Automatic 3D modeling and simulation of bone-fixator system in a novel graphical user interface

External ring fixators are widely used in orthopaedics for the purposes of fracture fixation, bone lengthening and deformity correction. In these fixators, the clinician typically brings the bone fragments to an anatomically desired position by changing the lengths of the rods connecting the fixator rings. This task is accomplished by the clinician based on experience and expertise. As an alternative, commercial systems exist where the same task is automatized with the help of an accompanying software that implements a mathematical model of the fixator. In this work, we have developed a graphical user interface (GUI) implementing a mathematical theory introduced previously. The GUI also allows visualization and simulation of the patient specific bone-fixator system, something that lacks in the available software systems. The information gathered from the bone X-ray images is used to convert a canonical bone model to the patient-specific bone model. This conversion algorithm has been tested on eight different bone models and found to be effective. The visualization tool has been used in the simulation of two orthopaedic procedures, one involving a tibia and the other a femur. In both examples, the visualization tool has provided a realistic depiction of the treatment procedure. We believe that the developed GUI equipped with the visualization module could be a useful clinical tool where the clinician can visualize the applied treatment or evaluate different treatment scenarios a priori per patient

Peripheral Artery Disease and Atrial Fibrillation

Hemodynamics of patient-specific aorta-pulmonary shunt configurations

Optimal hemodynamics in aorta-pulmonary shunt reconstruction is essential for improved post-operative recovery of the newborn congenital heart disease patient. However, prior to in vivo execution, the prediction of post-operative hemodynamics is extremely challenging due to the interplay of multiple confounding physiological factors. It is hypothesized that the post-operative performance of the surgical shunt can be predicted through computational blood flow simulations that consider patient size, shunt configuration, cardiac output and the complex three-dimensional disease anatomy. Utilizing only the routine patient-specific pre-surgery clinical data sets, we demonstrated an intelligent decision-making process for a real patient having pulmonary artery atresia and ventricular septal defect. For this patient, a total of 12 customized candidate shunt configurations are contemplated and reconstructed virtually using a sketch-based computer-aided anatomical editing tool. Candidate shunt configurations are evaluated based on the parameters that are computed from the flow simulations, which include 3D flow complexity, outlet flow splits, shunt patency, coronary perfusion and energy loss. Our results showed that the modified Blalock-Taussig (mBT) shunt has 12% higher right pulmonary artery (RPA) and 40% lower left pulmonary artery (LPA) flow compared to the central shunt configuration. Also, the RPA flow regime is distinct from the LPA, creating an uneven flow split at the pulmonary arteries. For all three shunt sizes, right mBT innominate and central configurations cause higher pulmonary artery (PA) flow and lower coronary artery pressure than right and left mBT subclavian configurations. While there is a trade-off between energy loss, flow split and coronary artery pressure, overall, the mBT shunts provide sufficient PA perfusion with higher coronary artery pressures and could be preferred for similar patients having PA overflow risk. Central shunts would be preferred otherwise particularly for cases with very low PA overflow risk.

A phase 3, multi-center, multinational, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of levofloxacin inhalation solution (APT-1026) in stable cystic fibrosis patients

For patients with cystic fibrosis (CF), the use of inhaled antibiotics has become standard of care to suppress chronic Pseudomonas airways infection. There are limited antibiotic options formulated and approved for inhaled use and antibiotic efficacies attenuate over time, making additional inhaled antibiotic classes desirable. APT-1026 (levofloxacin inhalation solution, LIS) is a fluoroquinolone in development for management of chronic P. aeruginosa airways infection in patients with CF.

Reversible airway obstruction in cystic fibrosis: Common, but not associated with characteristics of asthma

As asthma-like symptoms are common in CF, we evaluated reversible airway obstruction and associated characteristics.

High prevalence of W1282x mutation in cystic fibrosis patients from Karachay-Cherkessia

Cystic fibrosis (CF; OMIM #219700) is a common autosomal recessive disease. The spectrum and frequency of CFTR mutations vary significantly in different populations and ethnic groups. A genetic epidemiological study was conducted in the indigenous ethnic group of people known as the Karachais. They live in the Republic of Karachay-Cherkessia, which lies in the northwest of Russia's North Caucasus region. Karachai's are Turkic-speaking and consist of 194 thousand people (approximately 40% of the population of the Republic). Molecular genetic analysis was performed in 10 unrelated Karachai families with CF patients from three districts in the Republic. A high frequency of W1282X mutation was found (18 of 20 mutant alleles): eight patients were homozygous for the W1282X mutation, and two were compound heterozygous (the second alleles were R1066C and R709X). Analysis for 13 common CF mutations in the sample of 142 healthy Karachais identified two 1677delTA and two W1282X mutation carriers. Thus, the most common CFTR mutation, F508del, was not detected among the CF patients or in healthy Karachais. The most frequent mutation among Karachai patients is W1282X (90%). Its frequency in healthy Karachais is approximately 0.007. Haplotype analysis using the CFTR intragene DNA markers IVS1CA, IVS6aGATT, IVS8CA and IVS17bCA showed that the origins of the W1282X mutation in Karachay-Cherkessia and the Eastern European part of Russia are different.

Eradication failure of newly acquired Pseudomonas aeruginosa isolates in cystic fibrosis

Eradication of Pseudomonas aeruginosa (PA) is critical in cystic fibrosis (CF) patients.

Equitable CF care as a basic human right

Estimation of plate material properties by means of a complex wavenumber fit using Hankel's functions and the image source method

This paper presents a new wave fitting approach to estimate the frequency dependent material properties of thin isotropic plate structures from an experimentally obtained vibrational field, exciting the plate at a single point. The method projects the measurement data on to an analytical image source model, in which Hankel's functions are used for a description of the wave fields emanating from the point of excitation, including the reflected wave fields from the edges of the finite plate. By minimizing the error between the projected field and the measured field, varying the complex wave number and the source strengths of the image sources, an optimum fit is searched for. Thus the source strengths of the image sources do not need to be determined theoretically, but are estimated from the fit on to the experimental data instead (thus avoiding difficulties in theoretically assessing the reflection coefficient of the edges of the plate). The approach uses a complex wavenumber fit, enabling the determination of the dynamic stiffness of the plate structure and its damping properties as function of frequency. The method is especially suited for plates with a sufficient amount of damping, excited at high frequenciesstatus: publishe

Ischemia‐modified albumin levels in the prediction of acute critical neurological findings in carbon monoxide poisoning

The aim of the study was to determine whether serum ischemia‐modified albumin (IMA) levels in patients with carbon monoxide (CO) poisoning were higher compared with a control group of healthy volunteers. In addition, the study sought to determine if there was a correlation between serum IMA levels and carboxyhemoglobin (COHB) levels and other critical neurological findings (CNFs). In this prospective study, the IMA levels of 100 patients with CO poisoning and 50 control individuals were compared. In addition, the IMA and COHB levels were analyzed according to absence or presence CNFs in patients with CO poisoning. The levels of IMA (mg/dL) on admittance, and during the 1 st hour and 3 rd hour, in patients with CO poisoning (49.90 ± 35.43, 30.21 ± 14.81, and 21.87 ± 6.03) were significantly higher, compared with the control individuals (17.30 ± 2.88). The levels of IMA in the 6 th hour were not higher compared with control individuals. The levels of IMA on admittance, and during the 1 st hour, 3 rd hour, and 6 th hour, and COHB (%) levels in patients who had CNFs were higher compared with IMA levels and COHB levels in patients who had no CNFs ( p  < 0.001). However, when the multivariate model was created, it was observed that IMA level on admittance was a poor indicator for prediction of CNFs (odds ratio = 1.05; 95% confidence interval, 1.01–1.08). We therefore concluded that serum IMA levels could be helpful in the diagnosis of CO poisoning. However, we believe that IMA levels cannot be used to predict which patients will develop CNFs due to CO poisoning.