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Wearable augmented reality in neurosurgery offers significant advantages by enabling the visualization of navigation information directly on the patient, seamlessly integrating virtual data with the real surgical field. This ergonomic approach can facilitate a more intuitive understanding of spatial relationships and guidance cues, potentially reducing cognitive load and enhancing the accuracy of surgical gestures by aligning critical information with the actual anatomy in real-time. This study evaluates the benefits of a novel AR platform, VOSTARS, by comparing its targeting accuracy to that of the gold-standard electromagnetic (EM) navigation system, Medtronic StealthStation® S7®. Both systems were evaluated in phantom and human studies. In the phantom study, participants targeted 13 predefined landmarks using identical pointers to isolate system performance. In the human study, three facial landmarks were targeted in nine volunteers post-brain tumor surgery. The performance of the VOSTARS system was superior to that of the standard neuronavigator in both the phantom and human studies. In the phantom study, users achieved a median accuracy of 1.4 mm (IQR: 1.2 mm) with VOSTARS compared to 2.9 mm (IQR: 1.4 mm) with the standard neuronavigator. In the human study, the median targeting accuracy with VOSTARS was significantly better for selected landmarks in the outer eyebrow (3.7 mm vs. 6.6 mm, p = 0.05) and forehead (4.5 mm vs. 6.3 mm, p = 0.021). Although the difference for the pronasal point was not statistically significant (2.7 mm vs. 3.5 mm, p = 0.123), the trend towards improved accuracy with VOSTARS is clear. These findings suggest that the proposed AR technology has the potential to significantly improve surgical outcomes in neurosurgery.

The objective of this study was to evaluate the influence of different light spectra on growth, development indices, survival and color preferences in Macrobrachium rosenbergii larvae. First (trial 1, 25 days), prawns (100 larvae/L) were randomly allocated to 30 cylindrical plastic containers (1 L). This trial was designed with five treatments (light spectra) and six replications: red light, blue light, green light and white light or absence of light (controls) in the 12:12 light:dark (LD) cycle. Next (trial 2), 30 groups of five larvae in two different development stages (VII and XI) were allocated to a system of compartments with different lights: white, red, blue or green. This system was connected by tubes to enable light spectra choices. Final weight, weight gain, consumption and metamorphosis significantly improved under the white light condition versus the other tested groups (p

IntroductionSystemic sclerosis (SSc) is a complex autoimmune connective tissue disease characterized by microvascular damage, immune system reactivity and progressive fibrosis of skin and internal organs. Interstitial lung disease is the leading cause of death for SSc patients (SSc-ILD), and the process of lung fibrosis involves also circulating monocytes and alveolar macrophages.MethodsCurrent study aimed to identify monocyte/macrophage phenotypes in lung and peripheral blood of SSc-ILD patients by immunostaining and flow cytometry, respectively. Single immunostaining was performed using primary antibodies against CD68 (pan-macrophage marker), CD80, CD86, TLR4 (M1 markers), CD163, CD204, and CD206 (M2 markers). Flow cytometry analysis included the evaluation of CD45, CD14, CD16 (monocyte lineage), CD1c (dendritic lineage), together with M1 and M2 activation markers on circulating monocytes. Protein synthesis of TLR4 and M2 markers was also investigated in cultured monocytes-derived macrophages (MDMs) from SSc-ILD patients by Western Blotting.ResultsLung samples were obtained from 9 SSc-ILD patients (50 ± 9 years old) and 5 control non-SSc patients without lung fibrosis (58 ± 23 years old). Alveolar macrophages (CD68+ cells) showed a significantly higher positivity of M1 and M2 markers in SSc-ILD lung samples than in controls (p

The cattle tick, Rhipicephalus microplus, causes significant economic losses to the cattle industry. Tick control is predominately achieved via pesticide applications. However, alternative control methods such as vaccines are needed due to the tick's capacity to quickly develop pesticide resistance and to combat tick-borne diseases. We used an in silico reverse vaccinology approach to evaluate and rank open reading frames (ORFs) from the tick's transcriptome for their potential use as anti-R. microplus vaccine antigens. We manually annotated the 200 highest ranked antigens and selected 10 transcript ORFs as vaccine antigen candidates for expression in Pichia pastoris or insect cells. Six of the ten candidate antigens could be successfully expressed and purified in vitro as recombinant proteins with > 1 mg quantity. RT-PCR confirmed the expression of all six transcripts in tick RNA. However, only three of the six transcripts' corresponding ORFs could be confirmed as present in tick tissue protein extracts. Only four of the six vaccine candidate antigens were successfully expressed and purified in sufficient quantity (> 10 mg) for immunogenicity and efficacy trials in cattle. These four were designated BI-TS002, BI-TS004, BI-TS008, and BI-TS009 and sufficient annotation existed that showed sequence similarity to serine‑rich adhesin for platelets, glycine-rich cell wall structural membrane protein, SWM-1 tick serine protease inhibitor, and venom-like dermonecrotic toxins from ticks and spiders, respectively. Cattle immunized with BI-TS004, BI-TS008 and BI-TS009 yielded a statistically significant difference in antibody response post-immunization. This difference was noted on Days 42, 56, 70, and 84 post-immunization for BI-TS008 and BI-TS009, but only on Day 56 for BI-TS004. BI-TS008 and BI-TS009, were formulated with adjuvant and cattle stall tests conducted over a 175 day period to evaluate efficacy against R. microplus infestations. Both an adjuvant only negative control group and a positive control group using the commercially available GAVAC anti-tick vaccine were used. Efficacy was determined by comparing number of engorged adult female ticks, total egg mass weight, and egg hatchability produced from the immunized group to corresponding data from the adjuvant only negative control group. Thus, effects on engorged adult tick number, reproductive capacity, and fertility were measured. Both initial (designated Phase 1 and calculated from tick collections of Days 60–94 days post-first immunization) and long-term (designated Phase 2 and calculated from tick collections of Days 152–175 post-first immunization) efficacies were determined. The overall Phase 1 trial efficacies of BI-TS008, BI-TS009, and GAVAC were 68.3 %, 48.5 %, and 70.7 %, respectively. The overall Phase 2 trial efficacies of BI-TS008, BI-TS009, and GAVAC were 64.4 %, -30.1 %, and 45.1 %, respectively.

RESUMO Uma ‘boa’ relação médico-paciente é fundamental para uma prática clínica efetiva no Sistema Único de Saúde. São comuns, na prática clínica, os problemas de comunicação, o autoritarismo e certa desconsideração da situação existencial e da agenda dos usuários. Paulo Freire tratou de temas similares na educação, sendo menos aproveitado para ensino e prática da condução dos atendimentos médicos. O objetivo deste ensaio foi sintetizar contribuições das ideias freirianas para construção/melhoria da relação médico-paciente em contexto clínico ambulatorial. Metodologicamente, foi realizada uma análise de literatura articulando aspectos da relação médico-paciente e ideias de Freire. A análise consistiu em leitura e síntese livre de obras selecionadas sobre a relação clínica e das ideias contidas nos principais livros de Freire, consideradas pertinentes a essa temática (primeiro e segundo tópicos do artigo). Seguiuse uma síntese das contribuições freirianas, organizadas em cinco temas: reforço ao desafio de desviar da objetificação do usuário; concepção emancipadora, crítica e participativa da relação médico-paciente e dos seus aspectos educativos; importância do mundo da vida dos usuários; importância de abrir e manter o diálogo; ‘bem’ manejar as dinâmicas de poder. As ideias de Freire continuam muito relevantes e contribuem para o ensino e a melhoria da prática clínica ambulatorial.

Abstract Recent research studies reported that the employment of wearable augmented reality (AR) systems such as head‐mounted displays for the in situ visualisation of ultrasound (US) images can improve the outcomes of US‐guided biopsies through reduced procedure completion times and improved accuracy. Here, the authors continue in the direction of recent developments and present the first AR system for guiding an in‐depth tumour enucleation procedure under US guidance. The system features an innovative visualisation modality with cutting trajectories that ‘sink’ into the tissue according to the depth reached by the electric scalpel, tracked in real‐time, and a virtual‐to‐virtual alignment between the scalpel's tip and the trajectory. The system has high accuracy in estimating the scalpel's tip position (mean depth error of 0.4 mm and mean radial error of 1.34 mm). Furthermore, we demonstrated with a preliminary user study that our system allowed us to successfully guide an in‐depth tumour enucleation procedure (i.e. preserving the safety margin around the lesion).

Abstract Background Systemic sclerosis (SSc) is an autoimmune connective tissue disease characterized by vasculopathy and progressive fibrosis of skin and several internal organs, including lungs. Macrophages are the main cells involved in the immune-inflammatory damage of skin and lungs, and alternatively activated (M2) macrophages seem to have a profibrotic role through the release of profibrotic cytokines (IL10) and growth factors (TGFβ1). Nintedanib is a tyrosine kinase inhibitor targeting several fibrotic mediators and it is approved for the treatment of SSc-related interstitial lung disease (ILD). The study aimed to evaluate the effect of nintedanib in downregulating the profibrotic M2 phenotype in cultured monocyte-derived macrophages (MDMs) obtained from SSc-ILD patients. Methods Fourteen SSc patients, fulfilling the 2013 ACR/EULAR criteria for SSc, 10 SSc patients affected by ILD (SSc-ILD pts), 4 SSc patients non affected by ILD (SSc pts no-ILD), and 5 voluntary healthy subjects (HSs), were recruited at the Division of Clinical Rheumatology-University of Genova, after obtaining Ethical Committee approval and patients’ informed consent. Monocytes were isolated from peripheral blood, differentiated into MDMs, and then maintained in growth medium without any treatment (untreated cells), or treated with nintedanib (0.1 and 1µM) for 3, 16, and 24 h. Gene expression of macrophage scavenger receptors (CD204, CD163), mannose receptor-1 (CD206), Mer tyrosine kinase (MerTK), identifying M2 macrophages, together with TGFβ1 and IL10, were evaluated by quantitative real-time polymerase chain reaction. Protein synthesis was investigated by Western blotting and the level of active TGFβ1 was evaluated by ELISA. Statistical analysis was carried out using non-parametric Wilcoxon test. Results Cultured untreated SSc-ILD MDMs showed a significant increased protein synthesis of CD206 (p

In this paper, the recently proposed structural optimization strategy, the Galilei-Optimization (GO), is adapted for improving the toughness response of a holed two-dimensional lattice system made of a network of micro-beams whose geometrical arrangement was prescribed. By taking advantage of the possibility of minimizing stress gradients and stress peaks around the hole via GO, we redesigned the cross sections of the lattice beam elements, equalizing the stresses over the entire domain. Consequently, the resulting optimized microstructure highlighted a significant enhancement of the overall toughness due to a drastic decrease of the stress concentration factor in the hole proximity, preserving the initial stiffness and lowering the total overall weight. To validate the robustness of the procedure and the numerical Finite Element outcomes, two non-optimized and optimized structures were actually built up through 3D printing and tested in the laboratory under the same boundary conditions used for the simulations. This evidence confirmed the effectiveness of the proposed method in obtaining optimized beam-like plates with high toughness, which could pave the way for designing new light materials with extreme mechanical performance well beyond the sole stiffness and strength.

Objectives To investigate pregnancy outcomes in women with autoimmune rheumatic diseases (ARD) in the Italian prospective cohort study P-RHEUM.it.Methods Pregnant women with different ARD were enrolled for up to 20 gestational weeks in 29 Rheumatology Centres for 5 years (2018–2023). Maternal and infant information were collected in a web-based database.Results We analysed 866 pregnancies in 851 patients (systemic lupus erythematosus was the most represented disease, 19.6%). Maternal disease flares were observed in 135 (15.6%) pregnancies. 53 (6.1%) pregnancies were induced by assisted reproduction techniques, 61 (7%) ended in miscarriage and 11 (1.3%) underwent elective termination. Obstetrical complications occurred in 261 (30.1%) pregnancies, including 2.3% pre-eclampsia. Two cases of congenital heart block were observed out of 157 pregnancies (1.3%) with anti-Ro/SSA. Regarding treatments, 244 (28.2%) pregnancies were treated with glucocorticoids, 388 (44.8%) with hydroxychloroquine, 85 (9.8%) with conventional synthetic disease-modifying anti-rheumatic drugs and 122 (14.1%) with biological disease-modifying anti-rheumatic drugs. Live births were 794 (91.7%), mostly at term (84.9%); four perinatal deaths (0.5%) occurred. Among 790 newborns, 31 (3.9%) were small-for-gestational-age and 169 (21.4%) had perinatal complications. Exclusive maternal breast feeding was received by 404 (46.7%) neonates. The Edinburgh Postnatal Depression Scale was compiled by 414 women (52.4%); 89 (21.5%) scored positive for emotional distress.Conclusions Multiple factors including preconception counselling and treat-to-target with pregnancy-compatible medications may have contributed to mitigate disease-related risk factors, yielding limited disease flares, good pregnancy outcomes and frequency of complications which were similar to the Italian general obstetric population. Disease-specific issues need to be further addressed to plan preventative measures.

Achieving and maintaining proper image registration accuracy is an open challenge of image-guided surgery. This work explores and assesses the efficacy of a registration sanity check method for augmented reality-guided navigation (AR-RSC), based on the visual inspection of virtual 3D models of landmarks. We analyze the AR-RSC sensitivity and specificity by recruiting 36 subjects to assess the registration accuracy of a set of 114 AR images generated from camera images acquired during an AR-guided orthognathic intervention. Translational or rotational errors of known magnitude up to ±1.5 mm/±15.5°, were artificially added to the image set in order to simulate different registration errors. This study analyses the performance of AR-RSC when varying (1) the virtual models selected for misalignment evaluation (e. g., the model of brackets, incisor teeth, and gingival margins in our experiment), (2) the type (translation/rotation) of registration error, and (3) the level of user experience in using AR technologies. Results show that: 1) the sensitivity and specificity of the AR-RSC depends on the virtual models (globally, a median true positive rate of up to 79.2% was reached with brackets, and a median true negative rate of up to 64.3% with incisor teeth), 2) there are error components that are more difficult to identify visually, 3) the level of user experience does not affect the method. In conclusion, the proposed AR-RSC, tested also in the operating room, could represent an efficient method to monitor and optimize the registration accuracy during the intervention, but special attention should be paid to the selection of the AR data chosen for the visual inspection of the registration accuracy.