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The significance of this work lies in its simplicity in clinical setting and the seamless integration into the current medical procedure with satisfactory response time and overlay accuracy. Copyright © 2016 John Wiley & Sons, Ltd.

Uniaxial stress-strain data were obtained from in vitro experiments on 20 porcine livers for compressions, elongations and cycles of compression and then elongation. There were about 70 cylindrical samples, with diameter 7mm and varying height (4-11 mm). The combined compression and elongation test provide a unified framework for both compression and elongation for applications such as computer-aided surgical simulation. It enable the zero stress state of the experimental liver sample to be precisely determined. A new equation that combined both logarithmic and polynomial strain energy forms was proposed in modelling these experimental data. The assumption of incompressibility was justified from a preliminary Poisson's ratio for elongation and compression at 0.43+/-0.16 and 0.47+/-0.15, respectively. This equation provided a good fit for the observed mechanical properties of liver during compression-elongation cycles and for separate compressions or elongations. The root mean square errors were 91.92+/-17.43 Pa, 57.55+/-13.23 Pa and 29.78+/-17.67 Pa, respectively. In comparison with existing strain energy functions, this combined model was the better constitutive equation. Application of this theoretical model to small liver samples and other tissues demonstrated its suitability as the material model of choice for soft tissue.

The blood–brain barrier (BBB) has hampered the efficiency of nanoparticle delivery into the brain via conventional strategies. The widening of BBB tight junctions via focused ultrasound (FUS) offers a promising approach for enhancing the delivery of nanoparticles into the brain. However, there is currently an insufficient understanding of how nanoparticles pass through the opened BBB gaps. Here we investigated the size-dependence of nanoparticle delivery into the brain assisted by FUS-induced BBB opening, using gold nanoparticles (AuNPs) of 3, 15, and 120 nm diameter. For 3- and 15-nm AuNPs, FUS exposure significantly increased permeation across an in vitro BBB model by up to 9.5 times, and the permeability was higher with smaller diameter. However, in vivo transcranial FUS exposure in mice demonstrated that smaller particles were not necessarily better for delivery into the brain. Medium-sized (15 nm) AuNPs showed the highest delivery efficiency (0.22% ID), compared with 3- and 120-nm particles. A computational model suggested that this optimum size was determined by the competition between their permeation through opened BBB gaps and their excretion from blood. Our results would greatly contribute to designing nanoparticles for their delivery into the brain for the treatment of central nervous system diseases.

Knowledge of the biomechanical properties of soft tissue, such as liver, is important in modelling computer aided surgical procedures. Liver tissue does not bear mechanical loads, and, in numerical simulation research, is typically assumed to be isotropic. Nevertheless, a typical biological soft tissue is anisotropic. In vitro uniaxial tension and compression experiments were conducted on porcine cylindrical and cubical liver tissue samples respectively assuming a simplistic architecture of liver tissue with its constituent lobule and connective tissues components. With the primary axis perpendicular to the cross sectional surface of samples, the tissue is stiffer with tensile or compressive force in the axial direction compared to that of the transverse direction. At 20% strain, about twice as much force is required to elongate a longitudinal tissue sample than that of a transverse sample. Results of the study suggest that liver tissue is transversely isotropic. A combined strain energy based constitutive equation for transversely isotropic material is proposed. The improved capability of this equation to model the experimental data compared to its previously disclosed isotropic version suggests that the assumption on the fourth invariant in the constitutive equation is probably correct and that anisotropy properties of liver tissue should be considered in surgical simulation.

Nifekalant (NF) is a novel class III antiarrhythmic agent that is effective in preventing life-threatening ventricular tachycardia/fibrillation (VT/VF). We investigated mechanisms of destabilization and early termination of spiral-type reentrant VT by NF in a two-dimensional subepicardial myocardial layer of Langendorff-perfused rabbit hearts (n = 21) using a high-resolution optical action potential mapping system. During basic stimulation, NF (0.1 microM) caused uniform prolongation of action potential duration (APD) without affecting conduction velocity and an increase of APD restitution slope. VTs induced by direct current stimulation in the presence of NF were of shorter duration (VTs > 30 s: 2/54 NF vs. 19/93 control). During VTs in control (with visible rotors), the wave front chased its own tail with a certain distance (repolarized zone), and they seldom met each other. The average number of phase singularity (PS) points was 1.31 +/- 0.14 per 665 ms (n = 7). In the presence of NF, the wave front frequently encountered its own tail, causing a transient breakup of the spiral wave or sudden movement of the rotation center (spatial jump of PS). The average number of PS was increased to 1.63 +/- 0.22 per 665 ms (n = 7, P < 0.05) after NF. The mode of spontaneous termination of rotors in control was in most cases (9/10, 90.0%) the result of mutual annihilation of counterrotating wave fronts. With NF, rotors frequently terminated by wave front collision with the atrioventricular groove (12/19, 63.2%) or by trapping the spiral tip in a refractory zone (7/19, 36.8%). Destabilization and early termination of spiral wave reentry induced by NF are the result of a limited proportion of excitable tissue after modulation of repolarization.

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This paper describes an autostereoscopic image overlay technique that is integrated into a surgical navigation system to superimpose a real three-dimensional (3-D) image onto the patient via a half-silvered mirror. The images are created by employing a modified version of integral videography (IV), which is an animated extension of integral photography. IV records and reproduces 3-D images using a microconvex lens array and flat display; it can display geometrically accurate 3-D autostereoscopic images and reproduce motion parallax without the need for special devices. The use of semitransparent display devices makes it appear that the 3-D image is inside the patient's body. This is the first report of applying an autostereoscopic display with an image overlay system in surgical navigation. Experiments demonstrated that the fast IV rendering technique and patient-image registration method produce an average registration accuracy of 1.13 mm. Experiments using a target in phantom agar showed that the system can guide a needle toward a target with an average error of 2.6 mm. Improvement in the quality of the IV display will make this system practical and its use will increase surgical accuracy and reduce invasiveness.