610 Medizin, Gesundheit
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Durch das stetige Wachstum an neuen Technologien und Möglichkeiten steht der Verschmelzung von Technologien mit dem Menschen kaum noch etwas im Wege. Die Untersuchung der Implantate und die damit verbundenen Risiken sind ein Teil dieser Arbeit. Von Bedeutung sind hier die Funktionsweise und die IT-Sicherheitsaspekte. Alle in dieser Arbeit dargestellten Implantate benötigen eine Kommunikation nach außen. Diese Kommunikationsmöglichkeit birgt Risiken, die nicht nur auf die Daten der Träger beschränkt sind, sondern auch gesundheitliche Risiken beinhalten.
Segmentierung von Polypen in Koloskopie-Bilddaten : eine Potentialanalyse von Deep-Learning-Methoden
(2018)
Kolorektale Karzinome haben eine hohe Sterblichkeitsrate, wenn sie spät entdeckt werden. Eine frühzeitige Entfernung von bösartigen Polypen im Magen-Darm-Trakt, die deren Vorstufen bilden, bietet jedoch hohe Überlebenschancen. Bei Darmspiegelungen werden gerade kleine Polypen aber recht häufig übersehen. Zuverlässige bildverarbeitende Systeme, die Polypen in einem Koloskopie-Frame nicht nur detektieren, sondern pixelgenau segmentieren, könnten Ärzten bei Darmkrebs-Screenings helfen. Diese Arbeit analysiert den aktuellen Stand der Segmentierung von Polypen im Gastrointestinaltrakt. Weiterführend wird untersucht, inwiefern die in letzter Zeit sehr erfolgreichen Methoden des Deep Learning hier Vorteile bieten.
Completely defined co-culture of adipogenic differentiated ASCs and microvascular endothelial cells
(2018)
Vascularized adipose tissue models are in high demand as alternatives to animal models to elucidate the mechanisms of widespread diseases, screen for new drugs or assess drug safety levels. Animal-derived sera such as fetal bovine serum (FBS), which are commonly used in these models, are associated with ethical concerns, risk of contaminations and inconsistencies of their composition and impact on cells. In this study, we developed a serum-free, defined co culture medium and implemented it in an adipocyte/endothelial cell (EC) co culture model.
Human adipose-derived stem cells were differentiated under defined conditions (diffASCs) and, like human microvascular ECs (mvECs), cultured in a defined co culture medium in mono-, indirect or direct co-culture for 14 days. The defined co-culture medium was superior when compared to mono-culture media and facilitated the functional maintenance and maturation of diffASCs including perilipin A expression, lipid accumulation, and also glycerol and leptin release. The medium also allowed mvEC maintenance, confirmed by the expression of CD31 and von Willebrand factor (vWF), and by acetylated low density lipoprotein (acLDL) uptake. Thereby, mvECs showed strong dependence on EC-specific factors. Additionally, mvECs formed vascular structures in direct co-culture with diffASCs.
The completely defined co-culture system allows for the serum-free culture of adipocyte/EC co-cultures and thereby represents a valuable and ethically acceptable tool for the culture and study of vascularized adipose tissue models.
Background aims: In vitro engineered adipose tissue is in great demand to treat lost or damaged soft tissue or to screen for new drugs, among other applications.However, today most attempts depend on the use of animal-derived sera. To pave the way for the application of adipose tissue-engineered
products in clinical trials or as reliable and robust in vitro test systems, sera should be completely excluded from the production process. In this study, we aimed to develop an in vitro adipose tissue model in the absence of sera and maintain its function long-term.
Methods: Human adipose tissue-derived stem cells were expanded and characterized in a xeno- and serum-free environment. Adipogenic differentiation was induced using a completely defined medium. Developed adipocytes were maintained in a completely defined maturation medium for additional 28 days. In addition to cell-viability and adherence, adipocyte-specific markers such as perilipin A expression of leptin release were evaluated.
Results: The defined differentiation medium enhanced cell adherence and lipid
accumulation at a significant level compared with the corresponding negative control. The defined maturation medium also significantly supported cell adherence and functional adipocyte maturation during the long-term culture period.
Conclusions: The process described here enables functional adipocyte generation and maintenance without the addition fo unknown or unimal-derived constituents, achieving an important milestone in the introduction of adipose tissue engineered products into clinical trials or in vitro screening.
Bone remodeling can be mimicked in vitro by co-culture models. Based on bone cells, such co-cultures help to study synergistic morphological changes and the impact of materials and applied substances. Hence, we examined the formation of osteoclasts on bovine bone materials to prove the bone resorption functionality of the osteoclasts in three different co-culture set-ups using human monocytes (hMCs) and (I) human mesenchymal stem cells (hMSCs), (II) osteogenic differentiated hMSCs (hOBs), and (III) hOBs in addition of soluble monocyte-colony stimulating factor (M CSF) and cytokine receptor activator of NFkB ligand (RANKL).We detected osteoclast-specific actin morphology, as well as the expression of cathepsin K and CD51/61 in single cells in set-up II and in numerous cells in set-up III. Resorption pits on bone material as characteristic proof of functional osteoclasts were not found in set-up I and II, but we detected such resorption pits in set–up III. We conclude in co culture models without M-CSF and RANKL that monocytes can differentiate into osteoclasts that show the characteristic actin structures and protein expression. However, to receive functional bone resorbing osteoclasts in vitro, the addition of M-CSF and RANKL is needed. Moreover, we suggest the use of bone or bone-like materials for future studies evaluating osteoclastogenesis.
Background: Internationally, teledermatology has proven to be a viable alternative to conventional physical referrals. Travel cost and referral times are reduced while patient safety is preserved. Especially patients from rural areas benefit from this healthcare innovation. Despite these established facts and positive experiences from EU neighboring countries like the Netherlands or the United Kingdom, Germany has not yet implemented store-and-forward teledermatology in routine care.
Methods: The TeleDerm study will implement and evaluate store-and-forward teledermatology in 50 general practitioner (GP) practices as an alternative to conventional referrals. TeleDerm aims to confirm that the possibility of store-and-forward teledermatology in GP practices is going to lead to a 15% (n = 260) reduction in referrals in the intervention arm. The study uses a cluster-randomized controlled trial design. Randomization is planned for the cluster “county”. The main observational unit is the GP practice. Poisson distribution of referrals is assumed. The evaluation of secondary outcomes like acceptance, enablers and barriers uses a mixed methods design with questionnaires and interviews.
Discussion: Due to the heterogeneity of GP practice organization, patient management software, information technology service providers, GP personal technical affinity and training, we expect several challenges in implementing teledermatology in German GP routine care. Therefore, we plan to recruit 30% more GPs than required by the power calculation. The implementation design and accompanying evaluation is expected to deliver vital insights into the specifics of implementing telemedicine in German routine care.
Die Segmentierung und das Tracking von minimal-invasiven robotergeführten Instrumenten ist ein wesentlicher Bestandteil für verschiedene computer assistierte Eingriffe. Allerdings treten in der minimal-invasiven Chirurgie, die das Anwendungsfeld für den hier beschriebenen Ansatz darstellt, häufig Schwierigkeiten durch Reflexionen, Schatten oder visuelle Verdeckungen durch Rauch und Organe auf und erschweren die Segmentierung und das Tracking der Instrumente.
Dieser Beitrag stellt einen Deep Learning Ansatz für ein markerloses Tracking von minimal-invasiven Instrumenten vor und wird sowohl auf simulierten als auch realen Daten getestet. Es wird ein simulierter als auch realer Datensatz mit Ground Truth Kennzeichnung für die binäre Segmentierung von Instrument und Hintergrund erstellt. Für den simulierten Datensatz werden Bilder aus einem simulierten Instrument und realem Hintergrund zusammengesetzt. Im Falle des realen Datensatzes spricht man von der Zusammensetzung der Bilder aus einem realen Instrument und Hintergrund. Insgesamt wird auf den simulierten Daten eine Pixelgenauigkeit von 94.70 Prozent und auf den realen Daten eine Pixelgenauigkeit von 87.30 Prozent erreicht.
Die minimal-invasive Chirurgie (MIC) entwickelt sich durch den Einsatz von medizinischen Robotern wie dem da Vinci System von Intuitive Surgical stetig weiter. Hierdurch kann eine bessere oder gleichwertige Operation bei deutlich geringerer körperlicher Belastung des Operateurs erreicht werden. Dabei entstehen jedoch neue Problemstellungen wie beispielsweise Kollision zwischen Roboterarmen und die benötigte Zeit zum Einrichten einer geeigneten Roboterkonfiguration. Daher ist eine effiziente Vorbereitung und Planung der Interventionen erforderlich. Diese Arbeit präsentiert einen Ansatz für eine verbesserte Planung mit Augmented Reality (AR) und einer Robotik Simulationssoftware (RS). Die Robotik Simulation dient zur Berechnung einer Roboterkonfiguration unter Vorgabe der Port-Positionen. Augmented Reality wird verwendet, um die berechneten Pose in der realen Umgebung zu visualisieren und somit leichter in den Operationssaal zu übertragen.
The focus of the developed maturity model was set on processes. The concept of the widespread CMM and its practices has been transferred to the perioperative domain and the concept of the new maturity model. Additional optimization goals and technological as well as networking-specific aspects enable a process- and object-focused view of the maturity model in order to ensure broad coverage of different subareas. The evaluation showed that the model is applicable to the perioperative field. Adjustments and extensions of the maturity model are future steps to improve the rating and classification of the new maturity model.
Perivascular stromal cells, including mesenchymal stem/stromal cells (MSCs), secrete paracrine factor in response to exercise training that can facilitate improvements in muscle remodeling. This study was designed to test the capacity for muscle-resident MSCs (mMSCs) isolated from young mice to release regenerative proteins in response to mechanical strain in vitro, and subsequently determine the extent to which strain-stimulated mMSCs can enhance skeletal muscle and cognitive performance in a mouse model of uncomplicated aging. Protein arrays confirmed a robust increase in protein release at 24 h following an acute bout of mechanical strain in vitro (10%, 1 Hz, 5 h) compared to non-strain controls. Aged (24 month old), C57BL/6 mice were provided bilateral intramuscular injection of saline, non strain control mMSCs, or mMSCs subjected to a single bout of mechanical strain in vitro (4 ×104). No significant changes were observed in muscle weight, myofiber size, maximal force, or satellite cell quantity at 1 or 4 wks between groups. Peripheral perfusion was significantly increased in muscle at 4 wks post-mMSC injection (p < 0.05), yet no difference was noted between control and preconditioned mMSCs. Intramuscular injection of preconditioned mMSCs increased the number of new neurons and astrocytes in the dentate gyrus of the hippocampus compared to both control groups (p < 0.05), with a trend toward an increase in water maze performance noted (p=0.07). Results from this study demonstrate that acute injection of exogenously stimulated muscle-resident stromal cells do not robustly impact aged muscle structure and function, yet increase the survival of new neurons in the hippocampus.