In image-guided percutaneous interventions, a precise planning of the needle path is a key factor to a successful intervention. In this paper we propose a novel method for computing a patient-specific optimal path for such interventions, accounting for both the deformation of the needle and soft tissues due to the insertion of the needle in the body. To achieve this objective, we propose an optimization method for estimating preoperatively a curved trajectory allowing to reach a target even in the case of tissue motion and needle bending. Needle insertions are simulated and regarded as evaluations of the objective function by the iterative planning process. In order to test the planning algorithm, it is coupled with a fast needle insertion simulation involving a flexible needle model and soft tissue finite element modeling, and experimented on the use-case of thermal ablation of liver tumors. Our algorithm has been successfully tested on twelve datasets of patient-specific geometries. Fast convergence to the actual optimal solution has been shown. This method is designed to be adapted to a wide range of percutaneous interventions.

• MeSH
• ablace MeSH
• algoritmy * MeSH
• anatomické modely * MeSH
• chirurgie s pomocí počítače metody   MeSH
• játra patofyziologie   chirurgie   MeSH
• lidé MeSH
• nádory jater chirurgie   MeSH
• počítačová simulace * MeSH
• předoperační období * MeSH
• uživatelské rozhraní počítače MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Účel přehledu: Odborníci na paliativní péči si stále více uvědomují přítomnost globální epidemie chronické obstrukční plicní nemoci (CHOPN), udivující nárůst prevalence tohoto onemocnění a jeho závažný dopad na kvalitu života pacienta a na jeho funkční stav. Bohužel platí, že pacientům s CHOPN se předběžně plánované a paliativní péče dostává v menší míře než pacientům s jinými onemocněními, která mají podobnou prognózu. V tomto přehledu jsou zdůrazněny nedávno dosažené úspěchy v rozpoznávání překážek předběžného plánování péče a příležitosti pro zajištění účinnější a včasné paliativní péče. Nové poznatky: Pacienti s CHOPN vnímají jako nejhorší příznak z hlediska nepříznivého vlivu na funkční stav dušnost. Péče orientovaná na nemoc (disease directed care, disease oriented care) zajišťuje pouze částečnou úlevu od dušnosti; pacient postupně přestává reagovat na léčbu, co se týče dušnosti, a je nutné ho převést na paliativní péči. Integrace paliativní péče a léčebných postupů orientovaných na nemoc však ve všech stadiích CHOPN zlepšuje pohodu a funkční stav pacienta. V observačních studiích byla zaznamenána řada překážek bránících účinnému předběžnému plánování péče. Vzhledem k jedinečné „trajektorii“ CHOPN navrhují skupiny odborníků nové modely paliativní péče „šité na míru“ právě pro pacienty s tímto onemocněním. Souhrn: Pacientům s CHOPN prospívá lepší integrace paliativní péče specifické pro danou nemoc po celou dobu jejího trvání, tedy od stanovení diagnózy až do úmrtí nemocného. Platformou pro koordinaci integrované péče se může stát plicní rehabilitace. Poskytovatelé zdravotní péče budou stále více očekávat lepší koordinaci služeb pro pacienty s touto progresivní, zneschopňující a posléze smrtící nemocí.

Experts in palliative care have increasingly recognized the global epidemic of chronic obstructive pulmonary disease (COPD), its astonishing rise in prevalence, and its profound impact on patients' quality of life and functional capacity. Unfortunately, patients with COPD receive less advance care planning (ACP) and palliative care as compared with patients with other diseases with similar prognoses. This review highlights recent advances in identifying barriers to ACP and opportunities for providing more effective and timely palliative care. RECENT FINDINGS: Patients with COPD identify dyspnea as their most disabling symptom. Disease-directed care provides only partial relief from dyspnea, which eventually becomes refractory and requires transition to palliative care. Throughout all stages of COPD, however, integrating palliative care with disease-directed treatments improves patients' well being and functional capacities. Observational studies have identified multiple barriers to effective ACP. Because of the unique disease trajectory of COPD, professional groups have proposed new models for palliative care specifically tailored to COPD. SUMMARY: Patients with COPD benefit from better integration of palliative and disease-specific care throughout the course of their disease from diagnosis to death. Pulmonary rehabilitation may provide a platform for coordinating integrated care. Health agencies will increasingly expect better coordination of services for patients with this progressive, disabling, and eventually terminal disease

• MeSH
• chronická obstrukční plicní nemoc psychologie   terapie   MeSH
• komunikační bariéry MeSH
• lidé MeSH
• paliativní péče MeSH
• předběžné plánování péče MeSH
• prognóza MeSH
• progrese nemoci MeSH
• vztahy mezi lékařem a pacientem MeSH
• zlepšení kvality MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Cíl: Zhodnotit superioritu předoperačního trojrozměrného (3D) plánování pomocí CT nad dvojrozměrným (2D) plánováním z hlediska přesnosti umístění pedikulárních šroubů. Materiál a metody: Ve virtuálním prostředí umístili tři chirurgové osmi pacientům ve skupině 2D pedikulární šrouby do bederní páteře po konvenčním 2D plánování. Ve skupině 3D umístili pedikulární šrouby po 3D plánování na základě CT. Po virtuálních operacích byly zaznamenány úhly trajektorie, vzdálenost míst narušení pedikulární stěny a vzdálenost odchylek od místa vstupu šroubu. Výsledky: V 2D skupině pedikulární stěnu penetrovalo 69 šroubů (28,8 %) a v 3D skupině 37 šroubů (15,5 %). Porovnání těchto dvou skupin ukázalo významnou výhodu ve prospěch předoperačního 3D plánování (p = 0,003). V 2D skupině byl průměrný úhel trajektorie šroubu vypočítaný před operací 19,65 ± 6,35° a průměrný úhel vložených šroubů měřený po operaci byl 20,79 ± 5,95°. Ve skupině 3D byl průměrný úhel trajektorie šroubu vypočítaný předoperačně 20,18 ± 5,67° a průměrný úhel vloženého šroubu změřený pooperačně byl 20,07 ± 5,85°. V porovnání s předoperačním plánováním ve skupině 3D byly šrouby vloženy v podobné orientaci (p = 0,655), ale pooperačně nebylo možné ve skupině 2D podobné orientace dosáhnout u všech úrovní (p ≤ 0,001). Závěr: Předoperační 3D plánování zlepšuje přesnost tím, že pomáhá určit bod vstupu pedikulárního šroubu a jeho směr.

Aim: To evaluate the superiority of preoperative three-dimensional (3D) CT-based planning over two-dimensional (2D) planning in terms of pedicle screw placement accuracy. Materials and methods: In a virtual environment, three surgeons placed pedicle screws in the lumbar region of eight patients in the 2D group after conventional 2D planning. In the 3D group, they placed pedicle screws after 3D CT-based planning. Trajectory angles, distance of the wall breach and distance of the screw entry point deviation were recorded after virtual surgeries. Results: In the 2D group, 69 screws (28.8%) penetrated the pedicle wall and 37 screws (15.5%) penetrated the pedicle wall in the 3D group. Comparing these two groups, preoperative 3D planning showed a signifi cant advantage (P = 0.003). In the 2D group, the mean angle of the screw trajectory preoperatively calculated was 19.65 ± 6.35°, and the mean angle of the inserted screws was postoperatively measured at 20.79 ± 5.95°. In the 3D group, the mean angle of the screw trajectory calculated preoperatively was 20.18 ± 5.67°, and the mean angle of the inserted screws postoperatively was 20.07 ± 5.85°. The screws were inserted in the similar orientation comparing to preoperative planning in the 3D group (P = 0.655), but a similar orientation could not be obtained postoperatively in the 2D group (P ≤ 0.001) for all levels. Conclusion: Preoperative 3D planning improves accuracy by helping determine the pedicle screw entry point and direction.

• Klíčová slova
• plánování operace,
• MeSH
• bederní obratle * chirurgie   MeSH
• chirurgie s pomocí počítače * MeSH
• klinická studie jako téma MeSH
• lidé MeSH
• pedikulární šrouby * MeSH
• virtuální realita MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• lidé MeSH

In this work, we extend the previously proposed approach of improving mutual perception during human-robot collaboration by communicating the robot's motion intentions and status to a human worker using hand-worn haptic feedback devices. The improvement is presented by introducing spatial tactile feedback, which provides the human worker with more intuitive information about the currently planned robot's trajectory, given its spatial configuration. The enhanced feedback devices communicate directional information through activation of six tactors spatially organised to represent an orthogonal coordinate frame: the vibration activates on the side of the feedback device that is closest to the future path of the robot. To test the effectiveness of the improved human-machine interface, two user studies were prepared and conducted. The first study aimed to quantitatively evaluate the ease of differentiating activation of individual tactors of the notification devices. The second user study aimed to assess the overall usability of the enhanced notification mode for improving human awareness about the planned trajectory of a robot. The results of the first experiment allowed to identify the tactors for which vibration intensity was most often confused by users. The results of the second experiment showed that the enhanced notification system allowed the participants to complete the task faster and, in general, improved user awareness of the robot's movement plan, according to both objective and subjective data. Moreover, the majority of participants (82%) favoured the improved notification system over its previous non-directional version and vision-based inspection.

• MeSH
• hmat MeSH
• lidé MeSH
• robotika * MeSH
• ruka MeSH
• uživatelské rozhraní počítače MeSH
• zpětná vazba MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: To examine the influence of growth and maturation in the trajectory of stretch-shortening cycle capability. METHOD: Using a mixed-longitudinal design, absolute and relative leg stiffness and reactive strength index (RSI) were measured 3 times over a 3-year period in 44 youth team-sport players. Maturation was determined as maturity offset and included within the Bayesian inference analysis as a covariate alongside chronological age. RESULTS: Irrespective of age and maturation, there was no change in absolute leg stiffness, however relative leg stiffness decreased over time. Maturation and age reduced this decline, but the decline remained significant (Bayesian factor [10] = 5097, model averaged R2 = .61). The RSI increased over time and more so in older more mature youth players (Bayesian factor [10] = 9.29e8, model averaged R2 = .657). CONCLUSION: In youth players who are at/post peak height velocity, relative leg stiffness appears to decline, which could have an impact on both performance and injury risk. However, RSI increases during this period, and these data reinforce that leg stiffness and RSI reflect different components of stretch-shortening cycle capability. Practitioners should consider these differences when planning training to maximize stretch-shortening cycle capability during growth and maturation in athletes on the developmental performance pathway.

• MeSH
• Bayesova věta MeSH
• bérec fyziologie   MeSH
• kosterní svaly fyziologie   MeSH
• lidé MeSH
• longitudinální studie MeSH
• mladiství MeSH
• sport pro děti a mládež MeSH
• sportovci * MeSH
• svalová kontrakce * MeSH
• svalová síla MeSH
• týmové sporty MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Bilateral deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective treatment for refractory dystonia. Neuroradiological target and stimulation electrode trajectory planning with intraoperative microelectrode recordings (MER) and stimulation are used. With improving neuroradiological techniques, the need for MER is in dispute mainly because of the suspected risk of hemorrhage and the impact on clinical post DBS outcome. OBJECTIVE: The aim of the study is to compare the preplanned GPi electrode trajectories with final trajectories selected for electrode implantation after electrophysiological monitoring and to discuss the factors potentially responsible for differences between preplanned and final trajectories. Finally, the potential association between the final trajectory selected for electrode implantation and clinical outcome will be analyzed. METHODS: Forty patients underwent bilateral GPi DBS (right-sided implants first) for refractory dystonia. The relationship between preplanned and final trajectories (MicroDrive system) was correlated with patient (gender, age, dystonia type and duration) and surgery characteristics (anesthesia type, postoperative pneumocephalus) and clinical outcome measured using CGI (Clinical Global Impression parameter). The correlation between the preplanned and final trajectories together with CGI was compared between patients 1-20 and 21-40 for the learning curve effect. RESULTS: The trajectory selected for definitive electrode implantation matched the preplanned trajectory in 72.5% and 70% on the right and left side respectively; 55% had bilateral definitive electrodes implanted along the preplanned trajectories. Statistical analysis did not confirm any of the studied factors as predictor of the difference between the preplanned and final trajectories. Also no association between CGI and final trajectory selected for electrode implantation in the right/left hemisphere has been proven. The percentages of final electrodes implanted along the preplanned trajectory (the correlation between anatomical planning and intraoperative electrophysiology results) did not differ between patients 1-20 and 21-40. Similarly, there were no statistically significant differences in CGI (clinical outcome) between patients 1-20 and 21-40. CONCLUSION: The final trajectory selected after electrophysiological study differed from the preplanned trajectory in a significant percentage of patients. No predictor of this difference was identified. The anatomo-electrophysiological difference was not predictive of the clinical outcome (as measured using CGI parameter).

• Publikační typ
• časopisecké články MeSH

AIM: Advances in neuroradiological planning techniques in deep brain stimulation have put the need for intraoperative electrophysiological monitoring into doubt. Moreover intraoperative monitoring prolongs surgical time and there is potential association between the use of microelectrodes and increased incidence of hemorrhagic complications. The aim of this study was to analyze the correlation between the anatomically planned trajectory and the final subthalamic electrode placement after electrophysiological monitoring in patients with Parkinson"s disease and its change with the increasing experience of the surgical team. MATERIAL AND METHODS: The trajectories of right (first implanted) and left electrodes were compared in the first 50 patients operated on (Group 1) and the next 50 patients (Group 2). RESULTS: In Group 1, 52% of central trajectories were on the right and 38% on the left; in Group 2, the percentage of central trajectories was 76% on the right and 78% on the left; the difference was statistically significant (p=0.021 and 0.001). The difference in the percentage of posterior trajectories reflecting brain shift between the right and left sides was statistically insignificant in Groups 1 (26% and 28%, p=0.999) and 2 (18% and 12%, p=0.549). The percentage of bilateral central electrodes was 14% and 62% in Groups 1 and 2, respectively. CONCLUSION: The correlation between anatomically planned trajectory and final electrode placement markedly improves with the number of patients. However the significant percentage of patients with final electrode trajectory differing from anatomically planned target supports the use of intraoperative monitoring.

• MeSH
• hluboká mozková stimulace metody   MeSH
• implantované elektrody MeSH
• intraoperační neurofyziologická monitorace * MeSH
• klinické kompetence MeSH
• křivka učení * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikroelektrody MeSH
• nucleus subthalamicus fyziologie   MeSH
• Parkinsonova nemoc chirurgie   MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Thalamic gliomas represent a great challenge for neurosurgeons because of the high surgical risk of damaging the surrounding anatomy. Preoperative planning may considerably help the surgeon find the most ideal operative trajectory, avoiding thalamic nuclei and important white matter pathways adjacent to the tumor tissue. Thalamic segmentation is a promising imaging tool based on diffusion tensor magnetic resonance imaging. It provides the possibility to predict the relationship of the tumor to thalamic nuclei. OBJECTIVE: To propose a new tool in thalamic glioma surgery that may help to differentiate between normal thalamus and tumor tissue, making preoperative planning possible and facilitating the choice of the optimal surgical approach and trajectory for neuronavigation-assisted surgery. METHODS: Four patients with thalamic gliomas preoperatively underwent conventional and diffusion-weighted magnetic resonance imaging conducted on 1.5 T. Subsequently, probabilistic tractography and thalamic segmentation were performed with the FSL Software as preoperative planning. We also present a case when thalamic segmentation was applied retrospectively using preoperative images. All patients went through neuronavigation-assisted surgery (1 partial, 4 subtotal resections). RESULTS: Surgery performed based on the output of thalamic segmentation caused no deterioration in the neurological symptoms of our patients. Indeed, we noticed improvement in the neurological condition in 3 cases; furthermore, in 2 patients, a concern-free state was achieved. CONCLUSION: We suggest that thalamic segmentation may be applied successfully and routinely in the surgical treatment of thalamic gliomas.

• MeSH
• difuzní magnetická rezonance MeSH
• dospělí MeSH
• gliom patologie   chirurgie   MeSH
• lidé MeSH
• mladý dospělý MeSH
• nádory mozku patologie   chirurgie   MeSH
• nervová vlákna patologie   MeSH
• neurochirurgické výkony metody   MeSH
• neuronavigace MeSH
• počítačové zpracování obrazu MeSH
• senioři MeSH
• thalamus patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

The aim of the paper is to present an unusual case of ectopic posterior fossa craniopharyngioma after repeated surgeries for primary suprasellar tumor. The clinical condition of the patient favored minimally invasive neuroendoscopic surgery. After presurgical planning with the help of neuronavigation system a trajectory from the contralateral side through the cisterna magna was chosen. Endoscopic cyst fenestration and cyst wall resection were safely performed with an excellent outcome. The possible origin of this posterior fossa craniopharyngioma is discussed together with tumor dissemination pathways. The endoscopic contralateral approach to the tumor utilized the wide working space provided by the cisterna magna and the great versatility of the navigated neuroendoscopic approach was proven.

• MeSH
• cisterna magna chirurgie   MeSH
• kraniofaryngeom diagnóza   chirurgie   MeSH
• lidé MeSH
• lokální recidiva nádoru diagnóza   chirurgie   MeSH
• magnetická rezonance intervenční metody   MeSH
• magnetická rezonanční angiografie MeSH
• miniinvazivní chirurgické výkony MeSH
• nádory hypofýzy diagnóza   chirurgie   MeSH
• neuroendoskopie metody   MeSH
• neuronavigace metody   MeSH
• počítačové zpracování obrazu MeSH
• reoperace MeSH
• senioři MeSH
• zadní jáma lební chirurgie   MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH