Reversed-Image Mechanical Thrombectomy for Acute Ischemic Stroke in a Situs Inversus Totalis Patient.

An 85-year-old female with situs inversus totalis presented with right hemiplegia, right facial nerve palsy, eye deviation to the left, and aphasia. Magnetic resonance imaging revealed acute ischemic lesions in the left insular cortex and the frontal lobe. Magnetic resonance angiography revealed an occlusion of the left internal carotid artery. Reversed-image mechanical thrombectomy achieved complete reperfusion in three passes within 54 minutes. Six months post-intervention, the patient could walk indoors independently. Our technique, which replicates the normal arterial anatomy by inversion and angulation, was adapted to situs inversus totalis.

Image Inversion during Xi Robotic ventral hernia repair: making it even more effective / Inversão de imagem em cirurgia robótica de hérnia ventral com a plataforma Da vinci Xi: tornando-a ainda mais ergonômica

ABSTRACT Introduction: currently, there are several clinical applications for robot-assisted surgery and in the hernia scenario, robot-assisted surgery seems to have the ability to overcome laparoscopic ventral hernias repairs limitations, facilitating dissection, defect closure, and mesh positioning. Exponentially grown in numbers of robotic approaches have been seen and even more complex and initially not suitable cases have recently become eligible for it. An appropriate tension-free reestablishment of the linea alba is still a major concern in hernia surgery and even with the robotic platform, dissecting and suturing in anterior abdominal wall may be challenging. This article reports a technical image artifice during a da vinci Xi-platform robotic ventral hernia repair allowing the surgeon to establish a more familiar and ergonomic manner to perform dissection and suturing in anterior abdominal wall. Technical Report: a step by step guided technique of image inversion artifice is described using detailed commands and figures to assure optimal surgical field and ergonomics whenever acting in robotic ventral hernias repair with the da Vinci Xi-platform. Our group brief experience is also reported, showing an easy and reproducible feature among surgeons with safe outcomes. Conclusion: we consider that image inversion artifice is a simple and reproducible feature in robotic ventral hernia repair. Through a step-by-step guide, this report enables the creation of an artifice providing a comfortable operative field and allowing the surgeon to achieve its best proficiency in hernia surgery.

RESUMO Introdução: as qualidades da cirurgia robótica em diversos campos da cirurgia minimamente invasiva são notórias e, no cenário de hérnias abdominais, ela tem se mostrado capaz de superar as limitações da laparoscopia facilitando a dissecção, o fechamento do defeito herniário e o posicionamento da tela. O número de abordagens robóticas cresceu exponencialmente e casos ainda mais complexos e inicialmente inadequados tornaram-se recentemente elegíveis para uma cirurgia menos invasiva. A reconstrução adequada da linha alba e livre de tensão ainda é uma grande preocupação na cirurgia de hérnia e, mesmo com a plataforma robótica, dissecar e suturar na parede abdominal anterior pode ser um desafio. Este artigo relata um artifício técnico com inversão de imagem durante a correção de hérnia ventral robótica com a plataforma Da vinci Xi, permitindo ao cirurgião estabelecer uma maneira mais familiar e ergonômica de realizar dissecção e sutura na parede abdominal anterior. Nota Técnica: uma técnica guiada passo a passo com artifício de inversão de imagem é descrita usando comandos e figuras detalhadas para garantir campo cirúrgico ideal e melhor ergonomia ao cirurgião sempre que atuar na correção de hérnias ventrais robóticas com a plataforma Da vinci Xi. Nossa breve experiência de grupo também é relatada, mostrando-se uma técnica fácil e reprodutível entre cirurgiões com resultados seguros. Conclusão: consideramos que o artifício de inversão de imagens é uma característica simples e reprodutível na correção de hérnia ventral robótica. Por meio de um guia passo a passo, este artigo detalha a criação de um artifício técnico que proporciona um campo operatório confortável ao cirurgião atingindo sua melhor proficiência em cirurgia de hérnia.

Not all perceptual difficulties lower memory predictions: Testing the perceptual fluency hypothesis with rotated and inverted object images.

Studies typically show that perceptual difficulties at the time of encoding lower memory predictions. One potential exception to this is the inverted-word manipulation, in which participants produce equivalent memory predictions for upright and inverted words, despite higher free-recall performance for the inverted words (Sungkhasettee, Friedman, & Castel in Psychonomic Bulletin & Review, 18, 973-978, 2011). In the present set of experiments, we aimed to investigate the contributions of online perceptual difficulties versus a priori beliefs through two disfluency manipulations conceptually similar to the inverted-word manipulation: inversion and canonicity. The inversion manipulation involved presentation of upright and inverted object images, whereas the canonicity manipulation involved presentation of objects to participants from frequent (canonical) or infrequent (noncanonical) viewing perspectives. Memory predictions were made either on an item-by-item basis or aggregately. In all studies, the perceptual identification latencies for inverted and noncanonical items were slower than those for upright and canonical items, respectively. In experiments conducted with item-by-item memory predictions, predictions were not significantly different from each other across encoding conditions. In contrast, in experiments using aggregate memory predictions, fluent items produced higher memory predictions than did disfluent items. These results show that in certain cases, participants may not consider online objective perceptual difficulties. Moreover, item-by-item and aggregate memory predictions produce different patterns, evidence of a dissociation between the two types of predictions. The results are discussed in light of theories that rely on objective perceptual fluency differences across encoding conditions versus theories that rely on participants' a priori beliefs about fluency.

Adaptive image inversion of contrast 3D echocardiography for enabling automated analysis.

INTRODUCTION: Contrast 3D echocardiography (C3DE) is commonly used to enhance the visual quality of ultrasound images in comparison with non-contrast 3D echocardiography (3DE). Although the image quality in C3DE is perceived to be improved for visual analysis, however it actually deteriorates for the purpose of automatic or semi-automatic analysis due to higher speckle noise and intensity inhomogeneity. Therefore, the LV endocardial feature extraction and segmentation from the C3DE images remains a challenging problem. METHODS: To address this challenge, this work proposes an adaptive pre-processing method to invert the appearance of C3DE image. The image inversion is based on an image intensity threshold value which is automatically estimated through image histogram analysis. RESULTS: In the inverted appearance, the LV cavity appears dark while the myocardium appears bright thus making it similar in appearance to a 3DE image. Moreover, the resulting inverted image has high contrast and low noise appearance, yielding strong LV endocardium boundary and facilitating feature extraction for segmentation. CONCLUSIONS: Our results demonstrate that the inverse appearance of contrast image enables the subsequent LV segmentation.