BackgroundThis study investigated the effects of obesity on attentional resources allocated to postural control in seating and unipedal standing.MethodsTen non obese adults (BMI = 22.4±1.3, age = 42.4±15.1) and 10 obese adult patients (BMI = 35.2±2.8, age = 46.2±19.6) maintained postural stability on a force platform in two postural tasks (seated and unipedal). The two postural tasks were performed (1) alone and (2) in a dual-task paradigm in combination with an auditory reaction time task (RT). Performing the RT task together with the postural one was supposed to require some attentional resources that allowed estimating the attentional cost of postural control. 4 trials were performed in each condition for a total of 16 trials.Findings(1) Whereas seated non obese and obese patients exhibited similar centre of foot pressure oscillations (CoP), in the unipedal stance only obese patients strongly increased their CoP sway in comparison to controls. (2) Whatever the postural task, the additional RT task did not affect postural stability. (3) Seated, RT did not differ between the two groups. (4) RT strongly increased between the two postural conditions in the obese patients only, suggesting that body schema and the use of internal models was altered with obesity.InterpretationObese patients needed more attentional resources to control postural stability during unipedal stance than non obese participants. This was not the case in a more simple posture such as seating. To reduce the risk of fall as indicated by the critical values of CoP displacement, obese patients must dedicate a strong large part of their attentional resources to postural control, to the detriment of non-postural events. Obese patients were not able to easily perform multitasking as healthy adults do, reflecting weakened psycho-motor abilities.

The brain deformation that occurs during neurosurgery is a serious issue impacting the patient "safety" as well as the invasiveness of the brain surgery. Model-driven compensation is a realistic and efficient solution to solve this problem. However, a vital issue is the lack of reliable and easily obtainable patient-specific mechanical characteristics of the brain which, according to clinicians' experience, can vary considerably. We designed an aspiration device that is able to meet the very rigorous sterilization and handling process imposed during surgery, and especially neurosurgery. The device, which has no electronic component, is simple, light and can be considered as an ancillary instrument. The deformation of the aspirated tissue is imaged via a mirror using an external camera. This paper describes the experimental setup as well as its use during a specific neurosurgery. The experimental data was used to calibrate a continuous model. We show that we were able to extract an in vivo constitutive law of the brain elasticity: thus for the first time, measurements are carried out per-operatively on the patient, just before the resection of the brain parenchyma. This paper discloses the results of a difficult experiment and provide for the first time in vivo data on human brain elasticity. The results point out the softness as well as the highly non-linear behavior of the brain tissue.

Obese people suffer from postural deficits and are more subject to falls than their lean counterpart. To improve prevention and post-fall rehabilitation programs, it seems important to better understand the posturo-kinetic disorders in daily life situations by determining the contribution of some key factors, mainly morphological characteristics and physical activity level, in the apparition of these disorders.Twelve severe android obese and eight healthy non obese adults performed a reaching task mobilizing the whole body. To further determine the origin of the postural and motor behavior differences, non obese individuals also performed an experimental session with additional constraints which simulated some of the obese morphological characteristics. Impact of the sedentary lifestyle was also studied by dissociation of the obese in two subgroups: physically « active » and physically « inactive ». Movement kinetics and kinematics were characterized with an optoelectronic system synchronized to a force platform. The mechanical equilibrium pattern was evaluated through the displacements of the Centre of Mass (CoM) and the centre of foot pressure within the Base of Support (BoS).Results showed that obesity decreased movement speed (≈−23%, p<0.01), strongly increased CoM displacement (≈+30%, p<0.05) and induced an important spatio-temporal desynchronization (≈+40%, p<0.05) of the focal and postural components of the movement during the transition between the descending and ascending movements.The role of some morphological characteristics and of physical activity on obese patients' postural control disorder is discussed and set back in the more general context of overall factors contributing to postural deficits with obesity.

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Biomechanical modeling of the facial soft tissue behavior is needed in aesthetic or maxillo-facial surgeries where the simulation of the bone displacements cannot accurately predict the visible outcome on the patient's face. Because these tissues have different nature and elastic properties across the face, depending on their thickness, and their content in fat or muscle, individualizing their mechanical parameters could increase the simulation accuracy. Using a specifically designed aspiration device, the facial soft tissues deformation is measured at four different locations (cheek, cheekbone, forehead, and lower lip) on 16 young subjects. The stiffness is estimated from the deformations generated by a set of negative pressures using an inverse analysis based on a Neo Hookean model. The initial Young's modulus of the cheek, cheekbone, forehead, and lower lip are respectively estimated to be 31.0 kPa±4.6, 34.9 kPa±6.6, 17.3 kPa±4.1, and 33.7 kPa±7.3. Significant intra-subject differences in tissue stiffness are highlighted by these estimations. They also show important inter-subject variability for some locations even when mean stiffness values show no statistical difference. This study stresses the importance of using a measurement device capable of evaluating the patient specific tissue stiffness during an intervention.

Purpose: We present a hybrid 2D-3D ultrasound (US) rigid registration method for navigated prostate biopsy that enables continuous localization of the biopsy trajectory during the exam.Methods: Current clinical computer-assisted biopsy systems use either sensorbased or image-based approaches. We combine the advantages of both in order to obtain an accurate and real-time navigation based only on an approximate localization of the US probe. Starting with features extracted in both 2D and 3D images, our method introduces a variant of the Iterative Closest Point (ICP) algorithm. Among other differences to ICP, a combination of both the euclidean distance of feature positions and the similarity distance of feature descriptors is used to find matches between 2D and 3D features. The evaluation of the method is twofold. First, an analysis of variance on input parameters is conducted to estimate the sensitivity of our method to their initialization. Secondly, for a selected set of their values, the Target Registration Error (TRE) was calculated on 29,760 (resp. 4,000) registrations in two different experiments. It was obtained using manually identified anatomical fiducials.Results: For 160 US volumes, from 20 patients, recorded during routine biopsy procedures performed in two hospitals by 6 operators, the mean TRE was 3.91±3.22 mm (resp. 4.37±2.62 mm).Conclusion: This work allows envisioning further developments for prostate navigation and their clinical transfer.

In this paper, we present CamiTK, a specific modular framework that helps researchers and clinicians to collaborate in order to prototype Computer Assisted Medical Intervention (CAMI) applications by using the best knowledge and know-how during all the required steps. CamiTK is an open-source, crossplatform generic tool, written in C++, which can handle medical images, surgical navigations and biomechanical simulations. This paper first gives an overview of CamiTK core architecture and how it can be extended to fit particular scientific needs. The MML extension is then presented: it is an environment for comparing and evaluating soft-tissue simulation models and algorithms. Specifically designed as a soft-tissue simulation benchmark and a reference database for validation, it can compare models and algorithms built from different modeling techniques or biomechanical software. This article demonstrates the use of CamiTK on a textbook but complete example, where the medical image and MML extensions are collaborating in order to process and analyze MR brain images, reconstruct a patient-specific mesh of the brain, and simulate a basic brain-shift with different biomechanical models from ANSYS, SOFA and ArtiSynth.