Molecular medicine is undergoing fundamental changes driving the whole area towards a revolution in modern medicine. The breakthrough was generated the fast-developing technologies in molecular biology since the first draft sequence of the human genome was published. The technological advances enabled the analysis of biological samples from cells and organs to whole organisms in a depth that was not possible before. These technologies are increasingly implemented in the medical and health care system to study diseases and refine diagnostics. As a consequence, the understanding of diseases and the health status of an individual patient is now based on an enormous amount of data that can only be interpreted in the context of the body as a whole. Systems biology as a new field in the life sciences develops new approaches for data integration and interpretation. Systems medicine as a specialized aspect of systems biology combines in an interdisciplinary approach all expertise necessary to decipher the human body in all its complexity. This created new challenges in the area of information and communication technologies to provide the infrastructure and technology needed to cope with the data flood that will accompany the next generation of medicine. The new initiative 'IT Future of Medicine' aims at driving this development even further and integrates not only molecular data (especially genomic information), but also anatomical, physiological, environmental, and lifestyle data in a predictive model approach-the 'virtual patient'-that will allow the clinician or the general practitioner to predict and anticipate the optimal treatment for the individual patient. The application of the virtual patient model will allow truly personalized medicine.

https://www.springer.com/cda/content/document/cda_downloaddocument/9783642376900-c2.pdf?SGWID=0-0-45-1404784-p175092523

Future of medicine: models in predictive diagnostics and personalized medicine.

Human infants are born neurologically immature, potentially owing to conflicting selection pressures between bipedal locomotion and encephalization as suggested by the obstetrical dilemma hypothesis. Australopithecines are ideal for investigating this trade-off, having a bipedally adapted pelvis, yet relatively small brains. Our finite-element birth simulations indicate that rotational birth cannot be inferred from bony morphology alone. Based on a range of pelvic reconstructions and fetal head sizes, our simulations further imply that australopithecines, like humans, gave birth to immature, secondary altricial newborns with head sizes smaller than those predicted for non-human primates of the same body size especially when soft tissue thickness is adequately approximated. We conclude that australopithecines required cooperative breeding to care for their secondary altricial infants. These prerequisites for advanced cognitive development therefore seem to have been corollary to skeletal adaptations for bipedal locomotion that preceded the appearance of the genus Homo and the increase in encephalization. 

/pdf/dynamic-finite-element-simulations-reveal-early-origin-of-1utdo1x9.pdf

Dynamic finite-element simulations reveal early origin of complex human birth pattern

To describe the observable MRI changes in the urogenital sinus during the second stage of labor and delivery by comparing the changes in the positions of the anatomical structures of the maternal perineum using MRI-based vector 3-D models. Seven pregnant women underwent 3-D MRI sequences using a Philips 1 T Panorama open MRI during the pre-labor period and during the second stage of labor. A 3-D vector reconstruction platform (BABYPROGRESS, France) enabled the transformation of volumes of 2-D images into finite element meshes. The polygonal meshes labeled with the principal components of the urogenital sinus were used as part of a biomechanical study of the pressure exerted on the perineum during fetal descent. The expansion of the urogenital sinus was observed in all patients. Qualitative stretching was observed toward the rear and bottom of the iliococcygeus, pubococcygeus, puborectalis and obturator internus muscles. Significant length differences were measured along the iliococcygeus and pubococcygeus muscles but not along the tendinous arch of the levator ani or the puborectalis muscle. The inversion of the levator ani muscle curvature was accompanied by the transmission of pressure generated during fetal descent to the pubic muscle insertions and the descent of the tendinous arch of the levator ani. Mechanical pressures responsible for the tensioning of the constituent muscles of the urogenital sinus were qualitatively identified during the second stage of labor. MRI-based vector 3-D models allow the quantitative assessment of levator ani muscle stretching during labor, but 2-D MRI is not sufficient for describing perineal expansion. Vector 3-D models from larger scale studies have the potential to aid in the calibration of a realistic simulation based on the consideration of the reaction of each muscular element. These models offer perspectives to enhance our knowledge regarding perineal expansion during childbirth as a risk factor for postpartum perineal defects.

Comparative anatomy on 3-D MRI of the urogenital sinus and the periurethral area before and during the second stage of labor during childbirth.

Background Childbirth is a physiological process with significant medical risk, given that neurological impairment due to the birthing process can occur at any time. Improvements in risk assessment and anticipatory interventions are constantly needed; however, the birthing process is difficult to assess using simple imaging technology because the maternal bony pelvis and fetal skeleton interfere with visualizing the soft tissues. Magnetic resonance imaging (MRI) is a noninvasive technique with no ionizing radiation that can monitor the biomechanics of the birthing process. However, the effective use of this modality requires teamwork and the implementation of the appropriate safeguards to achieve appropriate safety levels. Objective This study describes a clinically effective and safe method to perform real-time MRI during the birthing process. We reported the experience of our team as part of the IMAGINAITRE study protocol (France), which aimed to better understand the biomechanics of childbirth. Methods A total of 27 pregnant women were examined with 3D MRI sequences before going into labor using a 1-Tesla open-field MRI. Of these 27 patients, 7 (26%) subsequently had another set of 3D MRI sequences during the second stage of labor. Volumes of 2D images were transformed into finite element 3D reconstructions. Polygonal meshes for each part of the fetal body were used to study fetal head moldability and brain compression. Results All 7 observed babies showed a sugarloaf skull deformity and brain compression at the middle strait. The fetus showing the greatest degree of molding and brain shape deformation weighed 4525 g and was born spontaneously but also presented with a low Apgar score. In this case, observable brain shape deformation demonstrated that brain compression had occurred, and it was not necessarily well tolerated by the fetus. Depending on fetal head moldability, these observations suggest that cephalopelvic disproportion can result in either obstructed labor or major fetal head molding with brain compression. Conclusions This study suggests the presence of skull moldability as a confounding factor explaining why MRI, even with the best precision to measure radiological landmarks, fails to accurately predict the modality of childbirth. This introduces the fetal head compliance criterion as a way to better understand cephalopelvic disproportion mechanisms in obstetrics. MRI might be the best imaging technology by which to explore all combined aspects of cephalopelvic disproportion and achieve a better understanding of the underlying mechanisms of fetal head molding and moldability. 

Using Magnetic Resonance Imaging During Childbirth to Demonstrate Fetal Head Moldability and Brain Compression: Prospective Cohort Study

Abstract Reducing failed labor and emergency cesarean section (CS) rates is an important goal. A childbirth simulation tool (PREDIBIRTH software and SIM37 platform) that evaluates a 5-min magnetic resonance imaging (MRI) assessment performed at 37 weeks of gestation was developed to enhance the consulting obstetrician’s ability to predict the optimal delivery mode. We aimed to determine the potential value of this childbirth simulation tool in facilitating the selection of an optimal delivery mode for both mother and infant. A retrospective cohort study was performed on all patients referred by their obstetricians to our level 2 maternity radiology department between December 15, 2015 and November 15, 2016, to undergo MRI pelvimetry at approximately 37 weeks of gestation. The childbirth simulation software was employed to predict the optimal delivery mode based on the assessment of cephalopelvic disproportion. The prediction was compared with the actual outcome for each case. Including childbirth simulations in the decision-making process had the potential to reduce emergency CSs, inappropriately scheduled CSs, and instrumental vaginal deliveries by up to 30.1%, 20.7%, and 20.0%, respectively. Although the use of the simulation tool might not have affected the overall CS rate, consideration of predicted birthing outcomes has the potential to improve the allocation between scheduled CS and trial of labor. The routine use of childbirth simulation software as a clinical support tool when choosing the optimal delivery mode for singleton pregnancies with a cephalic presentation could reduce the number of emergency CSs, insufficiently justified CSs, and instrumental deliveries. 

/pdf/childbirth-simulation-to-assess-cephalopelvic-disproportion-22rhs6fo.pdf

Childbirth simulation to assess cephalopelvic disproportion and chances for failed labor in a French population

Routine daily practice shows that successful vaginal delivery for women with suspected narrow pelvis or large fetus remains possible. We present a computer software for the detection of fetopelvic disproportion based on 3D vectorial reconstructions of the fetal head and maternal pelvis with simulation of head passage through the pelvis for collision detection. Three delivery simulations were generated from MR pelvimetry data in two patients, one with narrow pelvis and the other with macrosomic fetus. Based on the simulation, fetus size in both cases was appropriate for the pelvic size, but delivery simulation for the macrosomic fetus concluded that vaginal delivery was mechanically impossible. Further evaluation of this promising software on a larger patient population is necessary.

Détection des disproportions fœtopelviennes par réalité virtuelle : étude de faisabilité à propos de trois cas

a reconstruction tridimensionnelle (3D) a partir d’imagerie par resonance magnetique nucleaire (IRM) (1) d’echographie (2) ou de scanner (3) peut etre obtenue par technique en nuage de points, encore appelee « volume rendering » par les anglo-saxons, ou bien par une technique dite vectorielle qui necessite l’elaboration d’un maillage polygonal de type « fil de fer » moulant la surface des structures (4, 5). Cette derniere technique permet d’effectuer des evaluations volumiques precises, de realiser des comparaisons dynamiques, d’appliquer des deformations et d’animer les objets tridimensionnels. Un certain nombre de proprietes physiques et mecaniques peuvent egalement etre conferees a ces objets 3D, en vue d’une simulation en realite virtuelle a partir des donnees reelles des patients. Les techniques d’animation sont bien connues du monde informatique, et peuvent desormais servir a des applications medicales concretes. Nous presentons une technique d’animation fœtale a partir de reconstruction 3D vectorielle de patientes reelles, qui pourrait servir a la mise au point d’une serie d’outils de simulation d’accouchement pour la detection en routine des dystocies mecaniques.

Animation vectorielle tridimensionnelle d’un fœtus à partir d’imagerie par résonance magnétique pour simulation d’accouchement

Iconography : génito-urinaire - Animation vectorielle tridimensionnelle d’un fœtus à partir d’imagerie par résonance magnétique pour simulation d’accouchement

génito-urinaire - Animation vectorielle tridimensionnelle d’un fœtus à partir d’imagerie par résonance magnétique pour simulation d’accouchement

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Détection des disproportions fœtopelviennes par réalité virtuelle : étude de faisabilité à propos de trois cas

Animation vectorielle tridimensionnelle d’un fœtus à partir d’imagerie par résonance magnétique pour simulation d’accouchement

Iconography : génito-urinaire - Animation vectorielle tridimensionnelle d’un fœtus à partir d’imagerie par résonance magnétique pour simulation d’accouchement

génito-urinaire - Animation vectorielle tridimensionnelle d’un fœtus à partir d’imagerie par résonance magnétique pour simulation d’accouchement