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Objective In the field of cochlear implantation, the current trend toward patient-specific electrode selection and the achievement of optimal audiologic outcomes has resulted in implant manufacturers developing a large portfolio of electrodes. The aim of this study was to bridge the gap between the known variability of cochlea length and this electrode portfolio. Design Retrospective analysis on cochlear length and shape in micro–computed tomography and cone beam computed tomography data. Setting Tertiary care medical center. Subjects and Methods A simple 2-step approach was developed to accurately estimate the individual cochlear length as well as the projected length of an electrode array inside the cochlea. The method is capable of predicting the length of the cochlea and the inserted electrode length at any specific angle. Validation of the approach was performed with 20 scans of human temporal bones (micro–computed tomography) and 47 pre- and postoperative clinical scans (cone beam computed tomography). Results Mean ± SD absolute errors in cochlear length estimations were 0.12 ± 0.10 mm, 0.38 ± 0.26 mm, and 0.71 ± 0.43 mm for 1, 1.5, and 2 cochlea turns, respectively. Predicted insertion angles based on clinical cone beam computed tomography data showed absolute deviations of 27° ± 18° to the corresponding postoperative measurements. Conclusion With accuracy improvements of 80% to 90% in comparison with previously proposed approaches, the method is well suited for the use in individualized cochlear implantation.

A substantial number of newborns face postdelivery respiratory issues annually. Current ventilation devices in immediate newborn care lack integrated sensors and supporting mechanisms for medical professionals. This is a potential field of improvement, as safe ventilation relies on accurate pressure administration in current t-piece resuscitators. As the needed support during the process is currently limited, it highlights the demand for innovations in neonatal ventilation technology to improve efficacy and reduce potential errors. The objective of the study was to facilitate collaboration between medical and engineering experts to evaluate the critical factors for the successful implementation of an innovative ventilation technology in clinical immediate newborn care. Incorporating the views of medical professionals into the survey is expected to offer valuable insights to engineers for subsequent technological refinement. An international multicenter online survey was conducted among 51 neonatal health care professionals in the DACH region (Germany, Austria, and Switzerland) in order to (1) assess the specific functionalities required in a neonatal ventilation assistant in immediate newborn care from a medical technology viewpoint, (2) characterize the acceptance of such a device as support tool using the extended technology acceptance model, and (3) identify further steps toward integration of such technologies. According to the results, a visual representation of the current mask leakage and tidal volume is an essential feature. Integrating alarms in visual rather than audible form when limit values are exceeded is preferable. In contrast, medical professionals ranked an external control using a foot pedal as the least necessary feature. Based on the findings, acceptance constructs of the neonatal ventilation technology were moderately scored. Perceived usefulness (β=.76, P<.001) was the main predictor of the behavioral intention to use such a supportive instrument. There is an evident willingness to integrate sophisticated support techniques into a neonatal ventilation device for immediate newborn care.

Background 3D-printed temporal bone models can potentially provide a cost-effective alternative to cadaver surgery that can be manufactured locally at the training department. The objective of this study was to create a cost-effective 3D-printed model suitable for mastoidectomy training using entry level and commercially available print technologies, enabling individuals, without prior experience on 3D-printing, to manufacture their own models for basic temporal bone training. Methods Expert technical professionals and an experienced otosurgeon identified the best material for replicating the temporal bone and created a cost-effective printing routine for the model using entry-level print technologies. Eleven participants at a temporal bone dissection course evaluated the model using a questionnaire. Results The 3D-printed temporal bone model was printed using a material extrusion 3D-printer with a heat resistant filament, reducing melting during drilling. After printing, a few simple post-processing steps were designed to replicate the dura, sigmoid sinus and facial nerve. Modifying the 3D-printer by installing a direct-drive and ruby nozzle resulted in more successful prints and less need for maintenance. Upon evaluation by otorhinolaryngology trainees, unanimous feedback was that the model provided a good introduction to the mastoidectomy procedure, and supplementing practice to cadaveric temporal bones. Conclusion In-house production of a cost-effective 3D-printed model for temporal bone training is feasible and enables training institutions to manufacture their own models. Further, this work demonstrates the feasibility of creating new temporal bone models with anatomical variation to provide ample training opportunity.

Cochlear implantation (CI) is now widely used to provide auditory rehabilitation to individuals having severe to profound sensorineural hearing loss (SNHL). However, CI can lead to electrode insertion trauma (EIT) that can cause damage to sensory cells in the inner ear resulting in loss of residual hearing. Even with soft surgical techniques where there is minimal macroscopic damage, we can still observe the generation of molecular events that may initiate programmed cell death various mechanisms such as oxidative stress, the release of pro-inflammatory cytokines, and activation of the caspase pathway. In addition, individuals with CI may be exposed to noise trauma (NT) due to occupation and leisure activities that may affect their hearing ability. Recently, there has been an increased interest in the auditory community to determine the efficacy of drug-eluting electrodes for the protection of residual hearing. The objective of this study is to determine the effect of NT on implanted cochlea as well as the otoprotective efficacy of dexamethasone eluting electrode to implanted cochlea exposed to NT in a guinea pig model of CI. Animals were divided into five groups: EIT with dexamethasone eluting electrode exposed to NT; EIT exposed to NT; NT only; EIT only and naïve animals (control group). The hearing thresholds were determined by auditory brainstem recordings (ABRs). The cochlea was harvested and analyzed for transcript levels of inflammation, apoptosis and fibrosis genes. We observed that threshold shifts were significantly higher in EIT, NT or EIT + NT groups compared to naive animals at all the tested frequencies. The dexamethasone eluting electrode led to a significant decrease in hearing threshold shifts in implanted animals exposed to NT. Proapoptotic tumor necrosis factor-α [TNF-α, TNF-α receptor 1a (TNFαR1a)] and pro-fibrotic transforming growth factor β1 (TGFβ) genes were more than two-fold up-regulated following EIT and EIT + NT compared to the control group. The use of dexamethasone releasing electrode significantly decreased the transcript levels of pro-apoptotic and pro-fibrotic genes. The dexamethasone releasing electrode has shown promising results for hearing protection in implanted animals exposed to NT. The results of this study suggest that dexamethasone releasing electrode holds great potential in developing effective treatment modalities for NT in the implanted cochlea.

Virtual reality surgical simulation of temporal bone surgery requires digitized models of the full anatomical region in high quality and colour information to allow realistic texturization. Existing datasets which are usually based on microCT imaging are unable to fulfil these requirements as per the limited specimen size, and lack of colour information. The OpenEar Dataset provides a library consisting of eight three-dimensional models of the human temporal bone to enable surgical training including colour data. Each dataset is based on a combination of multimodal imaging including Cone Beam Computed Tomography (CBCT) and micro-slicing. 3D reconstruction of micro-slicing images and subsequent registration to CBCT images allowed for relatively efficient multimodal segmentation of inner ear compartments, middle ear bones, tympanic membrane, relevant nerve structures, blood vessels and the temporal bone. Raw data from the experiment as well as voxel data and triangulated models from the segmentation are provided in full for use in surgical simulators or any other application which relies on high quality models of the human temporal bone.

Cre-recombinase inducible model systems are extensively used in cancer research to manipulate gene expression in specific tissues and induce autochthonous tumor growth. These systems often involve the cross-breeding of genetically engineered organisms containing loxP -flanked alleles with those expressing Cre-recombinase. This approach, while effective, has the challenge of requiring high numbers of animals due to breeding requirements. Other frequently used tumor induction methods in cancer research involve the direct application of viral Cre-recombinase vectors. This approach presents the challenge of the accessibility of facilities that meet the necessary safety level. In this context, we perform a comprehensive comparison between TAT-CRE (biosafety level S1) and adenoviral Cre-recombinase induced (biosafety level S2) lung adenocarcinomas driven by Kras G12D expression and Trp53 depletion. We use in vivo lung tumor monitoring via computed tomography, single-cell RNA sequencing, immunohistochemistry and flow cytometry to elucidate similarities and differences between TAT-CRE and adenoviral Cre-recombinase induced lung adenocarcinomas. TAT-CRE induced lung tumors present differences in micro-vessels and macrophages but with corresponding tumor onset and growth characteristics compared to adenoviral-Cre recombinase induced lung tumors. Taken together, TAT-CRE is a valuable genetic engineering safety level S1 alternative for cancer induction and may be implemented in other cancer models than lung cancer. A comparison of lung adenocarcinomas induced by TAT-CRE or adenoviral Cre-recombinase revealed similar tumor growth with differences in micro-vessels and macrophages. TAT-CRE offers a valuable S1 alternative for cancer induction in mouse models

As adult lifespans increase, and the world population continues to age, the number of adult children caring for parents will continue to increase, as will the number of older adults experiencing senile dementia. Caregiving can be an involved and taxing experience on many levels, but dementia deserves special consideration, as family members related to older adults affected by it often experience a sense of ambiguous loss; grief related to the psychological loss of a loved one due to cognitive decline. Marriage and family therapy literature addresses the systemic and psychosocial aspects of chronic illness, but there has been little discussed regarding dementia in this context. Sibling relationships are important in the context of caring for a parent, as they can mitigate the inherent stress of caregiving. However, conflict may arise when there is disagreement about a parent’s diagnosis and care needs, thus exacerbating caregiver stress. In this study, the ways in which caring for a parent with dementia and how it affects sibling relationships were explored. The way one’s ability to understand and cope with ambiguous loss relating to sibling relationships and the overall caregiving experience in turn was also a focus of this study. A grounded theory methodology was utilized as a method of inquiry whereby a purposive sample of adult caregivers of parents with dementia with at least one sibling was recruited. Data collection involved 45-90-minute individual semi-structured interviews. Study participants shared broad accounts of their caregiving roles and responsibilities in addition to their sibling relationships and experiences around coping with ambiguous loss. It was found that mastery and acceptance in coping with the ambiguities of a parent’s cognitive decline are important mediating factors in siblings’ abilities to forge more intimate and cooperative relationships with one another in the context of managing the care of parents affected by dementia.

Absent fathers are often excluded from the treatment of their children for various reasons. They are often marginalized by mothers, and unintentionally excluded by clinicians. Absent fathers are also excluded from treatment in fear that their presence might undermine the competencies of single mothers, which social service agencies serve to empower. This article will discuss the potential benefits of including absent fathers in family therapy, and how to work with them once engaged in treatment.

Our experiences as consultants concerned with transforming a bankrupt stateowned textile enterprise into something more appealing to potential investors was instructive as well as being a good example of why some eastern and central European post-communist economies are failing to manage their transition to the new economic realities. Our conclusions to the first part of our experience suggest the need to understand cultural differences as well as engage in careful planning if investors are to reach positive results before a second, fruitful stage can be reached.

Described herein are methods for asymmetric allylation. Chapter 1 describes the scope of the Pd-catalyzed asymmetric diboration of prochiral allenes. The products of this process possess both a chiral allylboronate functional group and a vinylboronate moiety. The allylboronate functionality can subsequently be used for imine allylation, without isolation of the diboron intermediate, resulting in the formation of atypical allylation products through a tandem, one-pot sequence. Furthermore, enantioselection in the catalytic diboration and chirality transfer in the subsequent imine allylation are high; thus, non-racemic, protected homoallylic amines, and other derivatives, are produced in high enantiomeric excess. Chapter 2 describes the discovery and development of a transition-metal-catalyzed asymmetric conjugate allylation of allylboronate ester nucleophiles to activated enones. The scope, utility, and mechanistic aspects of this new reaction are discussed.