesion. Different injury severities were achieved by varying the contact time of the cooled copper-cylinder and the exposed cortex. Animals were randomized into 12 experimental groups. Hemispheric brain swelling was measured in groups A1-A6 (n = 4-8) by gravimetry 24 hrs after lesions of six increasing severity levels. Correspondingly, in animals of groups B1-B6 (n = 5-7) the volume of necrosis was planimetrically assessed in histological serial sections of the brain obtained 24 hrs after trauma of different severity. In groups A1-A6. hemispheric brain swelling (increase in weight) was growing with increasing contact duration of the cold probe with the exposed cerebral cortex, i.e. from 7.7 +/- 0.4% (5 s) to a maximum of 9.9 +/- 0.5% (25 s). Longer contact periodes (30 s) were not further effective to increase hemispheric brain swelling. The contact times and extent of swelling were linearly correlated between 5 s and 25 s (r = 0.47; p < 0.01). The volume of necrosis in groups B1-B6 increased from 35.7 +/- 3.7 mm3 (5 s) to 106.3 +/- 10.3 mm3 (30 s). There was again a linear correlation between the duration of contact of the cold probe (i.e. injury severity) with the brain cortex and the volume of necrosis (r = 0.77; p < 0.01). Accordingly. the lesion volume could be increased in a reproducible manner from 35.7 up to 106.3 mm3 by extending the contact times of the cooling device and cerebral cortex. Hemispheric swelling, predominantly due to vasogenic brain edema, was expanding in relationship with the volume of necrosis.

A computer-based method for the assessment of body-image distortions in anorexia-nervosa patients.

A computer-based method for the assessment of body-image distortions in anorexia nervosa and other eating-disorder patients is presented in this paper. At the core of the method is a realistic pictorial simulation of lifelike weight changes, applied to a real source image of the patient. The patients, using a graphical user interface, adjust their body shapes until they meet their self-perceived appearance. Measuring the extent of virtual fattening or slimming of a body with respect to its real shape and size allows direct quantitative evaluation of the cognitive distortion in body image. In a preliminary experiment involving 33 anorexia-nervosa patients, 70% of the subjects chose an image with simulated visual weight gain between 8%-16% as their "real" body image, while only one of them recognized the original body image. In a second experiment involving 30 healthy participants, the quality of the weight modified images was evaluated by pairwise selection trials. Over a weight change range from -16% to +28%, in about 30% of the trials, artificially modified images were mistakenly taken as "original" images, thus demonstrating the quality of the artificial images. The method presented is currently in a clinical validation phase, toward application in the research, diagnosis, evaluation, and treatment of eating disorders.

Lateralization and discrimination of dichotic clicks: evidence from patients with brainstem lesions and normal cohorts.

The ability to lateralize and discriminate dichotic clicks was tested in multiple sclerosis patients with normal audiograms and in normal cohorts. Lateral position spread over a greater range with interaural level differences than with interaural time differences, and was related to the two asymmetries by different functions. Measures of binaural acuity were inversely related to the slopes of the two functions. One group of patients performed normally with both types of interaural asymmetry, another group performed normally only with level differences; a third group of patients could not perform normally with either.

Objective detection and localization of multiple sclerosis lesions on magnetic resonance brainstem images: validation with auditory evoked potentials.

To develop an objective method for detecting multiple sclerosis (MS) brainstem lesions, magnetic resonance (MR) images (multiple planar, spin-echo, acquired in three planes of section) of sixteen MS patients and fourteen normal subjects were analyzed with an algorithm that detected regions with a relatively increased intensity on both a spin-echo image and a T2 image. To be considered a lesion, such regions had to overlap in at least two orthogonal planes. Using a digitized atlas of the human brainstem, the lesion locations were mapped with respect to the brainstem anatomy. This method was evaluated by comparing the location of MS lesions with the brainstem auditory evoked potentials obtained from these subjects. Brainstem lesions were detected in five MS patients; four had lesions impinging upon the auditory system and one did not. All four had abnormal evoked potentials. The fourteen normal subjects, the one MS patient with brainstem lesions outside the auditory pathway, and the eleven other MS patients with no brainstem lesions all had normal evoked potentials. The requirement that lesions be detected in at least two planes of section greatly improved the specificity of the algorithm. The consistency between the MR and brainstem auditory evoked potentials results supports the validity of this imaging analysis algorithm for objectively localizing brainstem lesions.

A review of aging of dental components and a retrospective radiographic study of aging of the dental pulp and dentin in normal teeth.

A review of aging of dental components is followed by a clinical radiographic study. Patients received radiographs at 5-year intervals with a 10-year minimum followup. Data obtained were age, gender, tooth, and systemic diseases. Measurements taken were tooth length, coronal length, apical length, cervical width, midroot width, and apical width. Root canal shrinkage was calculated vertically, horizontally, and as a combination (vertical and horizontal). Results showed statistically significantly more shrinkage in men, the elderly, and people with calcification-related diseases. Shrinkage increased with advancing age. With further studies, radiographically determined root canal measurements could prove useful in anthropology, forensics, and as a biomarker of aging.

Methicillin-resistant Staphylococcus aureus ST30-SCCmec IVc clone as the major cause of community-acquired invasive infections in Argentina.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have become a major concern worldwide. We conducted a prospective multicenter study of invasive CA-MRSA to evaluate clinical features and genotype of strains causing invasive infections in Argentina. A total of 55 patients with invasive CA-MRSA infections were included. Most patients (60%) had bloodstream infections, 42% required admission to intensive care unit and 16% died. No CA-MRSA isolates were multiresistant (resistant ⩾3 classes of antibiotics). All isolates carried Panton-Valentine leukocidin (PVL) genes and staphylococcal cassette chromosome (SCCmec) type IV. The majority CA-MRSA strains belonged to ST30 and had identical pulsed-field gel electrophoresis (PFGE) patterns, qualifying as a clonal dissemination of a highly transmissible strain. The main clone recovered from patients with CA-MRSA invasive infections was genotyped as pulsed-field gel electrophoresis type C-ST30, SCCmec type IVc-spa type 019, PVL positive. It has become predominant and replaced the previously described CA-MRSA clone (PFGE type A, ST5, SCCmec type IV, spa type 311).

Evaluation of robotic assistance in neurosurgical applications.

An analysis of usability aspects and accuracy for three different methods of neurosurgical intervention-stereotaxy, neuro-navigation, and robotic assistance-was accomplished in a detailed study including clinicians with different experience levels. Accuracy tests with a specially designed phantom were performed under clinical conditions according to EN ISO 9283. Test scenarios were designed according to a realistic clinical work-flow for the brain biopsy process. This paper presents the results of the accuracy evaluation as well as a discussion of the results and further steps.