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Brown A, Zhu M, Rohani A, Ladak H, Agrawal SK, Stankovic KM, Welling DB. Surgical Considerations in Inner Ear Gene Therapy from Human Temporal Bone Anatomy. Laryngoscope 2024; 134:2879-2888. [PMID: 38197496 DOI: 10.1002/lary.31259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/13/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE(S) Recently directed methods of inner ear drug delivery underscore the necessity for understanding critical anatomical dimensions. This study examines anatomical measurements of the human middle and inner ear relevant for inner ear drug delivery studied with three different imaging modalities. METHODS Post-mortem human temporal bones were analyzed using human temporal bone histopathology (N = 24), micro computerized tomography (μCT; N = 4), and synchrotron radiation phase-contrast imaging (SR-PCI; N = 7). Nine measurements involving the oval and round windows were performed when relevant anatomical structures were visualized for subsequent age-controlled analysis, and comparisons were made between imaging methods. RESULTS Combined human temporal bone histopathology showed the mean distance to the saccule from the center of the stapes footplate (FP) was 2.07 ± 0.357 mm and the minimum distance was 1.23 mm. The mean distance from the round window membrane (RWM) to the osseous spiral lamina (OSL) was 1.75 ± 0.199 mm and the minimum distance was 1.43 mm. Instruments inserted up to 1 mm past the center of the FP are unlikely to cause saccular damage, provided there are no endolymphatic hydrops. Similarly, instruments inserted up to 1 mm through the RWM in the trajectory toward the OSL are unlikely to cause OSL damage. CONCLUSION The combined analyses of inner-ear dimensions of age-controlled groups and imaging modalities demonstrate critical dimensions of importance to consider when inserting delivery vehicles into the human cochlea. LEVEL OF EVIDENCE N/A Laryngoscope, 134:2879-2888, 2024.
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Affiliation(s)
- Alyssa Brown
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts, U.S.A
| | - MengYu Zhu
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Otopathology Laboratory, Boston, Massachusetts, U.S.A
| | - Alireza Rohani
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Hanif Ladak
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Sumit K Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Konstantina M Stankovic
- Department of Otolaryngology Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - D Bradley Welling
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts, U.S.A
- Division of Otology and Neurotology, Harvard Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, Massachusetts, U.S.A
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Micuda A, Li H, Rask-Andersen H, Ladak HM, Agrawal SK. Morphologic Analysis of the Scala Tympani Using Synchrotron: Implications for Cochlear Implantation. Laryngoscope 2024; 134:2889-2897. [PMID: 38189807 DOI: 10.1002/lary.31263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/04/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVES To use synchrotron radiation phase-contrast imaging (SR-PCI) to visualize and measure the morphology of the entire cochlear scala tympani (ST) and assess cochlear implant (CI) electrode trajectories. METHODS SR-PCI images were used to obtain geometric measurements of the cochlear scalar diameter and area at 5-degree increments in 35 unimplanted and three implanted fixed human cadaveric cochleae. RESULTS The cross-sectional diameter and area of the cochlea were found to decrease from the base to the apex. This study represents a wide variability in cochlear morphology and suggests that even in the smallest cochlea, the ST can accommodate a 0.4 mm diameter electrode up to 720°. Additionally, all lateral wall array trajectories were within the anatomically accommodating insertion zone. CONCLUSION This is the first study to use SR-PCI to visualize and quantify the entire ST morphology, from the round window to the apical tip, and assess the post-operative trajectory of electrodes. These high-resolution anatomical measurements can be used to inform the angular insertion depth that can be accommodated in CI patients, accounting for anatomical variability. LEVEL OF EVIDENCE N/A. Laryngoscope, 134:2889-2897, 2024.
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Affiliation(s)
- Ashley Micuda
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Hao Li
- Department of Surgical Sciences, Otorhinolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Helge Rask-Andersen
- Department of Surgical Sciences, Otorhinolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Hanif M Ladak
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Western University, London, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - Sumit K Agrawal
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Western University, London, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
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Simpson ES, Salgado CD, Rohani SA, Agrawal SK, Ladak HM. Development and validation of a surgical planning tool for bone-conduction implants. Heliyon 2024; 10:e27436. [PMID: 38495182 PMCID: PMC10943392 DOI: 10.1016/j.heliyon.2024.e27436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024] Open
Abstract
Background The BONEBRIDGE® (Med-El GmbH) is a bone-conduction device comprising an external audio processor and an internal Bone Conduction-Floating Mass Transducer (BC-FMT) surgically anchored to the temporal bone. Due to the implant's size, its placement may be challenging in certain anatomies, necessitating thorough surgical planning. Manual planning methods are laborious, time-intensive, and prone to errors. This study aimed to develop and validate an automated algorithm for determining skull thickness, aiding in the surgical planning of the BONEBRIDGE and other devices requiring similar bone thickness estimations. Materials and methods Twelve cadaveric temporal bones underwent clinical computed tomography (CT). A custom Python algorithm was developed to automatically segment bone from soft tissue, generate 3D models, and perform ray-tracing to estimate bone thickness. Two thickness colormaps were generated for each sample: the cortical thickness to the first air cell and the total thickness down to the dura. The algorithm was validated against expert manual measurements to achieve consensus interpretation. Results The algorithm estimated bone-to-air thicknesses (mean = 4.7 mm, 95% Confidence Interval [CI] of 4.3-5.0 mm) that closely matched the expert measurements (mean = 4.7 mm, CI of 4.4-5.0 mm), with a mean absolute difference (MAD) of 0.3 mm. Similarly, the algorithm's estimations to the dura (6.0 mm, CI of 5.4-6.5 mm) were comparable to the expert markings (5.9 mm, CI of 5.4-6.5 mm), with a MAD of 0.3 mm. Conclusions The first automated algorithm to calculate skull thickness to both the air cells and dura in the temporal bone was developed. Colormaps were optimized to aid with the surgical planning of BONEBRIDGE implantation, however the tool can be generalized to aid in the surgical planning of any bone thickness application. The tool was published as a freely available extension to the open-source 3D Slicer software program (www.slicer.org).
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Affiliation(s)
- Evan S. Simpson
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Carlos D. Salgado
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Seyed Alireza Rohani
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Sumit K. Agrawal
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- School of Biomedical Engineering, Western University, London, ON, Canada
| | - Hanif M. Ladak
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- School of Biomedical Engineering, Western University, London, ON, Canada
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Lai C, Lui JT, de Lotbiniere-Bassett M, Chen JM, Lin VY, Agrawal SK, Blevins NH, Ladak HM, Pirouzmand F. Virtual Reality Simulation for the Middle Cranial Fossa Approach: A Validation Study. Oper Neurosurg (Hagerstown) 2024; 26:78-85. [PMID: 37747333 DOI: 10.1227/ons.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/22/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Virtual reality (VR) surgical rehearsal is an educational tool that exists in a safe environment. Validation is necessary to establish the educational value of this platform. The middle cranial fossa (MCF) is ideal for simulation because trainees have limited exposure to this approach and it has considerable complication risk. Our objectives were to assess the face, content, and construct validities of an MCF VR simulation, as well as the change in performance across serial simulations. METHODS Using high-resolution volumetric data sets of human cadavers, the authors generated a high-fidelity visual and haptic rendering of the MCF approach using CardinalSim software. Trainees from Neurosurgery and Otolaryngology-Head and Neck Surgery at two Canadian academic centers performed MCF dissections on this VR platform. Randomization was used to assess the effect of enhanced VR interaction. Likert scales were used to assess the face and content validities. Performance metrics and pre- and postsimulation test scores were evaluated. Construct validity was evaluated by examining the effect of the training level on simulation performance. RESULTS Twenty trainees were enrolled. Face and content validities were achieved in all domains. Construct validity, however, was not demonstrated. Postsimulation test scores were significantly higher than presimulation test scores ( P < .001 ). Trainees demonstrated statistically significant improvement in the time to complete dissections ( P < .001 ), internal auditory canal skeletonization ( P < .001 ), completeness of the anterior petrosectomy ( P < .001 ), and reduced number of injuries to critical structures ( P = .001 ). CONCLUSION This MCF VR simulation created using CardinalSim demonstrated face and content validities. Construct validity was not established because no trainee included in the study had previous MCF approach experience, which further emphasizes the importance of simulation. When used as a formative educational adjunct in both Neurosurgery and Otolaryngology-Head and Neck Surgery, this simulation has the potential to enhance understanding of the complex anatomic relationships of critical neurovascular structures.
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Affiliation(s)
- Carolyn Lai
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto , Ontario , Canada
| | - Justin T Lui
- Section of Otolaryngology-Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary , Alberta, Canada
| | - Madeleine de Lotbiniere-Bassett
- Section of Neurosurgery, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary , Alberta, Canada
| | - Joseph M Chen
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto , Ontario , Canada
| | - Vincent Y Lin
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto , Ontario , Canada
| | - Sumit K Agrawal
- Department of Otolaryngology-Head & Neck Surgery, London Health Sciences Centre-University Hospital, Western University, London , Ontario , Canada
| | - Nikolas H Blevins
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Palo Alto , California , USA
| | - Hanif M Ladak
- Department of Medical Biophysics, Western University, London , Ontario , Canada
- Department of Electrical & Computer Engineering, Western University, London , Ontario , Canada
| | - Farhad Pirouzmand
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto , Ontario , Canada
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Thompson CW, Rohani SA, Dirckx JJ, Ladak HM, Agrawal SK. Finite element modelling of the human middle ear using synchrotron-radiation phase-contrast imaging. Comput Biol Med 2023; 157:106747. [PMID: 36907036 DOI: 10.1016/j.compbiomed.2023.106747] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/18/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023]
Abstract
Finite element (FE) models of the middle ear often lack accurate geometry of soft tissue structures, such as the suspensory ligaments, as they can be difficult to discern using conventional imaging modalities, such as computed tomography. Synchrotron-radiation phase-contrast imaging (SR-PCI) is a non-destructive imaging modality that has been shown to produce excellent visualization of soft tissue structures without the need for extensive sample preparation. The objectives of the investigation were to firstly use SR-PCI to create and evaluate a biomechanical FE model of the human middle ear that includes all soft tissue structures, and secondly, to investigate how modelling assumptions and simplifications of ligament representations affect the simulated biomechanical response of the FE model. The FE model included the suspensory ligaments, ossicular chain, tympanic membrane, the incudostapedial and incudomalleal joints, and the ear canal. Frequency responses obtained from the SR-PCI-based FE model agreed well with published laser doppler vibrometer measurements on cadaveric samples. Revised models with exclusion of the superior malleal ligament (SML), simplification of the SML, and modification of the stapedial annular ligament were studied, as these revised models represented modelling assumptions that have been made in literature.
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Affiliation(s)
- Caleb W Thompson
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada.
| | - Seyed A Rohani
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Joris J Dirckx
- Laboratory of Biomedical Physics, University of Antwerp, Antwerp, Belgium
| | - Hanif M Ladak
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Sumit K Agrawal
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
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Lai C, Lui JT, Chen JM, Lin VY, Agrawal SK, Blevins NH, Ladak HM, Pirouzmand F. High-Fidelity Virtual Reality Simulation for the Middle Cranial Fossa Approach—Modules for Surgical Rehearsal and Education. Oper Neurosurg (Hagerstown) 2022; 23:505-513. [DOI: 10.1227/ons.0000000000000387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/12/2022] [Indexed: 11/16/2022] Open
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Santamaria V, Ai X, Agrawal SK. A motor learning-based postural intervention with a robotic trunk support trainer to improve functional sitting in spinal cord injury: case report. Spinal Cord Ser Cases 2022; 8:88. [PMID: 36433944 PMCID: PMC9700847 DOI: 10.1038/s41394-022-00554-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
STUDY DESIGN Single-subject-research-design. OBJECTIVES To improve seated postural control in a participant with spinal cord injury (SCI) with a robotic Trunk-Support-Trainer (TruST). SETTING Laboratory. METHODS TruST delivered "assist-as-needed" forces on the participant's torso during a motor learning-and-control-based intervention (TruST-intervention). TruST-assistive forces were progressed and matched to the participant's postural trunk control gains across six intervention sessions. The T-shirt test was used to capture functional improvements while dressing the upper body. Kinematics were used to compute upper body excursions (cm) and velocity (cm2), and sitting workspace area (cm2). Functional trunk dynamometry was used to examine muscle force (Kg). Surface electromyography (sEMG) was applied to measure trunk muscle activity. The Borg Rating of Perceived Exertion (RPE) was used to monitor physical exertion during TruST-intervention. A two-standard-deviation bandwidth method was adopted for data interpretation. RESULTS After TruST-intervention, the participant halved the time needed to don and doff a T-shirt, increased muscle force of trunk muscles (mean = 3 kg), acquired a steadier postural sitting control without vision (mean excursion baseline: 76.0 ± 2 SD = 5.25 cm and post-intervention: 44.1 cm; and mean velocity baseline: 3.0 ± 2 SD = 0.2 cm/s and post-intervention: 1.8 cm/s), and expanded his sitting workspace area (mean baseline: 36.7 ± 2 SD = 36.6 cm2 and post-intervention: 419.2 cm2). The participant increased his tolerance to counteract greater TruST-force perturbations in lateral and posterior directions. Furthermore, abdominal muscle activity substantially augmented after completion of TruST-intervention across all perturbation directions. CONCLUSIONS Our data indicate a potential effectiveness of TruST-intervention to promote functional sitting in SCI.
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Affiliation(s)
- V Santamaria
- Department of Physical Therapy, New York Medical College, New York, NY, USA
| | - X Ai
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - S K Agrawal
- Department of Mechanical Engineering, Columbia University, New York, NY, USA.
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA.
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Goff L, St. Croix R, Jing JW, Ferri D, Sivanathan M, Harris C, Pelletier F, Bénard F, Sédillot-Daniel È, Fleiszer D, Bhandari A, White A, Shah A, Zhang Y, Akbari P, Fugaru I, Aggarwal I, Zhang Y, Gold MS, Belliveau S, Lai C, Daud A, Hamdan NA, Carr L, Fazlollahi AM, Retrosi G, Del Fernandes R, Roberts S, Botelho F, Micallef J, Rathagirishnan R, Stachura N, Grewal K, Yilmaz R, Mahmood S, Tee T, Qiu R, Hindi MN, AlTinawi B, Qiu R, Tanya SM, Greene H, Munn A, Furey A, Smith N, Moffatt-Bruce S, Lefebvre G, Harvey EJ, Reindl R, Al Badi H, Berry GK, Martineau PA, Koucheki R, Lex JR, Morozova A, Hauer TM, Mirzaie S, Ferguson PC, Ballyk B, Micallef J, Franco LY, Drennan IR, Button D, Dubrowski A, Thorburn C, Skanes C, Kennedy R, Smith C, Torres A, Meloche-Dumas L, Guérard-Poirier N, Kaviani A, Kapralos B, Mercier F, Dubrowski A, Patocskai E, Habti M, Meloche-Dumas L, Bérubé S, Cadoret D, Arutiunian A, Papas Y, Torres A, Kapralos B, Mercier F, Dubrowski A, Patocskai E, Melkane A, Chiesa C, Fakhry N, Young V, Smith L, Lechien J, Guertin L, Olivier MJ, Maniakas A, Jun Lin R, Bissada É, Christopoulos A, Ayad T, Leclerc AA, Posel N, Rosenzveig A, Gariscsak P, Kemp L, Haji F, Reid A, Sidhu S, Moon M, Turner S, Zheng B, Wolfstadt JI, Hall J, Ward S, Jad A, Yee N, Ross TD, Ferguson P, Zheng B, Valiquette C, Brathwaite S, Hawley G, Martou G, Hendry M, Schouela V, Aubé-Peterkin M, Kemp L, Winthrop A, Zheng B, Belliveau S, Gold M, Lui JT, de Lotbiniere-Bassett M, Chen JM, Lin VY, Agrawal SK, Blevins NH, Ladak HM, Pirouzmand F, Hauer T, Wolfstadt J, Ferguson P, Almansouri A, Yilmaz R, Eskandari M, Tee T, Agu C, Pachchigar P, Giglio B, Balasubramniam N, Gueziri HE, Del Maestro R, McKechnie T, Hatamnejad A, Chan J, Beattie A, Yilmaz R, Alsayegh A, Bakhaidar M, Del Maestro RF, Dharamsi N, de Vries I, Mann S, McEwen L, Phillips T, Zevin B, Robart A, Brennan H, Conway J, Patey C, Harley J, Poenaru D, Sivanathan M, Clarke K, Habti M, Roy MÈ, Bedwani S, Patocskai É, Dubrowski A, Valiquette C, Zhu J, Adibfar A, Snell L, Nayak R, Malthaner R, Fortin D, Inculet R, Qiabi M, Azher S, Moreno M, Melo LP, Pekrun R, Wiseman J, Fried GM, Lajoie S, Brydges R, Hadwin A, Sun NZ, Khalil E, Harley JM, Bakhaidar M, Alsayegh A, Hamdan NA, Fazlollahi AM, Agu C, Pachchigar P, Del Maestro R, Almas S, Ryan J, Anderson B, Pachchigar P, Tarabay B, Yilmaz R, Del Maestro R, Lan L, Mao R, Kay J, Darren de SA, Blair G, Noorani A, Noorani S, Mak M, Ibrahim G, Hodaie M, van Kampen K, Domerchie E, Farrugia P, Joly-Chevrier M, Nguyen AXL, Pur DR, Power RJ, Sharma S, Costello F, Kherani F. C-CASE 2022: Competence to Excellence01. The Queen Bee phenomenon in Canadian surgical subspecialties: an evaluation of gender biases in the resident training environment02. Barriers to surgical peer coaching — What have we learned, and where do we go from here?03. Shared decision-making and evidence-based medicine: Pivotal or trivial to patient care in orthopedic trauma?04. Immersive virtual reality and cadaveric bone are equally effective in skeletal anatomy education: a randomized crossover noninferiority trial05. Development of simulators for decentralized simulation-based education IO training using design thinking and Delphi — a novel approach06. The impact of feedback on laparoscopic skills for surgical residents during COVID-1907. The role of collaborative feedback and remote practice in the acquisition of suturing skills by medical students at Université de Montréal08. Efficacy testing of an affordable and realistic small bowel simulator for hand-sewn anastomosis09. The LASER rating scale: a new teaching tool in otolaryngology10. Virtual patient case simulations: their role in undergraduate and postgraduate surgical training11. Evaluating the effectiveness of video-assisted informed consent in surgery: a systematic review12. Communication patterns in the cardiac surgery operating room are affected by task difficulty: a simulation model13. Improving adherence to postcall departure guidelines in orthopedics: a quality-improvement initiative14. Increasing familiarity among team members helps to reduce laparoscopic procedure time15. The effectiveness of a self-directed online learning module on trainee knowledge and confidence during plastic surgery clinical rotations16. Implementing an orientation handbook before a surgical rotation in urology17. An examination of equity-related experiences of surgical trainees at academic centres across Ontario: design of a targeted needs assessment18. Viewing differences between experts and trainees: implication for surgical education19. Assessment of medical student exposure to and satisfaction with surgical subspecialty education20. Assessment of student exposure to climate impacts of surgical personal protective equipment in the undergraduate medical curriculum21. Virtual reality simulation for the middle cranial fossa approach — a face, content and construct validation study22. Evaluating the Canadian Orthopaedic Surgery Medical Education Course (COSMEC)23. Subpial resection in a novel ex vivo calf brain epilepsy simulation model24. Effectiveness of the Eyesi augmented reality simulator for ophthalmology trainees: a systematic review and meta-analysis25. Learning beyond the objectives: an evidence-based analysis of AI-selected competencies in surgical simulation training26. Virtual compared with in-person surgical grand rounds: participants’ perceptions, preferences and directions for the future27. Quality of narrative feedback for entrustable professional activities assessed in the operating room: analysis of 4. years of assessments in the surgical foundations curriculum at Queen’s University28. SimOscopy: an accessible 3D-printed and laser-cut laparoscopic surgical simulator developed for a mobile device29. A debriefing tool to acquire nontechnical skills in trauma courses30. Capacity building using a hub-and-spokes model to produce customizable simulators for surgical education31. Exploring skin tone diversity in a plastic surgery resident education curriculum32. Video-based assessments of thoracic surgery trainees’ operative skills as adjuncts in competency-based medical education33. How do you feel? An examination of team leaders’ and members’ emotions in surgical simulations34. Comparing the efficacy of a real-time intelligent coaching system to human expert instruction in surgical technical skills training: randomized controlled trial35. Empowering women to pursue surgery: launching a pilot gender-congruent mentorship program for medical students36. Affective and cognitive responses to a virtual reality spine simulator37. Immersive virtual reality for patient-specific preoperative planning: a systematic review38. The categorization of surgical problems by junior and senior medical students39. The application of microlearning modules in surgical education to enhance procedural skills and surgical training40. Authorship gender disparity and trends in female authorship in 5 high-impact orthopedic journals from 2002 to 202241. The landscape of Canadian academic surgery: analysis of gender representation, academic rank, and research productivity. Can J Surg 2022. [DOI: 10.1503/cjs.014622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Wimalarathna H, Ankmnal-Veeranna S, Allan C, Agrawal SK, Samarabandu J, Ladak HM, Allen P. Machine learning approaches used to analyze auditory evoked responses from the human auditory brainstem: A systematic review. Comput Methods Programs Biomed 2022; 226:107118. [PMID: 36122495 DOI: 10.1016/j.cmpb.2022.107118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/01/2022] [Accepted: 09/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The application of machine learning algorithms for assessing the auditory brainstem response has gained interest over recent years with a considerable number of publications in the literature. In this systematic review, we explore how machine learning has been used to develop algorithms to assess auditory brainstem responses. A clear and comprehensive overview is provided to allow clinicians and researchers to explore the domain and the potential translation to clinical care. METHODS The systematic review was performed based on PRISMA guidelines. A search was conducted of PubMed, IEEE-Xplore, and Scopus databases focusing on human studies that have used machine learning to assess auditory brainstem responses. The duration of the search was from January 1, 1990, to April 3, 2021. The Covidence systematic review platform (www.covidence.org) was used throughout the process. RESULTS A total of 5812 studies were found through the database search and 451 duplicates were removed. The title and abstract screening process further reduced the article count to 89 and in the proceeding full-text screening, 34 articles met our full inclusion criteria. CONCLUSION Three categories of applications were found, namely neurologic diagnosis, hearing threshold estimation, and other (does not relate to neurologic or hearing threshold estimation). Neural networks and support vector machines were the most commonly used machine learning algorithms in all three categories. Only one study had conducted a clinical trial to evaluate the algorithm after development. Challenges remain in the amount of data required to train machine learning models. Suggestions for future research avenues are mentioned with recommended reporting methods for researchers.
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Affiliation(s)
- Hasitha Wimalarathna
- Department of Electrical & Computer Engineering, Western University, London, Ontario, Canada; National Centre for Audiology, Western University, London, Ontario, Canada.
| | - Sangamanatha Ankmnal-Veeranna
- National Centre for Audiology, Western University, London, Ontario, Canada; College of Nursing and Health Professions, School of Speech and Hearing Sciences, The University of Southern Mississippi, J.B. George Building, Hattiesburg, MS, USA
| | - Chris Allan
- National Centre for Audiology, Western University, London, Ontario, Canada; School of Communication Sciences & Disorders, Western University, London, Ontario, Canada
| | - Sumit K Agrawal
- Department of Electrical & Computer Engineering, Western University, London, Ontario, Canada; National Centre for Audiology, Western University, London, Ontario, Canada; School of Biomedical Engineering, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Jagath Samarabandu
- Department of Electrical & Computer Engineering, Western University, London, Ontario, Canada
| | - Hanif M Ladak
- Department of Electrical & Computer Engineering, Western University, London, Ontario, Canada; National Centre for Audiology, Western University, London, Ontario, Canada; School of Biomedical Engineering, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Prudence Allen
- National Centre for Audiology, Western University, London, Ontario, Canada; School of Communication Sciences & Disorders, Western University, London, Ontario, Canada
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Siegel L, Araslanova R, Stepniak C, Zimmerman K, Agrawal SK. Achondroplasia and severe sensorineural hearing loss: The role of active bone conduction implants. Cochlear Implants Int 2022; 23:291-299. [DOI: 10.1080/14670100.2022.2045073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lauren Siegel
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Rakhna Araslanova
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Camilla Stepniak
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Kim Zimmerman
- Cochlear Implant Program, London Health Sciences Centre, London, Canada
| | - Sumit K. Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Cochlear Implant Program, London Health Sciences Centre, London, Canada
- National Centre for Audiology, University of Western Ontario, London, Canada
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11
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Instrum RS, Koch RW, Rocha T, Rohani SA, Ladak H, Agrawal SK, Sowerby LJ. Improving Nasopharyngeal Swab Technique via Simulation for Frontline Workers. Laryngoscope 2022; 133:38-42. [PMID: 35102548 PMCID: PMC9015425 DOI: 10.1002/lary.30034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES/HYPOTHESIS Nasopharyngeal swabs currently remain the gold standard for COVID-19 sample collection. A surge in testing volume has resulted in a large number of health care workers who are unfamiliar with nasal anatomy performing this test, which can lead to improper collection practices culminating in false-negative results and complications. Therefore, we aimed to assess the accuracy and educational potential of a realistic 3D-printed nasal swab simulator to expedite health care workers' skill acquisition. STUDY DESIGN Prospective pre-post interventional study. METHODS A nasal swab task trainer (NSTT) was developed to scale from computed tomography data with a deviated septum. Frontline workers at COVID-19 testing sites in Ontario, Canada, were recruited to use the NSTT for nasopharyngeal swab training. Integrated video recording capability allowed participants to self-evaluate procedure accuracy. A five-point Likert scale was collected regarding the NSTT's educational value and procedural fidelity. RESULTS Sixty-two frontline workers included in the study were primarily registered nurses (52%) or paramedics (16%). Following simulator use, self-assessed accuracy improved in 77% of all participants and 100% of participants who expressed low confidence before training. Ninety-four percent reported that the NSTT provided a complete educational experience, and 82% regarded the system as a more effective training approach than what is currently available. Eighty-one indicated that the simulator should be used at all COVID-19 testing sites, with 77% stating province-wide implementation was warranted. CONCLUSIONS The nasal swab task trainer is an effective educational tool that appears well-suited for improved skill acquisition in COVID-19 testing and may be useful for training other nasal swab applications. LEVEL OF EVIDENCE 3 Laryngoscope, 133:38-42, 2023.
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Affiliation(s)
- Ryan S. Instrum
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Robert W. Koch
- School of Biomedical EngineeringWestern UniversityLondonOntarioCanada
| | - Taciano Rocha
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Seyed Alizera Rohani
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Hanif Ladak
- Department of Electrical and Computer EngineeringWestern UniversityLondonOntarioCanada
| | - Sumit K. Agrawal
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Leigh J Sowerby
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
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Yadav SK, Agrawal SK, Singh SK, Giri A, Singh GK, Ghimire R, Stewart AG, Show KL, Moses FL. Antimicrobial resistance in neonates with suspected sepsis. Public Health Action 2021; 11:6-12. [PMID: 34778009 PMCID: PMC8575386 DOI: 10.5588/pha.21.0038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022] Open
Abstract
SETTING Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. OBJECTIVE To determine the pattern of antimicrobial resistance and hospital exit outcomes in neonates with suspected sepsis in a tertiary neonatal intensive care unit (NICU). DESIGN This hospital-based cohort study was conducted to follow patients from January to December 2019. All identified cases of suspected sepsis were enlisted from hospital records. RESULTS Sepsis was suspected in 177 (88%) of the 200 cases admitted in the NICU; 52 (29%) were culture-positive. Pseudomonas was the predominant organism isolated (n = 40; 78%), followed by coagulase negative staphylococcus (n = 12, 23%). Nine (17%) of the 52 isolates were resistant to the Access and Watch group of antibiotics, including some resistance to Reserve group drugs such as imipenem and linezolid. Most treated cases (n = 170, 96%) improved, although 7 (4%) left against medical advice. CONCLUSION Most of the pathogens were resistant to WHO Access and Watch antibiotics and occasional resistance was observed to Reserve group drugs. Most sepsis was caused by Gram-negative bacilli. Improving turnaround times for antibiotic sensitivity testing using point-of-care testing, and a greater yield of culture-positive results are needed to enhance the management of neonatal sepsis.
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Affiliation(s)
- S K Yadav
- Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
| | - S K Agrawal
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - S K Singh
- Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
| | - A Giri
- Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
| | - G K Singh
- Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
| | - R Ghimire
- Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
| | - A G Stewart
- College of Life and Environmental Science, University of Exeter, Exeter, UK
| | - K L Show
- Department of Medical Research, Yangon, Myanmar
| | - F L Moses
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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13
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Bartling ML, Rohani SA, Ladak HM, Agrawal SK. Micro-CT of the human ossicular chain: Statistical shape modeling and implications for otologic surgery. J Anat 2021; 239:771-781. [PMID: 34057736 PMCID: PMC8450485 DOI: 10.1111/joa.13457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 12/01/2020] [Accepted: 04/28/2021] [Indexed: 11/29/2022] Open
Abstract
The ossicular chain is a middle ear structure consisting of the small incus, malleus and stapes bones, which transmit tympanic membrane vibrations caused by sound to the inner ear. Despite being shown to be highly variable in shape, there are very few morphological studies of the ossicles. The objective of this study was to use a large sample of cadaveric ossicles to create a set of three-dimensional models and study their statistical variance. Thirty-three cadaveric temporal bone samples were scanned using micro-computed tomography (μCT) and segmented. Statistical shape models (SSMs) were then made for each ossicle to demonstrate the divergence of morphological features. Results revealed that ossicles were most likely to vary in overall size, but that more specific feature variability was found at the manubrium of the malleus, the long process and lenticular process of the incus, and the crura and footplate of the stapes. By analyzing samples as whole ossicular chains, it was revealed that when fixed at the malleus, changes along the chain resulted in a wide variety of final stapes positions. This is the first known study to create high-quality, three-dimensional SSMs of the human ossicles. This information can be used to guide otological surgical training and planning, inform ossicular prosthesis development, and assist with other ossicular studies and applications by improving automated segmentation algorithms. All models have been made publicly available.
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Affiliation(s)
| | - Seyed A. Rohani
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonCanada
| | - Hanif M. Ladak
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonCanada
- Department of Medical BiophysicsWestern UniversityLondonCanada
- Department of Electrical and Computer EngineeringWestern UniversityLondonCanada
- National Centre for AudiologyWestern UniversityLondonCanada
| | - Sumit K. Agrawal
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonCanada
- National Centre for AudiologyWestern UniversityLondonCanada
- Cochlear Implant ProgramLondon Health Sciences CentreLondonCanada
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Wimalarathna H, Ankmnal-Veeranna S, Allan C, Agrawal SK, Allen P, Samarabandu J, Ladak HM. Comparison of machine learning models to classify Auditory Brainstem Responses recorded from children with Auditory Processing Disorder. Comput Methods Programs Biomed 2021; 200:105942. [PMID: 33515845 DOI: 10.1016/j.cmpb.2021.105942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/10/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Auditory brainstem responses (ABRs) offer a unique opportunity to assess the neural integrity of the peripheral auditory nervous system in individuals presenting with listening difficulties. ABRs are typically recorded and analyzed by an audiologist who manually measures the timing and quality of the waveforms. The interpretation of ABRs requires considerable experience and training, and inappropriate interpretation can lead to incorrect judgments about the integrity of the system. Machine learning (ML) techniques may be a suitable approach to automate ABR interpretation and reduce human error. OBJECTIVES The main objective of this paper was to identify a suitable ML technique to automate the analysis of ABR responses recorded as a part of the electrophysiological testing in the Auditory Processing Disorder clinical test battery. METHODS ABR responses recorded during routine clinical assessment from 136 children being evaluated for auditory processing difficulties were analyzed using several common ML algorithms: Support Vector Machines (SVM), Random Forests (RF), Decision Trees (DT), Gradient Boosting (GB), Extreme Gradient Boosting (Xgboost), and Neural Networks (NN). A variety of signal feature extraction techniques were used to extract features from the ABR waveforms as inputs to the ML algorithms. Statistical significance testing and confusion matrices were used to identify the most robust model capable of accurately identifying neurological abnormalities present in ABRs. RESULTS Clinically significant features in the time-frequency representation of the signal were identified. The ML model trained using the Xgboost algorithm was identified as the most robust model with an accuracy of 92% compared to other models. CONCLUSION The findings of the present study demonstrate that it is possible to develop accurate ML models to automate the process of analyzing ABR waveforms recorded at suprathreshold levels. There is currently no ML-based application to screen children with listening difficulties. Therefore, it is expected that this work will be translated into an evaluation tool that can be used by audiologists in the clinic. Furthermore, this work may aid future researchers in exploring ML paradigms to improve clinical test batteries used by audiologists in achieving accurate diagnoses.
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Affiliation(s)
- Hasitha Wimalarathna
- Department of Electrical & Computer Engineering, Western University, London, Ontario, Canada; National Centre for Audiology, Western University, London, Ontario, Canada.
| | | | - Chris Allan
- National Centre for Audiology, Western University, London, Ontario, Canada; School of Communication Sciences & Disorders, Western University, Canada
| | - Sumit K Agrawal
- Department of Electrical & Computer Engineering, Western University, London, Ontario, Canada; National Centre for Audiology, Western University, London, Ontario, Canada; School of Biomedical Engineering, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Prudence Allen
- National Centre for Audiology, Western University, London, Ontario, Canada; School of Communication Sciences & Disorders, Western University, Canada
| | - Jagath Samarabandu
- Department of Electrical & Computer Engineering, Western University, London, Ontario, Canada
| | - Hanif M Ladak
- Department of Electrical & Computer Engineering, Western University, London, Ontario, Canada; National Centre for Audiology, Western University, London, Ontario, Canada; School of Biomedical Engineering, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
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Goel K, Sharma S, Baral DD, Agrawal SK. Current status of periodontitis and its association with tobacco use amongst adult population of Sunsari district, in Nepal. BMC Oral Health 2021; 21:66. [PMID: 33579264 PMCID: PMC7881591 DOI: 10.1186/s12903-021-01416-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 01/28/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Tobacco products are considered significant, but preventable factors related to initiation and progression of periodontal diseases. We assessed the prevalence of periodontitis and evaluated its association with tobacco use and other factors amongst the adult population of Sunsari district in eastern Nepal. METHODS A community-based, cross-sectional study was conducted in rural municipalities in the province one of eastern Nepal. A total of 440 adults were interviewed with a set of a pre-tested semi-structured questionnaire. Data on social demographics, adverse oral habits followed by periodontal clinical examination were recorded. Prevalence of periodontitis was assessed by a case definition provided by CDC-AAP. Univariate and multivariate logistic regression analysis was done to measure the association between tobacco use and other factors with periodontitis. RESULTS The overall prevalence of periodontitis was found to be 71.6%. Majority (85.4%) of tobacco users had periodontitis and they were significantly associated with the disease and its severity. The study identified age groups, 45-65 years (AOR = 7.58, 95% CI 3.93-14.61), plaque accumulation (AOR = 1.01, 95% CI 1.00-1.02), smoking (AOR = 3.14, 95% CI 1.36-7.27), khaini users (smokeless tobacco, AOR = 2.27, 95% CI 1.12-4.61) and teeth loss (AOR = 2.02, 95% CI 1.21-3.38) as the significant factors associated with periodontitis. CONCLUSION The prevalence of periodontitis is high in the surveyed rural adult population. Cigarette smoking along with the use of smokeless tobacco in the form of khaini were identified as significant factors associated with periodontitis.
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Affiliation(s)
- K Goel
- Department of Periodontology and Oral Implantology, College of Dental Surgery, B.P Koirala Institute of Health and Sciences, Dharan, 56700, Nepal.
| | - S Sharma
- Department of Periodontology and Oral Implantology, College of Dental Surgery, B.P Koirala Institute of Health and Sciences, Dharan, 56700, Nepal
| | - D D Baral
- School of Public Health and Community Medicine, B.P Koirala Institute of Health and Sciences, Dharan, 56700, Nepal
| | - S K Agrawal
- Department of Public Health Dentistry, College of Dental Surgery, B.P Koirala Institute of Health and Sciences, Dharan, 56700, Nepal
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Nikan S, Van Osch K, Bartling M, Allen DG, Rohani SA, Connors B, Agrawal SK, Ladak HM. PWD-3DNet: A Deep Learning-Based Fully-Automated Segmentation of Multiple Structures on Temporal Bone CT Scans. IEEE Trans Image Process 2020; 30:739-753. [PMID: 33226942 DOI: 10.1109/tip.2020.3038363] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The temporal bone is a part of the lateral skull surface that contains organs responsible for hearing and balance. Mastering surgery of the temporal bone is challenging because of this complex and microscopic three-dimensional anatomy. Segmentation of intra-temporal anatomy based on computed tomography (CT) images is necessary for applications such as surgical training and rehearsal, amongst others. However, temporal bone segmentation is challenging due to the similar intensities and complicated anatomical relationships among critical structures, undetectable small structures on standard clinical CT, and the amount of time required for manual segmentation. This paper describes a single multi-class deep learning-based pipeline as the first fully automated algorithm for segmenting multiple temporal bone structures from CT volumes, including the sigmoid sinus, facial nerve, inner ear, malleus, incus, stapes, internal carotid artery and internal auditory canal. The proposed fully convolutional network, PWD-3DNet, is a patch-wise densely connected (PWD) three-dimensional (3D) network. The accuracy and speed of the proposed algorithm was shown to surpass current manual and semi-automated segmentation techniques. The experimental results yielded significantly high Dice similarity scores and low Hausdorff distances for all temporal bone structures with an average of 86% and 0.755 millimeter (mm), respectively. We illustrated that overlapping in the inference sub-volumes improves the segmentation performance. Moreover, we proposed augmentation layers by using samples with various transformations and image artefacts to increase the robustness of PWD-3DNet against image acquisition protocols, such as smoothing caused by soft tissue scanner settings and larger voxel sizes used for radiation reduction. The proposed algorithm was tested on low-resolution CTs acquired by another center with different scanner parameters than the ones used to create the algorithm and shows potential for application beyond the particular training data used in the study.
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17
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Rohani SA, Bartling ML, Ladak HM, Agrawal SK. The BONEBRIDGE active transcutaneous bone conduction implant: effects of location, lifts and screws on sound transmission. J Otolaryngol Head Neck Surg 2020; 49:58. [PMID: 32778163 PMCID: PMC7418375 DOI: 10.1186/s40463-020-00454-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The BONEBRIDGE (MED-EL, Innsbruck, Austria) is a bone-conduction implant used in the treatment of conductive and mixed hearing loss. The BONEBRIDGE consists of an external audio processor and a bone-conduction floating mass transducer that is surgically implanted into the skull in either the transmastoid, retrosigmoid or middle fossa regions. The manufacturer includes self-tapping screws to secure the transducer; however, self-drilling screws have also been used with success. In cases where the skull is not thick enough to house the transducer, lifts are available in a variety of sizes to elevate the transducer away from the skull. The objective of the present study was to investigate the effects of screw type, lift thickness, and implant location on the sound transmission of the BONEBRIDGE. METHOD Six cadaveric temporal bones were embalmed and dried for use in this study. In each sample, a hole was drilled in each of the three implant locations to house the implant transducer. At the middle fossa, six pairs of screw holes were pre-drilled; four pairs to be used with self-tapping screws and lifts (1, 2, 3, and 4 mm thick lifts, respectively), one pair with self-tapping screws and no lifts, and one pair with self-drilling screws and no lifts. At the transmastoid and retrosigmoid locations, one pair of screw holes were pre-drilled in each for the use of the self-tapping screws. The vibration of transmitted sound to the cochlea was measured using a laser Doppler vibrometry technique. The measurements were performed on the cochlear promontory at eight discrete frequencies (0.5, 0.75, 1, 1.5, 2, 3, 4 and 6 kHz). Vibration velocity of the cochlear wall was measured in all samples. Measurements were analyzed using a single-factor ANOVA to investigate the effect of each modification. RESULTS No significant differences were found related to either screw type, lift thickness, or implant location. CONCLUSIONS This is the first known study to evaluate the effect of screw type, lift thickness, and implant location on the sound transmission produced by the BONEBRIDGE bone-conduction implant. Further studies may benefit from analysis using fresh cadaveric samples or in-vivo measurements.
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Affiliation(s)
- Seyed Alireza Rohani
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Canada
| | | | - Hanif M Ladak
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Canada
- Department of Medical Biophysics, Western University, London, Canada
- Department of Electrical and Computer Engineering, Western University, London, Canada
- National Centre for Audiology, Western University, London, Canada
| | - Sumit K Agrawal
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Canada.
- National Centre for Audiology, Western University, London, Canada.
- Cochlear Implant Program, London Health Sciences Centre, London, Canada.
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18
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Mei X, Glueckert R, Schrott-Fischer A, Li H, Ladak HM, Agrawal SK, Rask-Andersen H. Publisher Correction: Vascular Supply of the Human Spiral Ganglion: Novel Three-Dimensional Analysis Using Synchrotron Phase-Contrast Imaging and Histology. Sci Rep 2020; 10:7681. [PMID: 32355270 PMCID: PMC7193631 DOI: 10.1038/s41598-020-64611-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Xueshuang Mei
- Department of Surgical Sciences, Section of Otolaryngology, Uppsala University Hospital, SE, 751 85, Uppsala, Sweden. .,Department of Otolaryngology, Peking University Shenzhen Hospital, Shenzhen, China.
| | - Rudolf Glueckert
- Department of Otolaryngology, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Annelies Schrott-Fischer
- Department of Otolaryngology, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Hao Li
- Department of Surgical Sciences, Section of Otolaryngology, Uppsala University Hospital, SE, 751 85, Uppsala, Sweden
| | - Hanif M Ladak
- Department of Otolaryngology-Head and Neck Surgery, Department of Medical Biophysics and Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Sumit K Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Helge Rask-Andersen
- Department of Surgical Sciences, Section of Otolaryngology, Uppsala University Hospital, SE, 751 85, Uppsala, Sweden.
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Compton EC, Agrawal SK, Ladak HM, Chan S, Hoy M, Nakoneshny SC, Siegel L, Dort JC, Lui JT. Correction to: Assessment of a virtual reality temporal bone surgical simulator: a national face and content validity study. J Otolaryngol Head Neck Surg 2020; 49:20. [PMID: 32321592 PMCID: PMC7178585 DOI: 10.1186/s40463-020-00416-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- Evan C Compton
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sumit K Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.,Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - Hanif M Ladak
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.,Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Sonny Chan
- Department of Computer Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Monica Hoy
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Steven C Nakoneshny
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
| | - Lauren Siegel
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Joseph C Dort
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.
| | - Justin T Lui
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Compton EC, Agrawal SK, Ladak HM, Chan S, Hoy M, Nakoneshny SC, Siegel L, Dort JC, Lui JT. Assessment of a virtual reality temporal bone surgical simulator: a national face and content validity study. J Otolaryngol Head Neck Surg 2020; 49:17. [PMID: 32264952 PMCID: PMC7137498 DOI: 10.1186/s40463-020-00411-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trainees in Otolaryngology-Head and Neck Surgery must gain proficiency in a variety of challenging temporal bone surgical techniques. Traditional teaching has relied on the use of cadavers; however, this method is resource-intensive and does not allow for repeated practice. Virtual reality surgical training is a growing field that is increasingly being adopted in Otolaryngology. CardinalSim is a virtual reality temporal bone surgical simulator that offers a high-quality, inexpensive adjunct to traditional teaching methods. The objective of this study was to establish the face and content validity of CardinalSim through a national study. METHODS Otolaryngologists and resident trainees from across Canada were recruited to evaluate CardinalSim. Ethics approval and informed consent was obtained. A face and content validity questionnaire with questions categorized into 13 domains was distributed to participants following simulator use. Descriptive statistics were used to describe questionnaire results, and either Chi-square or Fishers exact tests were used to compare responses between junior residents, senior residents, and practising surgeons. RESULTS Sixty-two participants from thirteen different Otolaryngology-Head and Neck Surgery programs were included in the study (32 practicing surgeons; 30 resident trainees). Face validity was achieved for 5 out of 7 domains, while content validity was achieved for 5 out of 6 domains. Significant differences between groups (p-value of < 0.05) were found for one face validity domain (realistic ergonomics, p = 0.002) and two content validity domains (teaching drilling technique, p = 0.011 and overall teaching utility, p = 0.006). The assessment scores, global rating scores, and overall attitudes towards CardinalSim, were universally positive. Open-ended questions identified limitations of the simulator. CONCLUSION CardinalSim met acceptable criteria for face and content validity. This temporal bone virtual reality surgical simulation platform may enhance surgical training and be suitable for patient-specific surgical rehearsal for practicing Otolaryngologists.
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Affiliation(s)
- Evan C Compton
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sumit K Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - Hanif M Ladak
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Sonny Chan
- Department of Computer Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Monica Hoy
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Steven C Nakoneshny
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
| | - Lauren Siegel
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Joseph C Dort
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.
| | - Justin T Lui
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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21
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Mei X, Glueckert R, Schrott-Fischer A, Li H, Ladak HM, Agrawal SK, Rask-Andersen H. Vascular Supply of the Human Spiral Ganglion: Novel Three-Dimensional Analysis Using Synchrotron Phase-Contrast Imaging and Histology. Sci Rep 2020; 10:5877. [PMID: 32245997 PMCID: PMC7125215 DOI: 10.1038/s41598-020-62653-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/27/2020] [Indexed: 12/24/2022] Open
Abstract
Human spiral ganglion (HSG) cell bodies located in the bony cochlea depend on a rich vascular supply to maintain excitability. These neurons are targeted by cochlear implantation (CI) to treat deafness, and their viability is critical to ensure successful clinical outcomes. The blood supply of the HSG is difficult to study due to its helical structure and encasement in hard bone. The objective of this study was to present the first three-dimensional (3D) reconstruction and analysis of the HSG blood supply using synchrotron radiation phase-contrast imaging (SR-PCI) in combination with histological analyses of archival human cochlear sections. Twenty-six human temporal bones underwent SR-PCI. Data were processed using volume-rendering software, and a representative three-dimensional (3D) model was created to allow visualization of the vascular anatomy. Histologic analysis was used to verify the segmentations. Results revealed that the HSG is supplied by radial vascular twigs which are separate from the rest of the inner ear and encased in bone. Unlike with most organs, the arteries and veins in the human cochlea do not follow the same conduits. There is a dual venous outflow and a modiolar arterial supply. This organization may explain why the HSG may endure even in cases of advanced cochlear pathology.
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Grants
- the Sanming Project of Medicine in Shenzhen, China [SZSM201612076]
- Innsbruck University
- This study was supported by the Swedish Research Council [2017-03801], ALF grants from the Uppsala University Hospital, the Tysta Skolan Foundation, the Swedish Hearing Research Foundation, generous private funds from
- Natural Sciences and Engineering Research Council of Canada, the National Research Council Canada, the Canadian Institutes of Health Research, the Government of Saskatchewan, Western Economic Diversification Canada, and the University of Saskatchewan.
- This study was supported by the Swedish Research Council [2017-03801], ALF grants from the Uppsala University Hospital, the Tysta Skolan Foundation, the Swedish Hearing Research Foundation, generous private funds from Börje Runögård, Sweden, and the Sanming Project of Medicine in Shenzhen, China [SZSM201612076]. This work was made in collaboration with MED-EL Medical Electronics, R&D, GmbH, Innsbruck, Austria. Part of the research described in this paper was conducted at the BioMedical Imaging and Therapy (BMIT) facility at the Canadian Light Source Inc., which is funded by the Canada Foundation for Innovation, the Natural Sciences and Engineering Research Council of Canada, the National Research Council Canada, the Canadian Institutes of Health Research, the Government of Saskatchewan, Western Economic Diversification Canada, and the University of Saskatchewan.
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Affiliation(s)
- Xueshuang Mei
- Department of Surgical Sciences, Section of Otolaryngology, Uppsala University Hospital, SE, 751 85, Uppsala, Sweden.
- Department of Otolaryngology, Peking University Shenzhen Hospital, Shenzhen, China.
| | - Rudolf Glueckert
- Department of Otolaryngology, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Annelies Schrott-Fischer
- Department of Otolaryngology, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Hao Li
- Department of Surgical Sciences, Section of Otolaryngology, Uppsala University Hospital, SE, 751 85, Uppsala, Sweden
| | - Hanif M Ladak
- Department of Otolaryngology-Head and Neck Surgery, Department of Medical Biophysics and Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Sumit K Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Helge Rask-Andersen
- Department of Surgical Sciences, Section of Otolaryngology, Uppsala University Hospital, SE, 751 85, Uppsala, Sweden.
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22
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Helpard L, Li H, Rask-Andersen H, Ladak HM, Agrawal SK. Characterization of the human helicotrema: implications for cochlear duct length and frequency mapping. J Otolaryngol Head Neck Surg 2020; 49:2. [PMID: 31907040 PMCID: PMC6945762 DOI: 10.1186/s40463-019-0398-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/23/2019] [Indexed: 11/15/2022] Open
Abstract
Background Despite significant anatomical variation amongst patients, cochlear implant frequency-mapping has traditionally followed a patient-independent approach. Basilar membrane (BM) length is required for patient-specific frequency-mapping, however cochlear duct length (CDL) measurements generally extend to the apical tip of the entire cochlea or have no clearly defined end-point. By characterizing the length between the end of the BM and the apical tip of the entire cochlea (helicotrema length), current CDL models can be corrected to obtain the appropriate BM length. Synchrotron radiation phase-contrast imaging has made this analysis possible due to the soft-tissue contrast through the entire cochlear apex. Methods Helicotrema linear length and helicotrema angular length measurements were performed on synchrotron radiation phase-contrast imaging data of 14 cadaveric human cochleae. On a sub-set of six samples, the CDL to the apical tip of the entire cochlea (CDLTIP) and the BM length (CDLBM) were determined. Regression analysis was performed to assess the relationship between CDLTIP and CDLBM. Results The mean helicotrema linear length and helicotrema angular length values were 1.6 ± 0.9 mm and 67.8 ± 37.9 degrees, respectively. Regression analysis revealed the following relationship between CDLTIP and CDLBM: CDLBM = 0.88(CDLTIP) + 3.71 (R2 = 0.995). Conclusion This is the first known study to characterize the length of the helicotrema in the context of CDL measurements. It was determined that the distance between the end of the BM and the tip of the entire cochlea is clinically consequential. A relationship was determined that can predict the BM length of an individual patient based on their respective CDL measured to the apical tip of the cochlea.
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Affiliation(s)
- Luke Helpard
- School of Biomedical Engineering, Western University, London, Ontario, Canada.
| | - Hao Li
- Department of Surgical Sciences, Head and Neck Surgery, Section of Otolaryngology, Uppsala University Hospital, Uppsala, Sweden.,Department of Otolaryngology, Uppsala University Hospital, Uppsala, Sweden
| | - Helge Rask-Andersen
- Department of Surgical Sciences, Head and Neck Surgery, Section of Otolaryngology, Uppsala University Hospital, Uppsala, Sweden.,Department of Otolaryngology, Uppsala University Hospital, Uppsala, Sweden
| | - Hanif M Ladak
- School of Biomedical Engineering, Western University, London, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - Sumit K Agrawal
- School of Biomedical Engineering, Western University, London, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
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23
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Gare BM, Hudson T, Rohani SA, Allen DG, Agrawal SK, Ladak HM. Multi-atlas segmentation of the facial nerve from clinical CT for virtual reality simulators. Int J Comput Assist Radiol Surg 2019; 15:259-267. [DOI: 10.1007/s11548-019-02091-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/06/2019] [Indexed: 01/19/2023]
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24
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Van Osch K, You P, Zimmerman K, Yoo J, Agrawal SK. Chronic inflammatory reaction to bone wax in cochlear implantation: A case report and literature review. Cochlear Implants Int 2019; 21:295-298. [DOI: 10.1080/14670100.2019.1667068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kylen Van Osch
- Schulich School of Medicine & Dentistry, Western University, London, Ontario N6A 5C1, Canada
| | - Peng You
- Department of Otolaryngology – Head and Neck Surgery, Western University, London, Ontario N6A 5A5, Canada
| | - Kim Zimmerman
- Department of Otolaryngology – Head and Neck Surgery, Western University, London, Ontario N6A 5A5, Canada
| | - John Yoo
- Department of Otolaryngology – Head and Neck Surgery, Western University, London, Ontario N6A 5A5, Canada
| | - Sumit K. Agrawal
- Department of Otolaryngology – Head and Neck Surgery, Western University, London, Ontario N6A 5A5, Canada
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25
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Koch RW, Saleh H, Folkeard P, Moodie S, Janeteas C, Agrawal SK, Ladak HM, Scollie S. Skill Transference of a Probe-Tube Placement Training Simulator. J Am Acad Audiol 2019; 31:40-49. [PMID: 31274072 DOI: 10.3766/jaaa.18054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Probe-tube placement is a necessary step in hearing aid verification which needs ample hands-on experience and confidence before performing in clinic. To improve the methods of training in probe-tube placement, a manikin-based training simulator was developed consisting of a 3D-printed head, a flexible silicone ear, and a mounted optical tracking system. The system is designed to provide feedback to the user on the depth and orientation of the probe tube, and the time required to finish the task. Although a previous validation study was performed to determine its realism and teachability with experts, further validation is required before implementation into educational settings. PURPOSE This study aimed to examine the skill transference of a newly updated probe-tube placement training simulator to determine if skills learned on this simulator successfully translate to clinical scenarios. RESEARCH DESIGN All participants underwent a pretest in which they were evaluated while performing a probe-tube placement and real-ear-to-coupler difference (RECD) measurement on a volunteer. Participants were randomized into one of two groups: the simulator group or the control group. During a two-week training period, all participants practiced their probe-tube placement according to their randomly assigned group. After two weeks, each participant completed a probe-tube placement on the same volunteer as a posttest scenario. STUDY SAMPLE Twenty-five novice graduate-level student clinicians. DATA COLLECTION AND ANALYSIS Participants completed a self-efficacy questionnaire and an expert observer completed a questionnaire evaluating each participant's performance during the pre- and posttest sessions. RECD measurements were taken after placing the probe tube and foam tip in the volunteer's ear. Questionnaire results were analyzed through nonparametric t-tests and analysis of variance, whereas RECD results were analyzed using a nonlinear mixed model method. RESULTS Results suggested students in the simulator group were less likely to contact the tympanic membrane when placing a probe tube, appeared more confident, and had better use of the occluding foam tip, resulting in more improved RECD measurements. CONCLUSIONS The improved outcomes for trainees in the simulator group suggest that supplementing traditional training with the simulator provides useful benefits for the trainees, thereby encouraging its usage and implementation in educational settings.
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Affiliation(s)
- Robert W Koch
- School of Biomedical Engineering, Western University, London, ON, Canada
| | - Hasan Saleh
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - Paula Folkeard
- National Centre for Audiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Sheila Moodie
- School of Communication Sciences and Disorders, Western University, London, ON, Canada.,National Centre for Audiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | | | - Sumit K Agrawal
- School of Biomedical Engineering, Western University, London, ON, Canada.,National Centre for Audiology, Faculty of Health Sciences, Western University, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada.,Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada.,Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Hanif M Ladak
- School of Biomedical Engineering, Western University, London, ON, Canada.,National Centre for Audiology, Faculty of Health Sciences, Western University, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada.,Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada.,Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Susan Scollie
- School of Communication Sciences and Disorders, Western University, London, ON, Canada.,National Centre for Audiology, Faculty of Health Sciences, Western University, London, ON, Canada
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26
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Singh A, Subedi K, Shrestha A, Bhagat T, Pyakurel P, Agrawal SK. Impact of Community Diagnosis Programme on Undergraduate Students at BP Koirala Institute of Health Sciences. Kathmandu Univ Med J (KUMJ) 2019; 17:82-87. [PMID: 32632052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background Community Diagnosis Programme (CDP) aims to demonstrate the importance of teamwork in health care to understand the comprehensive health needs of the rural people and conceive about the research. Objective To assess the impact of community diagnosis program on undergraduate students of BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. Method A cross sectional study with mixed design (quantitative and qualitative) was conducted among the undergraduate students of batch 2017 participating in community diagnosis programme of BP Koirala Institute of Health Sciences, Dharan, Nepal. Eight questions assessed the students' perceptions regarding their abilities about community diagnosis program using six point Likert Scale and four open ended questions were used to know the students' experience and perception of community diagnosis programme. Result Overall mean ± SD score for pre-exposure response was 30.47 ± 6.18 and for the post-exposure response was 40.49 ± 5.16. The overall mean ± SD score of the students categorized according to streams showed similar results in both pre-exposure response and post-exposure responses. Qualitative analysis revealed the themes like "Research, a reflection of community and new method of learning to medical students"; "method of developing confidence and good communication skills", "learning to work as a team" and "exposure to rural area"; "Research an adjunct to medical profession". Conclusion Community diagnosis programme had a positive impact on the students about basic survey process, learnt to communicate with rural people, understood the type of data and were willing to participate in similar projects in future. Qualitative analysis showed most of the students had positive experience with some negative experience of community diagnosis programme.
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Affiliation(s)
- A Singh
- Consultant Public Health Dentist, Narayani Hospital, Birgunj, Nepal
| | - K Subedi
- Department of Public Health Dentistry, College of Dental Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - A Shrestha
- Department of Public Health Dentistry, College of Dental Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - T Bhagat
- Department of Public Health Dentistry, College of Dental Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - P Pyakurel
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - S K Agrawal
- Department of Public Health Dentistry, College of Dental Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
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27
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Van Osch K, Allen D, Gare B, Hudson TJ, Ladak H, Agrawal SK. Morphological analysis of sigmoid sinus anatomy: clinical applications to neurotological surgery. J Otolaryngol Head Neck Surg 2019; 48:2. [PMID: 30635049 PMCID: PMC6329078 DOI: 10.1186/s40463-019-0324-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/02/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES The primary objective of this study was to use high-resolution micro-CT images to create accurate three-dimensional (3D) models of several intratemporal structures, and to compare several surgically important dimensions within the temporal bone. The secondary objective was to create a statistical shape model (SSM) of a dominant and non-dominant sigmoid sinus (SS) to provide a template for automated segmentation algorithms. METHODS A free image processing software, 3D Slicer, was utilized to create three-dimensional reconstructions of the SS, jugular bulb (JB), facial nerve (FN), and external auditory canal (EAC) from micro-CT scans. The models were used to compare several clinically important dimensions between the dominant and non-dominant SS. Anatomic variability of the SS was also analyzed using SSMs generated using the Statismo software framework. RESULTS Three-dimensional models from 38 temporal bones were generated and analyzed. Right dominance was observed in 74% of the paired SSs. All distances were significantly shorter on the dominant side (p < 0.05), including: EAC - SS (dominant: 13.7 ± 3.4 mm; non-dominant: 15.3 ± 2.7 mm), FN - SS (dominant: 7.2 ± 1.8 mm; non-dominant: 8.1 ± 2.3 mm), 2nd genu FN - superior tip of JB (dominant: 8.7 ± 2.2 mm; non-dominant: 11.2 ± 2.6 mm), horizontal distance between the superior tip of JB - descending FN (dominant: 9.5 ± 2.3 mm; non-dominant: 13.2 ± 3.5 mm), and horizontal distance between the FN at the stylomastoid foramen - JB (dominant: 5.4 ± 2.2 mm; non-dominant: 7.7 ± 2.1). Analysis of the SSMs indicated that SS morphology is most variable at its junction with the transverse sinus, and least variable at the JB. CONCLUSIONS This is the first known study to investigate the anatomical variation and relationships of the SS using high resolution scans, 3D models and statistical shape analysis. This analysis seeks to guide neurotological surgical approaches and provide a template for automated segmentation and surgical simulation.
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Affiliation(s)
- Kylen Van Osch
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, N6A 5C1, Canada
| | - Daniel Allen
- Department of Electrical and Computer Engineering, Western University, London, Ontario, N6A 5C1, Canada
| | - Bradley Gare
- Department of Electrical and Computer Engineering, Western University, London, Ontario, N6A 5C1, Canada
| | - Thomas J Hudson
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, N6A 5C1, Canada
| | - Hanif Ladak
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Sumit K Agrawal
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, N6A 5C1, Canada.
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28
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Koch RW, Saleh H, Folkeard P, Moodie S, Janeteas C, Agrawal SK, Ladak HM, Scollie S. Skill Transference of a Probe-Tube Placement Training Simulator. J Am Acad Audiol 2019. [DOI: 10.3766/jaaa18054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Robert W. Koch
- School of Biomedical Engineering, Western University, London, ON, Canada
| | - Hasan Saleh
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - Paula Folkeard
- National Centre for Audiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Sheila Moodie
- School of Communication Sciences and Disorders, Western University, London, ON, Canada, and National Centre for Audiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | | | | | | | - Susan Scollie
- School of Communication Sciences and Disorders, Western University, London, ON, Canada and National Centre for Audiology, Faculty of Health Sciences, Western University, London, ON, Canada
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29
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Koch RW, Moodie S, Folkeard P, Scollie S, Janeteas C, Agrawal SK, Ladak HM. Face and Content Validity of a Probe Tube Placement Training Simulator. J Am Acad Audiol 2018; 30:227-234. [PMID: 30461412 DOI: 10.3766/jaaa.17114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Probe tube placement is an important skill audiologists must learn to make real-ear measurements in an audiology clinic. With current evidence-based guidelines recommending insertion of the probe tube within 5 mm of the tympanic membrane (TM) for proper acoustical measurements, students must be well trained to ensure they are capable to perform this placement in clinical practice. This is not always the case as it has been found that real-ear measurements are not performed in a clinic as often as required. To address this, a simulator consisting of a 3D-printed ear model and an optical tracking system was developed to provide a training system for students to practice probe tube placement and to provide a method to evaluate competency before starting clinical practicum placements. Two simulators were developed, an adult model and a pediatric model. PURPOSE To assess the face and content validity of the two probe tube placement simulators (adult and pediatric) and define barriers and facilitators to implementing this system into an educational setting. RESEARCH DESIGN Participants followed the setup and operating instructions designed to guide them through each functionality of the simulator. A questionnaire was used to assess face and content validity, applicability to an educational setting, and to determine perceived barriers and facilitators to using the probe tube simulators for training purposes. Five additional probe tube placements with each simulator were performed in which distance-to-TM was recorded. STUDY SAMPLE Twelve participants with significant probe tube placement experience. DATA COLLECTION AND ANALYSIS Participants rated each question in the questionnaire from 0% to 100% depending on their level of agreement. Averages and standard deviations (SDs) were compiled and presented for each section (face validity, content validity, and applicability to an educational setting). Final facilitators and barriers for the simulator were compiled and the top answers of each are presented. The five quantitative probe tube placement measurements for each participant were averaged, SDs were calculated, and contacts with the TM while placing the probe tube were recorded. RESULTS The average face validity score over all questions for the adult model was 65% (SD = 18.2) whereas the pediatric model received a score of 64% (16.4). The overall content validity average score was 78.7% (17) and applicability to an educational setting had an average score of 80% (5.33). The average distance-to-TM across all trials and participants was 3.74 mm (1.82) for the adult model and 2.77 mm (0.94) for the pediatric model with only one participant exceeding the recommended maximum of 5 mm. Listed shortcomings of the current simulator included realism of the 3D-printed ear, ease of insertion of an otoscope tip into the ear, ability to visualize the ear canal "landmarks" and the TM, and foam tip insertion experience. CONCLUSIONS Results were generally very positive for the simulator, and future iterations will look to improve the flexibility and texture of the ear, as well as the otoscopic view of the ear canal and TM.
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Affiliation(s)
- Robert W Koch
- Biomedical Engineering Graduate Program, Western University, London, ON, Canada
| | - Sheila Moodie
- National Centre for Audiology, Faculty of Health Sciences, Western University, London, ON, Canada.,School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - Paula Folkeard
- National Centre for Audiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Susan Scollie
- National Centre for Audiology, Faculty of Health Sciences, Western University, London, ON, Canada.,School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | | | - Sumit K Agrawal
- Biomedical Engineering Graduate Program, Western University, London, ON, Canada.,National Centre for Audiology, Faculty of Health Sciences, Western University, London, ON, Canada.,Department of Otolaryngology, Head and Neck Surgery, Western University, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Hanif M Ladak
- Biomedical Engineering Graduate Program, Western University, London, ON, Canada.,National Centre for Audiology, Faculty of Health Sciences, Western University, London, ON, Canada.,Department of Otolaryngology, Head and Neck Surgery, Western University, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
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30
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Iyer JS, Zhu N, Gasilov S, Ladak HM, Agrawal SK, Stankovic KM. Visualizing the 3D cytoarchitecture of the human cochlea in an intact temporal bone using synchrotron radiation phase contrast imaging. Biomed Opt Express 2018; 9:3757-3767. [PMID: 30338153 DOI: 10.1364/boe.9.00375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/17/2018] [Accepted: 05/23/2018] [Indexed: 05/21/2023]
Abstract
The gold standard method for visualizing the pathologies underlying human sensorineural hearing loss has remained post-mortem histology for over 125 years, despite awareness that histological preparation induces severe artifacts in biological tissue. Historically, the transition from post-mortem assessment to non-invasive clinical biomedical imaging in living humans has revolutionized diagnosis and treatment of disease; however, innovation in non-invasive techniques for cellular-level intracochlear imaging in humans has been difficult due to the cochlea's small size, complex 3D configuration, fragility, and deep encasement within bone. Here we investigate the ability of synchrotron radiation-facilitated X-ray absorption and phase contrast imaging to enable visualization of sensory cells and nerve fibers in the cochlea's sensory epithelium in situ in 3D intact, non-decalcified, unstained human temporal bones. Our findings show that this imaging technique resolves the bone-encased sensory epithelium's cytoarchitecture with unprecedented levels of cellular detail for an intact, unstained specimen, and is capable of distinguishing between healthy and damaged epithelium. All analyses were performed using commercially available software that quickly reconstructs and facilitates 3D manipulation of massive data sets. Results suggest that synchrotron radiation phase contrast imaging has the future potential to replace histology as a gold standard for evaluating intracochlear structural integrity in human specimens, and motivate further optimization for translation to the clinic.
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Affiliation(s)
- Janani S Iyer
- Eaton-Peabody Laboratories and Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, 25 Shattuck St, Boston, MA, USA
- Program in Speech and Hearing Bioscience and Technology, Harvard University Graduate School of Arts and Sciences, 1350 Massachusetts Ave, Cambridge, MA, USA
| | - Ning Zhu
- Canadian Light Source Inc., Saskatoon, Saskatchewan, Canada
| | - Sergei Gasilov
- Canadian Light Source Inc., Saskatoon, Saskatchewan, Canada
| | - Hanif M Ladak
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - Sumit K Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - Konstantina M Stankovic
- Eaton-Peabody Laboratories and Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, 25 Shattuck St, Boston, MA, USA
- Program in Speech and Hearing Bioscience and Technology, Harvard University Graduate School of Arts and Sciences, 1350 Massachusetts Ave, Cambridge, MA, USA
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Iyer JS, Zhu N, Gasilov S, Ladak HM, Agrawal SK, Stankovic KM. Visualizing the 3D cytoarchitecture of the human cochlea in an intact temporal bone using synchrotron radiation phase contrast imaging. Biomed Opt Express 2018; 9:3757-3767. [PMID: 30338153 PMCID: PMC6191620 DOI: 10.1364/boe.9.003757] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/17/2018] [Accepted: 05/23/2018] [Indexed: 05/21/2023]
Abstract
The gold standard method for visualizing the pathologies underlying human sensorineural hearing loss has remained post-mortem histology for over 125 years, despite awareness that histological preparation induces severe artifacts in biological tissue. Historically, the transition from post-mortem assessment to non-invasive clinical biomedical imaging in living humans has revolutionized diagnosis and treatment of disease; however, innovation in non-invasive techniques for cellular-level intracochlear imaging in humans has been difficult due to the cochlea's small size, complex 3D configuration, fragility, and deep encasement within bone. Here we investigate the ability of synchrotron radiation-facilitated X-ray absorption and phase contrast imaging to enable visualization of sensory cells and nerve fibers in the cochlea's sensory epithelium in situ in 3D intact, non-decalcified, unstained human temporal bones. Our findings show that this imaging technique resolves the bone-encased sensory epithelium's cytoarchitecture with unprecedented levels of cellular detail for an intact, unstained specimen, and is capable of distinguishing between healthy and damaged epithelium. All analyses were performed using commercially available software that quickly reconstructs and facilitates 3D manipulation of massive data sets. Results suggest that synchrotron radiation phase contrast imaging has the future potential to replace histology as a gold standard for evaluating intracochlear structural integrity in human specimens, and motivate further optimization for translation to the clinic.
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Affiliation(s)
- Janani S. Iyer
- Eaton-Peabody Laboratories and Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, 25 Shattuck St, Boston, MA, USA
- Program in Speech and Hearing Bioscience and Technology, Harvard University Graduate School of Arts and Sciences, 1350 Massachusetts Ave, Cambridge, MA, USA
| | - Ning Zhu
- Canadian Light Source Inc., Saskatoon, Saskatchewan, Canada
| | - Sergei Gasilov
- Canadian Light Source Inc., Saskatoon, Saskatchewan, Canada
| | - Hanif M. Ladak
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - Sumit K. Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - Konstantina M. Stankovic
- Eaton-Peabody Laboratories and Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, 25 Shattuck St, Boston, MA, USA
- Program in Speech and Hearing Bioscience and Technology, Harvard University Graduate School of Arts and Sciences, 1350 Massachusetts Ave, Cambridge, MA, USA
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32
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Schart-Morén N, Hallin K, Agrawal SK, Ladak HM, Eriksson PO, Li H, Rask-Andersen H. Peri-operative electrically evoked auditory brainstem response assessment of facial nerve/cochlea interaction at cochlear implantation. Cochlear Implants Int 2018; 19:324-329. [DOI: 10.1080/14670100.2018.1481179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Nadine Schart-Morén
- Department of Surgical Sciences, Section of Otolaryngology, Head and Neck Surgery, Uppsala University Hospital, Uppsala SE-75185, Sweden
| | - Karin Hallin
- Department of Surgical Sciences, Section of Otolaryngology, Head and Neck Surgery, Uppsala University Hospital, Uppsala SE-75185, Sweden
| | - Sumit K. Agrawal
- Department of Otolaryngology – Head and Neck Surgery, Western University, 1151 Richmond Street, London, ON, Canada, N6A3K7
| | - Hanif M. Ladak
- Department of Otolaryngology – Head and Neck Surgery, Department of Medical Biophysics, Department of Electrical and Computer Engineering, Western University, 1151 Richmond Street, London, ON, Canada, N6A3K7
| | - Per-Olof Eriksson
- Department of Surgical Sciences, Section of Otolaryngology, Head and Neck Surgery, Uppsala University Hospital, Uppsala SE-75185, Sweden
| | - Hao Li
- Department of Surgical Sciences, Section of Otolaryngology, Head and Neck Surgery, Uppsala University Hospital, Uppsala SE-75185, Sweden
| | - Helge Rask-Andersen
- Department of Surgical Sciences, Section of Otolaryngology, Head and Neck Surgery, Uppsala University Hospital, Uppsala SE-75185, Sweden
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Abstract
Stapedectomy and stapedotomy represent the state-of-the-art surgical procedures in addressing the conductive hearing loss caused by otosclerosis. Their high rates of success and long-term stability have been demonstrated repeatedly in many studies. In comparing the short- and long-term results of the 2 procedures, it is evident that stapedotomy confers better hearing gain at high frequencies and lower complication rates. Modified stapes mobilization procedures may represent the next major development in stapes surgery in a selected patient population.
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Affiliation(s)
- Horace C S Cheng
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Sumit K Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lorne S Parnes
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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34
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Iyaniwura JE, Elfarnawany M, Ladak HM, Agrawal SK. An automated A-value measurement tool for accurate cochlear duct length estimation. J Otolaryngol Head Neck Surg 2018; 47:5. [PMID: 29357924 PMCID: PMC5778705 DOI: 10.1186/s40463-018-0253-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/08/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND There has been renewed interest in the cochlear duct length (CDL) for preoperative cochlear implant electrode selection and postoperative generation of patient-specific frequency maps. The CDL can be estimated by measuring the A-value, which is defined as the length between the round window and the furthest point on the basal turn. Unfortunately, there is significant intra- and inter-observer variability when these measurements are made clinically. The objective of this study was to develop an automated A-value measurement algorithm to improve accuracy and eliminate observer variability. METHOD Clinical and micro-CT images of 20 cadaveric cochleae specimens were acquired. The micro-CT of one sample was chosen as the atlas, and A-value fiducials were placed onto that image. Image registration (rigid affine and non-rigid B-spline) was applied between the atlas and the 19 remaining clinical CT images. The registration transform was applied to the A-value fiducials, and the A-value was then automatically calculated for each specimen. High resolution micro-CT images of the same 19 specimens were used to measure the gold standard A-values for comparison against the manual and automated methods. RESULTS The registration algorithm had excellent qualitative overlap between the atlas and target images. The automated method eliminated the observer variability and the systematic underestimation by experts. Manual measurement of the A-value on clinical CT had a mean error of 9.5 ± 4.3% compared to micro-CT, and this improved to an error of 2.7 ± 2.1% using the automated algorithm. Both the automated and manual methods correlated significantly with the gold standard micro-CT A-values (r = 0.70, p < 0.01 and r = 0.69, p < 0.01, respectively). CONCLUSION An automated A-value measurement tool using atlas-based registration methods was successfully developed and validated. The automated method eliminated the observer variability and improved accuracy as compared to manual measurements by experts. This open-source tool has the potential to benefit cochlear implant recipients in the future.
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Affiliation(s)
- John E Iyaniwura
- Biomedical Engineering Graduate Program, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
| | - Mai Elfarnawany
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Hanif M Ladak
- Biomedical Engineering Graduate Program, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.,Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada.,Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Sumit K Agrawal
- Biomedical Engineering Graduate Program, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.,Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada.,Department of Electrical and Computer Engineering, Western University, London, ON, Canada.,London Health Science Centre, Room B1-333, University Hospital, 339 Windermere Rd., London, ON, Canada
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35
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Koch RW, Ladak HM, Elfarnawany M, Agrawal SK. Measuring Cochlear Duct Length - a historical analysis of methods and results. J Otolaryngol Head Neck Surg 2017; 46:19. [PMID: 28270200 PMCID: PMC5341452 DOI: 10.1186/s40463-017-0194-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 02/22/2017] [Indexed: 11/22/2022] Open
Abstract
Background Cochlear Duct Length (CDL) has been an important measure for the development and advancement of cochlear implants. Emerging literature has shown CDL can be used in preoperative settings to select the proper sized electrode and develop customized frequency maps. In order to improve post-operative outcomes, and develop new electrode technologies, methods of measuring CDL must be validated to allow usage in the clinic. Purpose The purpose of this review is to assess the various techniques used to calculate CDL and provide the reader with enough information to make an informed decision on how to conduct future studies measuring the CDL. Results The methods to measure CDL, the modality used to capture images, and the location of the measurement have all changed as technology evolved. With recent popularity and advancement in computed tomography (CT) imaging in place of histologic sections, measurements of CDL have been focused at the lateral wall (LW) instead of the organ of Corti (OC), due to the inability of CT to view intracochlear structures. After analyzing results from methods such as directly measuring CDL from histology, indirectly reconstructing the shape of the cochlea, and determining CDL based on spiral coefficients, it was determined the three dimensional (3D) reconstruction method is the most reliable method to measure CDL. 3D reconstruction provides excellent visualization of the cochlea and avoids errors evident in other methods. Due to the number of varying methods with varying accuracies, certain guidelines must be followed in the future to allow direct comparison of CDL values between studies. Conclusion After summarizing and analyzing the interesting history of CDL measurements, the use of standardized guidelines and the importance of CDL for future cochlear implant developments is emphasized for future studies.
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Affiliation(s)
- Robert W Koch
- Biomedical Engineering, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
| | - Hanif M Ladak
- Biomedical Engineering, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.,Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada.,Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Mai Elfarnawany
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Sumit K Agrawal
- Biomedical Engineering, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.,Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada.,Department of Electrical and Computer Engineering, Western University, London, ON, Canada.,London Health Science Centre, University Hospital, Room B1-333, 339 Windermere Rd, London, ON, Canada
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36
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Ligorio G, Zanotto D, Sabatini AM, Agrawal SK. A novel functional calibration method for real-time elbow joint angles estimation with magnetic-inertial sensors. J Biomech 2017; 54:106-110. [PMID: 28236444 DOI: 10.1016/j.jbiomech.2017.01.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 01/15/2017] [Accepted: 01/17/2017] [Indexed: 11/18/2022]
Abstract
Magnetic-inertial measurement units (MIMUs) are often used to measure the joint angles between two body segments. To obtain anatomically meaningful joint angles, each MIMU must be computationally aligned (i.e., calibrated) with the anatomical rotation axes. In this paper, a novel four-step functional calibration method is presented for the elbow joint, which relies on a two-degrees-of-freedom elbow model. In each step, subjects are asked to perform a simple task involving either one-dimensional motions around some anatomical axes or a static posture. The proposed method was implemented on a fully portable wearable system, which, after calibration, was capable of estimating the elbow joint angles in real time. Fifteen subjects participated in a multi-session experiment that was designed to assess accuracy, repeatability and robustness of the proposed method. When compared against an optical motion capture system (OMCS), the proposed wearable system showed an accuracy of about 4° along each degree of freedom. The proposed calibration method was tested against different MIMU mountings, multiple repetitions and non-strict observance of the calibration protocol and proved to be robust against these factors. Compared to previous works, the proposed method does not require the wearer to maintain specific arm postures while performing the calibration motions, and therefore it is more robust and better suited for real-world applications.
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Affiliation(s)
- G Ligorio
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Italy.
| | - D Zanotto
- Robotics and Rehabilitation Lab., Columbia University, NY, USA
| | - A M Sabatini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Italy
| | - S K Agrawal
- Robotics and Rehabilitation Lab., Columbia University, NY, USA
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37
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Elfarnawany M, Alam SR, Rohani SA, Zhu N, Agrawal SK, Ladak HM. Micro-CT versus synchrotron radiation phase contrast imaging of human cochlea. J Microsc 2016; 265:349-357. [PMID: 27935035 DOI: 10.1111/jmi.12507] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/29/2016] [Accepted: 10/30/2016] [Indexed: 11/26/2022]
Abstract
High-resolution images of the cochlea are used to develop atlases to extract anatomical features from low-resolution clinical computed tomography (CT) images. We compare visualization and contrast of conventional absorption-based micro-CT to synchrotron radiation phase contrast imaging (SR-PCI) images of whole unstained, nondecalcified human cochleae. Three cadaveric cochleae were imaged using SR-PCI and micro-CT. Images were visually compared and contrast-to-noise ratios (CNRs) were computed from n = 27 regions-of-interest (enclosing soft tissue) for quantitative comparisons. Three-dimensional (3D) models of cochlear internal structures were constructed from SR-PCI images using a semiautomatic segmentation method. SR-PCI images provided superior visualization of soft tissue microstructures over conventional micro-CT images. CNR improved from 7.5 ± 2.5 in micro-CT images to 18.0 ± 4.3 in SR-PCI images (p < 0.0001). The semiautomatic segmentations yielded accurate reconstructions of 3D models of the intracochlear anatomy. The improved visualization, contrast and modelling achieved using SR-PCI images are very promising for developing atlas-based segmentation methods for postoperative evaluation of cochlear implant surgery.
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Affiliation(s)
- M Elfarnawany
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - S Riyahi Alam
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - S A Rohani
- Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada
| | - N Zhu
- Bio-Medical Imaging and Therapy Facility, Canadian Light Source Inc., University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - S K Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.,Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - H M Ladak
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.,Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
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38
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Stepniak C, Wickens B, Husein M, Paradis J, Ladak HM, Fung K, Agrawal SK. Blinded randomized controlled study of a web-based otoscopy simulator in undergraduate medical education. Laryngoscope 2016; 127:1306-1311. [DOI: 10.1002/lary.26246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 07/10/2016] [Accepted: 07/13/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Camilla Stepniak
- Schulich School of Medicine and Dentistry; Western University; London Ontario Canada
| | - Brandon Wickens
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Ontario Canada
| | - Murad Husein
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Ontario Canada
| | - Josee Paradis
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Ontario Canada
| | - Hanif M. Ladak
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Ontario Canada
- Department of Medical Biophysics; Western University; London Ontario Canada
- Department of Electrical and Computer Engineering; Western University; London Ontario Canada
- Biomedical Engineering Graduate Program; Western University; London Ontario Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Ontario Canada
| | - Sumit K. Agrawal
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Ontario Canada
- Department of Electrical and Computer Engineering; Western University; London Ontario Canada
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39
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Liu J, Agrawal SK, Ladak HM, Wan W. Fiber Arrangement in the Rat Tympanic Membrane. Anat Rec (Hoboken) 2016; 299:1531-1539. [PMID: 27532441 DOI: 10.1002/ar.23461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/15/2016] [Accepted: 06/20/2016] [Indexed: 11/07/2022]
Abstract
The fiber arrangement in the pars tensa of the rat tympanic membrane (TM) was observed using a high resolution scanning electron microscope. The entire pars tensa is composed of fibrils with diameter of approximately 25 nm. These fibrils can be grouped into radial, circular, parabolic, and oblique fibers as reported in other mammals. The radial fibrils interweave into a planar form rather than into discrete cylindrical fibers. Before attaching to the manubrium and tympanic ring, the radial fibrils bend and cross neighboring fibrils to form a random fibril network, and change their direction from perpendicular to somewhat parallel to the manubrium and tympanic ring. The circular fibrils form cylindrical fibers near the peripheral part of the TM while closer to the manubrium, they form planar bundles. The observed fiber morphology and arrangement may provide helpful information in improving numerical models for the TM's acoustical response and designing a fibrous graft for the repair of TM perforations. Anat Rec, 299:1531-1539, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jian Liu
- Department of Chemical and Biochemical Engineering, Western University, London, Ontario, Canada
| | - Sumit K Agrawal
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Hanif M Ladak
- Department of Medical Biophysics, Western University, London, Ontario, Canada.
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada.
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, London, Ontario, Canada.
- Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada.
| | - Wankei Wan
- Department of Chemical and Biochemical Engineering, Western University, London, Ontario, Canada.
- Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada.
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40
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Rohani SA, Ghomashchi S, Umoh J, Holdsworth DW, Agrawal SK, Ladak HM. Iodine potassium iodide improves the contrast-to-noise ratio of micro-computed tomography images of the human middle ear. J Microsc 2016; 264:334-338. [PMID: 27439684 DOI: 10.1111/jmi.12447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 06/21/2016] [Accepted: 06/30/2016] [Indexed: 12/11/2022]
Abstract
High-resolution imaging of middle-ear geometry is necessary for finite-element modeling. Although micro-computed tomography (microCT) is widely used because of its ability to image bony structures of the middle ear, it is difficult to visualize soft tissues - including the tympanic membrane and the suspensory ligaments/tendons - because of lack of contrast. The objective of this research is to quantitatively evaluate the efficacy of iodine potassium iodide (IKI) solution as a contrast agent. Six human temporal bones were used in this experiment, which were obtained in right-left pairs, from three cadaveric heads. All bones were fixed using formaldehyde. Three bones (one from each pair) were stained in IKI solution for 2 days, whereas the other three were not stained. Samples were scanned using a microCT system at a resolution of 20 μm. Eight soft tissues in the middle ear were segmented: anterior mallear ligament, incudomallear joint, lateral mallear ligament, posterior incudal ligament, stapedial annular ligament, stapedius muscle, tympanic membrane and tensor tympani muscle. Contrast-to-noise ratios (CNRs) of each soft tissue were calculated for each temporal bone. Combined CNRs of the soft tissues in unstained samples were 6.1 ± 3.0, whereas they were 8.1 ± 2.7 in stained samples. Results from Welch's t-test indicate significant difference between the two groups at a 95% confidence interval. Results for paired t-tests for each of the individual soft tissues also indicated significant improvement of contrast in all tissues after staining. Relatively large soft tissues in the middle ear such as the tympanic membrane and the tensor tympani muscle were impacted by staining more than smaller tissues such as the stapedial annular ligament. The increase in contrast with IKI solution confirms its potential application in automatic segmentation of the middle-ear soft tissues.
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Affiliation(s)
- S A Rohani
- Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada
| | - S Ghomashchi
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - J Umoh
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - D W Holdsworth
- Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - S K Agrawal
- Department of Otolaryngology - Head & Neck Surgery, Western University, London, Ontario, Canada
| | - H M Ladak
- Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, Western University, London, Ontario, Canada.,Department of Electrical & Computer Engineering, Western University, London, Ontario, Canada
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41
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Kao PC, Srivastava S, Higginson JS, Agrawal SK, Scholz JP. Short-term Performance-based Error-augmentation versus Error-reduction Robotic Gait Training for Individuals with Chronic Stroke: A Pilot Study. Phys Med Rehabil Int 2015; 2:1066. [PMID: 27336075 PMCID: PMC4914051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The success of locomotion training with robotic exoskeletons requires identifying control algorithms that effectively retrain gait patterns in neurologically impaired individuals. Here we report how the two training paradigms, performance-based error-augmentation versus error-reduction, modified walking patterns in four chronic post-stroke individuals as a proof-of-concept for future locomotion training following stroke. Stroke subjects were instructed to match a prescribed walking pattern template derived from neurologically intact individuals. Target templates based on the spatial paths of lateral ankle malleolus positions during walking were created for each subject. Robotic forces were applied that either decreased (error-reduction) or increased (error-augmentation) the deviation between subjects' instantaneous malleolus positions and their target template. Subjects' performance was quantified by the amount of deviation between their actual and target malleolus paths. After the error-reduction training, S1 showed a malleolus path with reduced deviation from the target template by 16%. In contrast, S4 had a malleolus path further away from the template with increased deviation by 12%. After the error-augmentation training, S2 had a malleolus path greatly approximating the template with reduced deviation by 58% whereas S3 walked with higher steps than his baseline with increased deviation by 37%. These findings suggest that an error-reduction force field has minimal effects on modifying subject's gait patterns whereas an error-augmentation force field may promote a malleolus path either approximating or exceeding the target walking template. Future investigation will need to evaluate the long-term training effects on over-ground walking and functional capacity.
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Affiliation(s)
- P C Kao
- Department of Physical Therapy, University of Massachusetts Lowell, USA
| | - S Srivastava
- Department of Health Sciences and Research, Medical University of South Carolina, USA
| | - J S Higginson
- Department of Mechanical Engineering, University of Delaware, USA
| | - S K Agrawal
- Department of Mechanical Engineering, Columbia University, USA
| | - J P Scholz
- Biomechanics and Movement Science Program, University of Delaware, USA
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42
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Huang C, Cheng H, Bureau Y, Agrawal SK, Ladak HM. Face and content validity of a virtual-reality simulator for myringotomy with tube placement. J Otolaryngol Head Neck Surg 2015; 44:40. [PMID: 26481401 PMCID: PMC4615336 DOI: 10.1186/s40463-015-0094-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 10/12/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Myringotomy with tube insertion can be challenging for junior Otolaryngology residents as it is one of the first microscopic procedures they encounter. The Western myringotomy simulator was developed to allow trainees to practice microscope positioning, myringotomy, and tube placement. This virtual-reality simulator is viewed in stereoscopic 3D, and a haptic device is used to manipulate the digital ear model and surgical tools. OBJECTIVE To assess the face and content validity of the Western myringotomy simulator. METHODS The myringotomy simulator was integrated with new modules to allow speculum placement, manipulation of an operative microscope, and insertion of the ventilation tube through a deformable tympanic membrane. A questionnaire was developed in consultation with instructing surgeons. Fourteen face validity questions focused on the anatomy of the ear, simulation of the operative microscope, appearance and movement of the surgical instruments, deformation and cutting of the eardrum, and myringotomy tube insertion. Six content validity questions focused on training potential on surgical tasks such as speculum placement, microscope positioning, tool navigation, ear anatomy, myringotomy creation and tube insertion. A total of 12 participants from the Department of Otolaryngology-Head and Neck Surgery were recruited for the study. Prior to completing the questionnaire, participants were oriented to the simulator and given unlimited time to practice until they were comfortable with all of its aspects. RESULTS Responses to 12 of the 14 questions on face validity were predominantly positive. One issue of concern was with contact modeling related to tube insertion into the eardrum, and the second was with the movement of the blade and forceps. The former could be resolved by using a higher resolution digital model for the eardrum to improve contact localization. The latter could be resolved by using a higher fidelity haptic device. With regard to content validity, 64% of the responses were positive, 21% were neutral, and 15% were negative. CONCLUSIONS The Western myringotomy simulator appears to have sufficient face and content validity. Further development with automated metrics and skills transference testing is planned.
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Affiliation(s)
- Caiwen Huang
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada.
| | - Horace Cheng
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Yves Bureau
- Lawson Health Research Institute, London, ON, Canada.
- Department of Medical Biophysics, Western University, London, ON, Canada.
| | - Sumit K Agrawal
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada.
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
- London Health Sciences Centre, Room B1-333, University Hospital, 339 Windermere Rd., London, N6A 5A5, ON, Canada.
| | - Hanif M Ladak
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada.
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
- Biomedical Engineering Graduate Program, Western University, London, ON, Canada.
- Department of Medical Biophysics, Western University, London, ON, Canada.
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Glicksman JT, Khalili S, Fung K, Parnes LS, Agrawal SK. Pentoxifylline-tocopherol-clodronate combination: A novel treatment for osteoradionecrosis of the temporal bone. Head Neck 2015; 37:E191-3. [DOI: 10.1002/hed.24057] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jordan T. Glicksman
- Department of Otolaryngology, Head and Neck Surgery; Schulich School of Medicine and Dentistry, Western University; London Ontario Canada
| | - Sammy Khalili
- Department of Otolaryngology, Head and Neck Surgery; Schulich School of Medicine and Dentistry, Western University; London Ontario Canada
| | - Kevin Fung
- Department of Otolaryngology, Head and Neck Surgery; Schulich School of Medicine and Dentistry, Western University; London Ontario Canada
| | - Lorne S. Parnes
- Department of Otolaryngology, Head and Neck Surgery; Schulich School of Medicine and Dentistry, Western University; London Ontario Canada
| | - Sumit K. Agrawal
- Department of Otolaryngology, Head and Neck Surgery; Schulich School of Medicine and Dentistry, Western University; London Ontario Canada
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Dahal S, Agrawal SK, Shrestha A, Bhagat TK. Self-perception regarding dental aesthetics, knowledge and attitude of traumatic dental injury and halitosis among people of Aurabani, Sunsari district of Eastern Nepal. J Coll Med Sci-Nepal 2015. [DOI: 10.3126/jcmsn.v11i1.13314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives: Increased concern over dental appearance has been observed during childhood and adolescence to early adulthood. The study was conducted with objectives to assess the self-perception of dental aesthetics, knowledge, attitude and management of dental trauma and halitosis.Materials and Methods: Self-administered questionnaire translated in Nepali language consisting of 32 questions was used. The completed questionnaires were analyzed using descriptive statistics.Results: Out of the total study population, 63% were satisfied with their overall tooth appearance and 71.7% with their tooth color. Twenty-nine percent had experienced dental trauma. More than half of the study population thought that immediate treatment was required after dental trauma. Fifty seven percent of the villagers had halitosis.Conclusion: The research clearly shows that the people of Aurabani VDC were satisfied with their tooth color and overall tooth appearance; however the knowledge regarding emergency management of dental trauma, the cause and management of halitosis was insufficient.JCMS Nepal. 2015;11(1):6-8
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Wickens B, Lewis J, Morris DP, Husein M, Ladak HM, Agrawal SK. Face and content validity of a novel, web-based otoscopy simulator for medical education. J Otolaryngol Head Neck Surg 2015; 44:7. [PMID: 25889997 PMCID: PMC4349665 DOI: 10.1186/s40463-015-0060-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/26/2015] [Indexed: 11/16/2022] Open
Abstract
Background Despite the fact that otoscopy is a widely used and taught diagnostic tool during medical training, errors in diagnosis are common. Physical otoscopy simulators have high fidelity, but they can be expensive and only a limited number of students can use them at a given time. Objectives 1) To develop a purely web-based otoscopy simulator that can easily be distributed to students over the internet. 2) To assess face and content validity of the simulator by surveying experts in otoscopy. Methods An otoscopy simulator, OtoTrain™, was developed at Western University using web-based programming and Unity 3D. Eleven experts from academic institutions in North America were recruited to test the simulator and respond to an online questionnaire. A 7-point Likert scale was used to answer questions related to face validity (realism of the simulator), content validity (expert evaluation of subject matter and test items), and applicability to medical training. Results The mean responses for the face validity, content validity, and applicability to medical training portions of the questionnaire were all ≤3, falling between the “Agree”, “Mostly Agree”, and “Strongly Agree” categories. The responses suggest good face and content validity of the simulator. Open-ended questions revealed that the primary drawbacks of the simulator were the lack of a haptic arm for force feedback, a need for increased focus on pneumatic otoscopy, and few rare disorders shown on otoscopy. Conclusion OtoTrain™ is a novel, web-based otoscopy simulator that can be easily distributed and used by students on a variety of platforms. Initial face and content validity was encouraging, and a skills transference study is planned following further modifications and improvements to the simulator.
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Affiliation(s)
- Brandon Wickens
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada.
| | - Jordan Lewis
- Department of Medical Biophysics, Western University, London, Ontario, Canada.
| | - David P Morris
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Murad Husein
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada.
| | - Hanif M Ladak
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada. .,Department of Medical Biophysics, Western University, London, Ontario, Canada. .,Department of Electrical & Computer Engineering, Western University, London, Ontario, Canada.
| | - Sumit K Agrawal
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada. .,Department of Medical Biophysics, Western University, London, Ontario, Canada. .,Department of Electrical & Computer Engineering, Western University, London, Ontario, Canada. .,London Health Sciences Centre, Room B1-333, University Hospital, 339 Windermere Rd., London, Ontario, N6A 5A5, Canada.
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Arora BS, Sharma E, Agrawal SK, Agrawal M. In vitro cytotoxicity of methanol extract from aerial parts of Aralia cachemirica and purified continentalic acid. Indian J Pharm Sci 2015; 77:792-5. [PMID: 26997711 PMCID: PMC4778243 DOI: 10.4103/0250-474x.174980] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The present study was designed to evaluate the in vitro cytotoxic effect of methanol extract of aerial parts including stems, leaves and twigs of Aralia cachemirica and purified continentalic acid isolated from this extract against a panel of human cancer cell lines of varied tissues. Percentage of growth inhibition was evaluated by sulphorhodamine B assay. Purified continentalic acid showed moderate cytotoxicity against all the cell lines used. In contrast, the extract exhibited significant concentration dependant cytotoxicity against A-549 (lung), THP-1 (leukemia) and MCF-7 (breast) cell lines. This work highlights cytotoxic potential of this extract, which can further be explored for different constituents for their possible use autonomously or in combined manner in cancer therapy. The detailed analysis of their cytotoxicity has been presented in this paper.
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Glicksman JT, Khalili S, Fung K, Parnes LS, Agrawal SK. PENTOCLO for Treatment of Osteoradionecrosis of the Temporal Bone. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541629a267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Osteoradionecrosis is a rare but devastating complication of radiation therapy that often requires surgical intervention. The objective of this report is to describe a case of osteoradionecrosis (ORN) of the temporal bone that was managed medically with PENTOCLO (pentoxifylline-tocopherol-clodronate). The use of PENTOCLO in the treatment of ORN of other sites in the head and neck will also be described. Methods: We report the case of a patient treated at our institution and present a review of literature. A 52-year-old woman presented with ORN of the temporal bone 20 years following radiation therapy for an ipsilateral parotid tumor. The patient had chronic infections and otorrhea. Results: She failed conservative treatment including antibiotic-steroid ear drops and aural lavage. As an alternative to hyperbaric oxygen and/or temporal bone resection, treatment with PENTOCLO was pursued and her condition improved dramatically. A literature review of ORN of the temporal bone and the use of PENTOCOLO in the management of ORN of other sites of the head and neck are described. Conclusions: PENTOCLO was effectively used in the management of our patient and may represent a valuable management option for other patients with ORN of the temporal bone. Further research is required to determine the effectiveness of PENTOCLO.
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Agrawal SK, Tikar S, Yadav R, Halve AK, Sathe M. The effect of aryl hydrazono ester containing dipeptides (AHEDs) on mosquito egg-laying behaviour. NEW J CHEM 2014. [DOI: 10.1039/c4nj00647j] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Fifteen peptide derivatives were synthesized to study oviposition responses in mosquitoes at two different concentrations. AHED-6 showed the maximum oviposition attractant activity while AHED-13 exhibited the highest oviposition deterrent activity.
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Affiliation(s)
| | - Sachin Tikar
- Vector Management Division
- Defence R & D Establishment
- Gwalior, India
| | - Ruchi Yadav
- Vector Management Division
- Defence R & D Establishment
- Gwalior, India
| | | | - Manisha Sathe
- Discovery Centre
- Defence R & D Establishment
- Gwalior, India
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Agrawal SK, Panini P, Sathe M, Chopra D, Kaushik MP. Design and synthesis of cyclic depsipeptides containing triazole (CDPT) rings. RSC Adv 2014. [DOI: 10.1039/c3ra45100c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Lenzi T, Zanotto D, Stegall P, Carrozza MC, Agrawal SK. Reducing muscle effort in walking through powered exoskeletons. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2012:3926-9. [PMID: 23366786 DOI: 10.1109/embc.2012.6346825] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper presents a novel assistive control for lower limb exoskeletons. The controller provides the user with a scaled version of the Winter's nominal torque profile, which is adapted online to the specific gait features of the user. The proposed assistive controller is implemented on the ALEX II exoskeleton and tested on two healthy subjects. Experimental results show that when assisted by the exoskeleton users can reduce the muscle effort compared to free walking.
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Affiliation(s)
- T Lenzi
- BioRobotics Institute, Scuola Superiore sant’Anna, 56025 Pisa, Italy. lenzi@ ieee.org
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