Less is more--a new general practiced oriented form of knee navigation]

Modern navigation technology appears to be acquiring an established place in the fields of orthopedics and orthopedic surgery. This technology helps the surgeon to apply his manual skills with greater precision and thus more effectively, and its positive impact on the quality of surgical treatment has already been demonstrated. The SURGETICS navigation system described in this paper shows that the technology can be adapted to the requirements of daily surgical practice, without compromising its utility for the surgeon and, in the last resort, the patient. Provided that due consideration is given to clinical needs, this technology will surely become a standard tool, not only in European hospitals.     

A Novel Capsulorhexis Technique Using Shearing Forces with Cystotome

Purpose:To demonstrate a capsulorhexis technique using predominantly shearing forces with a cystotome on a virtual reality simulator and on a human eye.Method:Our technique involves creating the initial anterior capsular tear with a cystotome to raise a flap. The flap left unfolded on the lens surface. The cystotome tip is tilted horizontally and is engaged on the flap near the leading edge of the tear. The cystotome is moved in a circular fashion to direct the vector forces. The loose flap is constantly swept towards the centre so that it does not obscure the view on the tearing edge.Results:Our technique has the advantage of reducing corneal wound distortion and subsequent anterior chamber collapse. The capsulorhexis flap is moved away from the tear leading edge allowing better visualisation of the direction of tear. This technique offers superior control of the capsulorhexis by allowing the surgeon to change the direction of the tear to achieve the desired capsulorhexis size.Conclusions:The EYESI Surgical Simulator is a realistic training platform for surgeons to practice complex capsulorhexis techniques. The shearing forces technique is a suitable alternative and in some cases a far better technique in achieving the desired capsulorhexis.     

The reverse auricular flap: a new flap for nose reconstruction.

In the present article, the authors describe a new chondrocutaneous island flap from the ear helix for nose reconstruction. Anatomic studies showed that helix vascularization depends mainly on the superficial temporal vessels. The presence of vascular communications between the anterior frontal branch of the superficial temporal system and the supraorbital and supratrochlear arterial systems allows this flap to be used in a reverse vascular flow fashion. This new flap has been used successfully in seven cases for reconstructing composite defects of the nasal tip and ala. The donor-site defect is repaired with an advancement and rotation flap from the helical rim, leaving an inconspicuous scar and giving an acceptable cosmetic result of the donor area.     

Stigmata: part I. Shame, guilt, and anger

The aesthetic surgeon may occasionally be consulted by a patient who wishes to discuss what can be done for the scars of self-inflicted wounds on the forearms. These scars are popularly referred to as "hesitation marks" or "suicide gestures." Unlike patients suffering from factitial ulcers or Münchhausen syndrome, these patients will admit to the physician that the scars are the result of self-inflicted wounds. These scars often consist of multiple, parallel, white lines extending up and down the forearms (usually volar surface), with more on the nondominant side. Although the pattern of these scars is apparently what drives these patients to the aesthetic surgeon for relief (because even lay people identify these scars as self-inflicted suicide marks), the authors propose a new and deeper motivation for surgery. Recent experiences with three of these patients resulted in an epiphany that prompted this report. Once the symbolic meaning of these scars was broached, a torrent of thoughts and theories followed. This article will recount these three cases and present a central thesis for this type of self-inflicted injury. A proposal for the proper surgical treatment of this condition will be offered. Uniquely, two of the patients will relate their own stories and propose guidelines and warnings for the aesthetic surgeon.     

A new animal model of continuous catheterization for investigating mechanisms of arteritis associated with chemotherapy

Although superselective continuous intra-arterial infusion has advantages for cancer therapy, intra-arterial chemotherapy is often interrupted by arterial damage due to arteritis. Therefore, an animal model must be developed to elucidate the mechanism of arteritis associated with continuous anti-cancer drug infusion. We developed a new rat model with which to investigate the causal mechanism(s) of vascular damage associated with continuous catheterization chemotherapy. Chemotherapeutic agents (fluorouracil (5-FU) or peplomycin (PEP)) were continuously administered for 7 days into the abdominal aorta of male Sprague-Dawley rats through a catheter fixed in situ. We found that the incidence of apoptotic endothelial cells of the aorta was higher nearer the tip of the catheter. The incidence of apoptosis was higher in the group treated with 5-FU than with PEP. This animal model will be useful to improve arterial damage among patients undergoing chemotherapy using continuous catheterization.     

Principles of Rodent Surgery for the New Surgeon

For both scientific and animal welfare reasons, training in basic surgical concepts and techniques should be undertaken before ever seeking to perform surgery on a rodent. Students, post-doctoral scholars, and others interested in performing surgery on rodents as part of a research protocol may not have had formal surgical training as part of their required coursework. Surgery itself is a technical skill, and one that will improve with practice. The principles of aseptic technique, however, often remain unexplained or untaught. For most new surgeons, this vital information is presented in piecemeal fashion or learned on the job, neither of which is ideal. It may also make learning how to perform a particular surgery difficult, as the new surgeon is learning both a surgical technique and the principles of asepsis at the same time. This article summarizes and makes recommendations for basic surgical skills and techniques necessary for successful rodent surgery. This article is designed to supplement hands-on training by the user''s institution.     

Thermal and hydrodynamic modelling of active catheters for interventional radiology

Interventional radiologists desire to improve their operating tools such as catheters. Active catheters in which the tip is moved using shape memory alloy actuators activated using the Joule effect present a promising approach for easier navigation in the small vessels. However, the increase in temperature caused by this Joule effect must be controlled in order to prevent damage to blood cells and tissues. This paper is devoted to the simulation and experimental validation of a fluid-thermal model of an active catheter prototype. Comparisons between computer-predicted and experimentally measured temperatures are presented for both experiments in air and water at 37°C. Good agreement between the computational and experimental results is found, demonstrating the validity of the developed computer model. These comparisons enable us to highlight some important issues in the modelling process and to determine the optimal current for the activation of the catheter.     

Thermal and hydrodynamic modelling of active catheters for interventional radiology

Interventional radiologists desire to improve their operating tools such as catheters. Active catheters in which the tip is moved using shape memory alloy actuators activated using the Joule effect present a promising approach for easier navigation in the small vessels. However, the increase in temperature caused by this Joule effect must be controlled in order to prevent damage to blood cells and tissues. This paper is devoted to the simulation and experimental validation of a fluid-thermal model of an active catheter prototype. Comparisons between computer-predicted and experimentally measured temperatures are presented for both experiments in air and water at 37°C. Good agreement between the computational and experimental results is found, demonstrating the validity of the developed computer model. These comparisons enable us to highlight some important issues in the modelling process and to determine the optimal current for the activation of the catheter.     

Actomyosin-mediated statolith positioning in gravisensing plant cells studied in microgravity

The positioning and gravity-induced sedimentation of statoliths is crucial for gravisensing in most higher and lower plants. In positively gravitropic rhizoids and, for the first time, in negatively gravitropic protonemata of characean green algae, statolith positioning by actomyosin forces was investigated in microgravity (<10(-4) g) during parabolic flights of rockets (TEXUS/MAXUS) and during the Space-Shuttle flight STS 65. In both cell types, the natural position of statoliths is the result of actomyosin forces which compensate the statoliths' weight in this position. When this balance of forces was disturbed in microgravity or on the fast-rotating clinostat (FRC), a basipetal displacement of the statoliths was observed in rhizoids. After several hours in microgravity, the statoliths were loosely arranged over an area whose apical border was in the same range as in 1 g, whereas the basal border had increased its distance from the tip. In protonemata, the actomyosin forces act net-acropetally. Thus, statoliths were transported towards the tip when protonemata were exposed to microgravity or rotated on the FRC. In preinverted protonemata, statoliths were transported away from the tip to a dynamically stable resting position. Experiments in microgravity and on the FRC gave similar results and allowed us to distinguish between active and passive forces acting on statoliths. The results indicate that actomyosin forces act differently on statoliths in the different regions of both cell types in order to keep the statoliths in a position where they function as susceptors and initiate gravitropic reorientation, even in cells that had never experienced gravity during their growth and development.     

Guidance of vascular and neural network formation

Blood vessels and nerves are structurally similar complex branched systems. Their guidance must be exquisitely regulated to ensure proper wiring of both networks. Recent results showed that specialized endothelial cells, resembling axonal growth cones, form the tips of growing capillaries. These endothelial tip cells guide outgrowing capillaries in response to gradients of extracellular matrix-bound vascular endothelial growth factor. Several axon guidance molecules, including Semaphorins, Netrins, Ephrins and Slits, have also been implicated in vessel pathfinding and network formation. In particular, Semaphorin3E and its receptor plexinD1 in addition to the Netrin receptor UNC5B have recently been shown to direct endothelial tip cell navigation.     

Measuring the interaction forces between protein inclusion bodies and an air bubble using an atomic force microscope

Interaction forces between protein inclusion bodies and an air bubble have been quantified using an atomic force microscope (AFM). The inclusion bodies were attached to the AFM tip by covalent bonds. Interaction forces measured in various buffer concentrations varied from 9.7 nN to 25.3 nN (+/- 4-11%) depending on pH. Hydrophobic forces provide a stronger contribution to overall interaction force than electrostatic double layer forces. It also appears that the ionic strength affects the interaction force in a complex way that cannot be directly predicted by DLVO theory. The effects of pH are significantly stronger for the inclusion body compared to the air bubble. This study provides fundamental information that will subsequently facilitate the rational design of flotation recovery system for inclusion bodies. It has also demonstrated the potential of AFM to facilitate the design of such processes from a practical viewpoint.     

Navigation impacts on freshwater fish assemblages: the ecological relevance of swimming performance

Waterways provide many ecological and socialservices, such as water supply, navigation,freshwater reservoirs for aquatic organisms,recreation, and fisheries. However, in heavilydeveloped waterways, the diversity andproductivity of fish assemblages typicallybecome reduced, mainly due to migrationbarriers, pollution, habitat loss, and biotopesimplification. Additionally, navigation maydirectly or indirectly reduce fish assemblages,amplifying the effects of habitat destruction.This study summarizes navigation impacts toimprove the evaluation of direct navigationeffects on fish assemblages. Literature onhydraulic forces created by moving tows wasreviewed to compare the pressures induced byshipping with the biological capabilities offish, especially with their swimming speeds.Available studies of swimming performance offreshwater fishes were compiled to developgeneral models of length-specific burst, aswell as critical swimming speeds. Modelsregressing total length on burst and criticalswimming speeds were highly significant.Linking applied hydrology and hydraulicengineering with fish ecology and physiology,absolute speed was concluded to be the bestpredictor for thresholds and limitations ofhabitat use by fish. A navigation-inducedhabitat bottleneck hypothesis (NBH) wasinferred from the threshold flow velocity,determining habitat availability for fish.According to the NBH presented here, swimmingperformance of juvenile freshwater fish is themajor bottleneck for fish recruitment inwaterways, as a result of their inability towithstand bank-directed navigation-inducedphysical forces. In essence, under commonnavigation conditions, with respect to inlandwaterway morphology, channel cross section,vessel speeds, and dimensions of commercialvessels, the navigation-induced return currentsalong the shore are usually around 0.8 ms^–1 (0.7–1.0 m s^–1) accompanied by a0.1–0.3 m drawdown. Under such conditions, theproposed threshold for small fish survival wasestimated to be 147 mm total length at criticalswimming performance (>20 s – 60 min withoutfatigue) and 47 mm at burst performance (<20s). These theoretical findings were supportedby empirical studies of fish recruitment inwaterways. The strong dependence of fishrecruitment on hydraulic forces opens uppossibilities of formulating suitable criteriafor safe ship operation (speed and distance tobank), as well as for effective fairwaymanagement (construction and maintenance) andsustainable fish conservation (species andproduction). A more ecologically orientatedhydraulic engineering will not constraincommercial navigation and their socioeconomicbenefits, but it will substantially enhancefish recruitment in waterways and theirecological sustainability, for the overallbenefit of fish, fisheries, and society.     

The two essential elements for planning tip surgery in primary and secondary rhinoplasty: observations based on review of 100 consecutive patients

Nasal tip surgery has become significantly more complex since the introduction of tip grafting and the many suture designs that followed the resurgence of open rhinoplasty. Independent of the surgeon's technical approach, however, is the need to identify the critical anatomical characteristics that will make nasal tip surgery successful. It is the author's contention that only two such features require mandatory preoperative identification: (1) whether the tip is adequately projecting and (2) whether the alar cartilage lateral crura are orthotopic or cephalically rotated ("malpositioned"). Data were generated from a review of 100 consecutive primary rhinoplasty patients on whom the author had operated. The results indicate that only 33 percent of the entire group had adequate preoperative tip projection and only 54 percent had orthotopic lateral crura (axes toward the lateral canthi). Forty-six percent of the patients had lateral crura that were cephalically rotated (axes toward the medial canthi). Both inadequate tip projection and convex lateral crura were more common among patients with malpositioned lateral crura (78 percent and 61 percent) than in patients with orthotopic lateral crura (57 percent and 20 percent, respectively). Tip projection can be reliably assessed by the relationship of the tip lobule to the septal angle. Malposition is characterized by abnormal lateral crural axes, long alar creases that extend to the nostril rims, alar wall hollows, frequent nostril deformities, and associated external valvular incompetence. The data suggest that the surgeon treating the average spectrum of primary rhinoplasty patients will see a majority (61 percent) who need increased tip support and a significant number (46 percent) with an anatomical variant (alar cartilage malposition) that places these patients at special risk for postoperative functional impairment. Correction of external valvular incompetence doubles nasal airflow in most patients. As few as 23 percent of primary rhinoplasty patients (the number with orthotopic, projecting alar cartilages in this series) may be proper candidates for reduction-only tip procedures. When tip projection and lateral crural orientation are accurately determined before surgery, nasal tip surgery can proceed successfully and secondary deformities can be avoided.     

Alternatives to thumb replantation

LEARNING OBJECTIVES: After studying this article, the participant should: 1. Have a variety of options for thumb reconstruction. 2. Know the advantages and disadvantages of the nonmicrosurgical and microsurgical techniques for thumb reconstruction. 3. Understand the decision making from the variety of thumb reconstruction techniques based on patient needs. 4. Have a basic understanding of the various thumb reconstruction techniques discussed. The traumatic amputation of the thumb is an absolute indication for attempted replantation. The profound disability of the hand resulting from absence of the thumb, with loss of pinch and grasp, obliges the surgeon to make every attempt to replant the amputated thumb and preserve hand function. However, not all attempts at replantation result in survival of the amputated portion, and unreconstructable damage to or complete loss of the amputated part may preclude attempted replantation. In such situations, the surgeon must have alternative methods of dealing with the sequelae of thumb loss. This article will discuss nonmicrosurgical and microsurgical techniques for thumb reconstruction.     

Computational Screening of Tip and Stalk Cell Behavior Proposes a Role for Apelin Signaling in Sprout Progression

Angiogenesis involves the formation of new blood vessels by sprouting or splitting of existing blood vessels. During sprouting, a highly motile type of endothelial cell, called the tip cell, migrates from the blood vessels followed by stalk cells, an endothelial cell type that forms the body of the sprout. To get more insight into how tip cells contribute to angiogenesis, we extended an existing computational model of vascular network formation based on the cellular Potts model with tip and stalk differentiation, without making a priori assumptions about the differences between tip cells and stalk cells. To predict potential differences, we looked for parameter values that make tip cells (a) move to the sprout tip, and (b) change the morphology of the angiogenic networks. The screening predicted that if tip cells respond less effectively to an endothelial chemoattractant than stalk cells, they move to the tips of the sprouts, which impacts the morphology of the networks. A comparison of this model prediction with genes expressed differentially in tip and stalk cells revealed that the endothelial chemoattractant Apelin and its receptor APJ may match the model prediction. To test the model prediction we inhibited Apelin signaling in our model and in an in vitro model of angiogenic sprouting, and found that in both cases inhibition of Apelin or of its receptor APJ reduces sprouting. Based on the prediction of the computational model, we propose that the differential expression of Apelin and APJ yields a “self-generated” gradient mechanisms that accelerates the extension of the sprout.     

Methods for reducing nonspecific interaction in antibody-antigen assay via atomic force microscopy

We developed a method to measure the rupture forces between antibody and antigen by atomic force microscopy (AFM). Previous studies have reported that in the measurement of antibody–antigen interaction using AFM, the specific intermolecular forces are often obscured by nonspecific adhesive binding forces between antibody immobilized cantilever and substrate surfaces on which antigen or nonantigen are fixed. Here, we examined whether detergent and nonreactive protein, which have been widely used to reduce nonspecific background signals in ordinary immunoassay and immunoblotting, could reduce the nonspecific forces in the AFM measurement. The results showed that, in the presence of both nonreactive protein and detergent, the rupture forces between anti-ferritin antibodies immobilized on a tip of cantilever and ferritin (antigen) on the substrate could be successfully measured, distinguishing from nonspecific adhesive forces. In addition, we found that approach/retraction velocity of the AFM cantilever was also important in the reduction of nonspecific adhesion. These insights will contribute to the detection of specific molecules at nanometer scale region and the investigation of intermolecular interaction by the use of AFM.     

Theoretical analysis of an iron mineral-based magnetoreceptor model in birds

Sensing the magnetic field has been established as an essential part of navigation and orientation of various animals for many years. Only recently has the first detailed receptor concept for magnetoreception been published based on histological and physical results. The considered mechanism involves two types of iron minerals (magnetite and maghemite) that were found in subcellular compartments within sensory dendrites of the upper beak of several bird species. But so far a quantitative evaluation of the proposed receptor is missing. In this article, we develop a theoretical model to quantitatively and qualitatively describe the magnetic field effects among particles containing iron minerals. The analysis of forces acting between these subcellular compartments shows a particular dependence on the orientation of the external magnetic field. The iron minerals in the beak are found in the form of crystalline maghemite platelets and assemblies of magnetite nanoparticles. We demonstrate that the pull or push to the magnetite assemblies, which are connected to the cell membrane, may reach a value of 0.2 pN -- sufficient to excite specific mechanoreceptive membrane channels in the nerve cell. The theoretical analysis of the assumed magnetoreceptor system in the avian beak skin clearly shows that it might indeed be a sensitive biological magnetometer providing an essential part of the magnetic map for navigation.     

Nasal reconstruction using both cranial bone and ear cartilage

In this article, an anatomic reconstruction is described using cranial bone graft for the bony part of the nose while reconstructing the cartilaginous part with ear cartilage. This modification provides protection of the nose from the traumatic forces creating a flexible nasal tip. A modification is described and compared with the nasal reconstruction by calvarial bone itself.     

Three-dimensional heart motion estimation using endoscopic monocular vision system: From artificial landmarks to texture analysis

In robot-assisted beating heart surgery, motion of the heart surface might be virtually stabilized to let the surgeon work as in on-pump cardiac surgery. Virtual stabilization means to compensate physically the relative motion between the instrument tool tip and the region of interest on the heart surface, and to offer surgeon a stable visual display of the scene. To this end, motion of the heart must be estimated. This article focusses on motion estimation of the heart surface. Two approaches are considered in the paper. The first one is based on landmark tracking allowing 3D pose estimation. The second is based on texture tracking. Classical computer vision methods, as well as a new texture-based tracking scheme has been applied to track the heart motion, and, when possible, reconstruct 3D distance to the heart surface. Experimental results obtained on in vivo images show the estimated motion of heart surface points.