Preoperative planning of Cam-type femoroacetabular impingement using spherical fitting technique in CT three-dimensional reconstruction / 中华骨科杂志

Objective:To explore the feasibility and effect of applying spherical fitting technology in CT three-dimensional reconstruction in preoperative planning of the resection range of Cam-type femoral acetabular impingement (FAI).Methods:46 Cam-type FAI patients who underwent arthroscopic femoroplasty in the Department of Sports Medicine in the Third Affiliated Hospital of Southern Medical University from July 2020 to June 2022 were enrolled in the spherical fitting group, including 26 females and 20 males, with an average age of 38.4±15.2 years (range of 24-53 years). The preoperative planning was performed using spherical fitting technology in CT three-dimensional reconstruction. Another 42 Cam-type FAI patients who underwent arthroscopic femoroplasty from July 2018 to June 2020 were enrolled in the observation group, including 25 females and 17 males, with an average age of 43.6±18.4 years (range 24-61 years). The preoperative planning was performed using CT three-dimensional reconstruction observation method. This study evaluated the impact of femoroplasty planned by spherical fitting technique on patients' prognosis though comparing the differences of postoperative α angle, femoral head-neck offset ratio, modified Harris hip score (mHHS), and visual analog score (VAS) at 3, 6, 9, and 12 months between two groups.Results:The average follow-up time was 11.8±0.6 months in spherical fitting group and 11.3±0.8 months in observation group. There was no significant difference regarding α angle, femoral head-neck offset ratio, mHHS, and VAS between two groups preoperatively ( P>0.05). The mHHS in two groups increased gradually, while VAS decreased sequentially at 3, 6, 9, and 12 months postoperatively. The postoperative mHHS and VAS were significantly better than those before surgery ( P<0.05). The mHHS was 83.2±14.8 vs. 70.5±11.2 in spherical fitting group and observation group at the followup of 9 months with significant difference ( t=4.471, P=0.007). It was 85.7±13.3 vs. 73.2±12.5 at the followup of 12 months with significant difference ( t=4.596, P=0.008). No significant difference was found in α angle, femoral head-neck offset ratio or mHHS at 3 and 6 months postoperatively ( P>0.05), and no significant difference was found in VAS at 3, 6, 9, and 12 months postoperatively between two groups. Conclusion:The spherical fitting technology in CT three-dimensional reconstruction could assist surgeons with planning of the resection range of Cam deformity preoperatively, and achieve a smooth progress of arthroscopic femoroplasty intraoperatively; after short term follow-up, we found that patients who underwent femoroplasty using this technology achieved satisfactory outcomes.

Application of digital three-dimensional reconstruction in placenta accreta spectrum disorders / 中华围产医学杂志

Placenta accreta spectrum (PAS) disorders are one of the important causes of adverse pregnancy outcomes. Some studies reported that the limitations in commonly used auxiliary examination methods led to missed or misdiagnosis, resulting in adverse pregnancy outcomes. Digital three-dimensional (3D) reconstruction is the 3D graphical visualization constructed on the original data to illustrate the spatial relationship between structures, overcoming the limitations of two-dimensional images. As a novel auxiliary diagnostic tool, digital 3D reconstruction provides promising insights into the development of personalized precision medicine. This article reviews the research and application of ultrasound and MRI 3D reconstruction in the field of PAS.

Efficacy and safety of three-dimensional visualization technology in assisting ablation therapy for hepatocellular carcinoma： A Meta-analysis / 临床肝胆病杂志

ObjectiveTo systematically evaluate the efficacy and safety of three-dimensional visualization technology in assisting ablation therapy for hepatocellular carcinoma. MethodsThis study was conducted according to PRISMA guidelines， with a PROSPERO registration number of CRD42023488398. PubMed， Embase， Web of Science， the Cochrane Library， CNKI， Wanfang Data， VIP， and CBM were searched for Chinese and English articles on three-dimensional visualization technology in assisting ablation therapy for hepatocellular carcinoma published up to March 2023. After quality assessment and data extraction of the studies included， RevMan 5.4 software was used to perform the meta-analysis. ResultsA total of 11 studies were included， with 972 patients in total， among whom 447 underwent ablation assisted by three-dimensional visualization technology （3D group） and 525 underwent ablation assisted by traditional two-dimensional imaging technology （2D group）. The meta-analysis showed that compared with the 2D group， the 3D group had significantly higher success rate of first-time ablation treatment （odds ratio ［OR］=5.43， 95% confidence interval ［CI］： 2.64‍ ‍—‍ ‍11.18， P<0.001）， technical efficiency （OR=6.15， 95%CI： 3.23‍ ‍—‍ ‍11.70， P<0.001）， and complete ablation rate （OR=2.50， 95%CI： 1.08‍ ‍—‍ ‍5.78， P=0.03）， as well as significantly lower incidence rate of major complications （OR=0.45， 95%CI： 0.24‍ ‍—‍ ‍0.87， P=0.02）， local recurrence rate （OR=0.35， 95%CI： 0.17‍ ‍—‍ ‍0.72， P=0.004）， and local tumor progression rate （OR=0.29， 95%CI： 0.16‍ ‍—‍ ‍0.50， P<0.001）， while there was no significant difference in the incidence rate of mild complications between the two groups （P>0.05）. ConclusionThree-dimensional visualization technology is safe and feasible in assisting ablation therapy for hepatocellular carcinoma and can improve ablation rate and reduce the incidence rate of serious complications， local recurrence rate， and local tumor progression rate， thereby showing an important application value in clinical practice.

The value of CT three-dimensional reconstruction combined with serum carbohydrate antigen 19-9 and carcinoembryonic antigen detection in the diagnosis and resectability evaluation of hilar cholangiocarcinoma / 中国基层医药

Objective:To investigate the value of three-dimensional reconstruction combined with serum carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) detection in the diagnosis and resectability evaluation of hilar cholangiocarcinoma (HCCA) before resectable lymph node metastasis.Methods:A total of 65 patients with suspected HCCA who were treated at Yiwu Central Hospital from June 2019 to June 2022 were included in the observation group. Thirty healthy people who concurrently underwent physical examinations in the same hospital were included in the control group. All participants underwent a CT three-dimensional reconstruction examination. Simultaneously, the automatic electrochemiluminescence immunoassay analyzer was used to measure serum levels of CA19-9 and CEA. The outcomes of percutaneous transhepatic cholangiography were used as the "gold standard". The consistency between CT three-dimensional reconstruction, CA19-9 detection, and CEA detection, either individually or combined, and the "gold standard" in the diagnosis of HCCA was evaluated.Results:Serum levels of CA19-9 and CEA in the observation group were (62.71 ± 10.63) U/mL and (62.71 ± 10.63) ng/mL, respectively, which were significantly higher than those in the control group [(12.37 ± 7.39) U/mL, (1.31 ± 0.97) ng/mL, t = 23.43, 11.59, both P < 0.05). The levels of CA19-9 [(71.69 ± 12.37) U/mL] and CEA [(8.89 ± 3.51) ng/mL] in patients with HCCA who had lymph node metastasis were significantly higher than those in patients with HCCA who had no lymph node metastasis [CA19-9 (56.78 ± 10.16) U/mL, CEA (6.45 ± 2.11) ng/mL, t = 4.14, 2.76, both P < 0.05].Compared with histopathological examination, the accuracy of CT three-dimensional reconstruction in typing was 85.00%. According to the "gold standard" diagnosis, CT three-dimensional reconstruction, CA19-9 detection, and CEA detection, alone and their combination, successfully detected HCCA in 22 cases (55.00%), 26 cases (65.00%), 31 cases (77.50%), and 38 cases (95.00%), respectively. The detection rate of HCCA was the highest when CT three-dimensional reconstruction, CA19-9 detection, and CEA detection were combined, and the difference was statistically significant ( χ2 = 18.15, P < 0.05). Compared with CT three-dimensional reconstruction (AUC: 0.808), CA19-9 detection (AUC: 0.721), and CEA detection (AUC: 0.703) individually, their combination (AUC: 0.913) had the highest value in the diagnosis of HCCA (all P < 0.05). Conclusion:CT three-dimensional reconstruction, CA19-9 detection, and CEA detection have a certain diagnostic value for HCCA, but the combination of CT three-dimensional reconstruction with the detection of serum levels of CA19-9 and CEA has a higher diagnostic value for HCCA, providing an effective reference for the preoperative evaluation of the resectability of HCCA in the clinic.

The diagnostic value of transvaginal two-dimensional ultrasound and three-dimensional ultrasound volume imaging technology for intrauterine adhesions / 中国医师杂志

Objective:To analyze the diagnostic value of transvaginal two-dimensional ultrasound and three-dimensional ultrasound volume imaging (3DVI) technology for intrauterine adhesions.Methods:A total of 120 suspected patients with intrauterine adhesions admitted to Beijing Tongzhou District Maternal and Child Health Hospital from July 2022 to June 2023 were selected as the research subjects. All patients underwent transvaginal two-dimensional ultrasound and 3DVI technology examination, and the diagnostic value of vaginal two-dimensional ultrasound and 3DVI technology single examination and combined examination was compared based on the results of hysteroscopy examination as the gold standard; Comparison of ultrasound parameters between the intrauterine adhesions group and the non intrauterine adhesions group, as well as patients with different degrees of intrauterine adhesions [endometrial thickness (ED), endometrial volume (EV), vascular index (VI), blood flow index (FI), vascular comprehensive index (VFI)].Results:Among 120 suspected patients with intrauterine adhesions, 104 cases were positive in hysteroscopy examination, with a positive rate of 86.67%. Among them, 50 cases were mild, 36 cases were moderate, and 18 cases were severe. 76 cases were positive in vaginal two-dimensional ultrasound examination, with a positive rate of 63.33%; 79 cases were positive for 3DVI technology examination, with a positive rate of 65.83%; The combined examination results of vaginal two-dimensional ultrasound and 3DVI technology were positive in 87 cases, with a positive rate of 72.50%. The sensitivity, specificity, positive predictive value, and negative predictive value of vaginal two-dimensional ultrasound examination were 68.27%, 68.75%, 93.42%, and 25.00%, respectively. The 3DVI technique examination was 73.08%, 81.25%, 96.20%, and 31.71%, respectively. The combined examination was 83.65%, 100.00%, 100.00%, and 48.48%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of the combined examination were all higher than those of vaginal two-dimensional ultrasound examination (all P<0.05). 104 cases in the intrauterine adhesions group and 16 cases in the non intrauterine adhesions group; The ED, EV, VI, FI, and VFI of the intrauterine adhesions group were lower than those of the non intrauterine adhesions group (all P<0.05). The differences in ED, EV, and VI among patients with different degrees of intrauterine adhesions were statistically significant (all P<0.05); The ED, EV, and VI in the moderate group were lower than those in the mild group (all P<0.05), while the ED, EV, and VI in the severe group were lower than those in the mild and moderate groups (all P<0.05), and the FI was lower than those in the mild group ( P<0.05). Conclusions:Transvaginal two-dimensional ultrasound combined with 3DVI technology has high diagnostic value for intrauterine adhesions and can be used to evaluate the degree of intrauterine adhesions.

O uso do planejamento virtual na cirurgia ortognática / The use of virtual planning in orthognathic surgery

Introdução: A cirurgia ortognática envolve manipulação da arquitetura óssea facial, através de osteotomias, para restaurar a forma e a função, corrigindo a má oclusão, as desproporções maxilomandibulares e assimetrias faciais. O planejamento virtual em cirurgia ortognática é realizado com ajuda de softwares que utilizam as medidas reais do esqueleto craniofacial e registros da oclusão do paciente, através de uma análise 3D. Método: Foram avaliados 18 pacientes com deformidades dentofaciais, de acordo com a classificação de Angle submetidos a cirurgia ortognática com o uso do planejamento virtual, entre 2018 e 2019. Os critérios de inclusão foram pacientes entre 16 e 60 anos com desproporções maxilo-mandibulares nas quais o tratamento ortodôntico isolado não era suficiente. Os critérios de exclusão foram a presença de lesões císticas ou tumorais nos maxilares e comorbidades clínicas que contraindicavam a cirurgia. O planejamento virtual foi realizado em todos os pacientes, utilizando o software Dolphin® Imaging 11 e os guias cirúrgicos confeccionados em impressora 3D. Resultados: O guia cirúrgico intermediário apresentou adaptação perfeita nas faces oclusais promovendo grande estabilidade para o reposicionamento e fixação da maxila na oclusão intermediária. Os 18 pacientes operados responderam como "totalmente satisfeitos" em relação ao resultado estético-funcional nessa série estudada. Foi encontrada uma semelhança muito grande da posição do esqueleto maxilofacial no planejamento virtual préoperatório e o obtido no pós-operatório, através da avaliação das telerradiografias. Conclusão: O planejamento virtual em cirurgia craniomaxilofacial possui inúmeras vantagens, como diminuição do tempo laboratorial pré-operatório, maior precisão na confecção dos guias cirúrgicos e melhor reprodutibilidade dos resultados simulados.

Introduction: Orthognathic surgery involves the manipulation of facial bone architecture through osteotomies to restore form and function, correcting malocclusion, maxillomandibular disproportions, and facial asymmetries. Virtual planning in orthognathic surgery is carried out with the help of software that uses real measurements of the craniofacial skeleton and records of the patient's occlusion through 3D analysis. Method: 18 patients with dentofacial deformities were evaluated, according to Angle's classification, who underwent orthognathic surgery using virtual planning between 2018 and 2019. The inclusion criteria were patients between 16 and 60 years old with maxylo-mandibular disproportions in which orthodontic treatment alone was not sufficient. Exclusion criteria were the presence of cystic or tumoral lesions in the jaw and clinical comorbidities that contraindicated surgery. Virtual planning was carried out on all patients, using Dolphin® Imaging 11 software and surgical guides made with a 3D printer. Results: The intermediate surgical guide presented perfect adaptation on the occlusal surfaces, promoting great stability for the repositioning and fixation of the maxilla in intermediate occlusion. The 18 operated patients responded as "completely satisfied" in relation to the aesthetic-functional result in this series studied. A very great similarity was found between the position of the maxillofacial skeleton in the preoperative virtual planning and that obtained post-operatively through the evaluation of teleradiography. Conclusion: Virtual planning in craniomaxillofacial surgery has numerous advantages, such as reduced pre-operative laboratory time, greater precision in the creation of surgical guides, and better reproducibility of simulated results.

Radiographic diagnosis of distal fibula avulsion fractures: Comparison of ankle X-ray and three-dimensional reconstruction of CT / 北京大学学报(医学版)

OBJECTIVE@#To investigate the difference in sensitivity between X-ray and three-dimensional reconstruction of computed tomography (3D-CT) for the diagnosis of distal fibular avulsion fracture, and the radiographic presentation of the ossicle.@*METHODS@#From January to October 2018, 92 patients with distal fibular avulsion fracture were visited for surgical treatment in Department of Sports Medicine, Peking University Third Hospital, and 60 cases were finally enrolled according to the inclusion and exclusion criteria. Intraoperative detection was regarded as the gold standard, and the diagnostic sensitivity of preoperative ankle X-ray and 3D-CT for the distal fibular avulsion fractures was statistically determined. The ossicle maximum diameter as well as the degree of its displacement were also measured. On 3D-CT, the distance from the ossicle center point to the anterior fibular tuberosity (a), the distance to the fibular tip (b), and the a/b value was used to present the ossicle displacement.@*RESULTS@#Among the 60 patients, 36 and the 52 patients were correctly detected by X-ray and 3D-CT, respectively, and the sensitivities was 60.0% and 86.7%, respectively (P=0.004). The mean diameter of the ossicle on X-ray and 3D-CT was (9.2±3.9) mm and (10.5±3.2) mm, respectively. The mean distance from the ossicle center to the anterior fibular tuberosity (a) was (17.5±3.6) mm and the mean distance to the fibular tip (b) was (17.4±4.8) mm, with mean a/b values of 1.1±0.7. The intraclass correlation coefficients (ICC) for each measurement ranged from 0.891-0.998 with a high degree of consistency.@*CONCLUSION@#Compared with X-ray, 3D-CT has higher sensitivity in diagnosing distal fibular avulsion fractures, can help clinicians evaluate ossicle's location and choose surgical methods, and is recommended to be performed in patients with suspected distal fibula avulsion fractures in clinical practice.

Automatic determination of mandibular landmarks based on three-dimensional mandibular average model / 北京大学学报(医学版)

OBJECTIVE@#To explore an efficient and automatic method for determining the anatomical landmarks of three-dimensional(3D) mandibular data, and to preliminarily evaluate the performance of the method.@*METHODS@#The CT data of 40 patients with normal craniofacial morphology were collected (among them, 30 cases were used to establish the 3D mandibular average model, and 10 cases were used as test datasets to validate the performance of this method in determining the mandibular landmarks), and the 3D mandibular data were reconstructed in Mimics software. Among the 40 cases of mandibular data after the 3D reconstruction, 30 cases that were more similar to the mean value of Chinese mandibular features were selected, and the size of the mandibular data of 30 cases was normalized based on the Procrustes analysis algorithm in MATLAB software. Then, in the Geomagic Wrap software, the 3D mandibular average shape model of the above 30 mandibular data was constructed. Through symmetry processing, curvature sampling, index marking and other processing procedures, a 3D mandible structured template with 18 996 semi-landmarks and 19 indexed mandibular anatomical landmarks were constructed. The open source non-rigid registration algorithm program Meshmonk was used to match the 3D mandible template constructed above with the tested patient's 3D mandible data through non-rigid deformation, and 19 anatomical landmark positions of the patient's 3D mandible data were obtained. The accuracy of the research method was evaluated by comparing the distance error of the landmarks manually marked by stomatological experts with the landmarks marked by the method of this research.@*RESULTS@#The method of this study was applied to the data of 10 patients with normal mandibular morphology. The average distance error of 19 landmarks was 1.42 mm, of which the minimum errors were the apex of the coracoid process [right: (1.01±0.44) mm; left: (0.56±0.14) mm] and maximum errors were the anterior edge of the lowest point of anterior ramus [right: (2.52±0.95) mm; left: (2.57±1.10) mm], the average distance error of the midline landmarks was (1.15±0.60) mm, and the average distance error of the bilateral landmarks was (1.51±0.67) mm.@*CONCLUSION@#The automatic determination method of 3D mandibular anatomical landmarks based on 3D mandibular average shape model and non-rigid registration algorithm established in this study can effectively improve the efficiency of automatic labeling of 3D mandibular data features. The automatic determination of anatomical landmarks can basically meet the needs of oral clinical applications, and the labeling effect of deformed mandible data needs to be further tested.

Advances in the application of three-dimensional visualization technique in hepatic alveolar echinococcosis / 临床肝胆病杂志

Hepatic alveolar echinococcosis (HAE) is a parasitic disease caused by Echinococcus multilocularis infection and has wide distribution and great harm in China. At present, ultrasound, CT, and MRI are the main radiological examination methods for HAE, with certain limitations in preoperative diagnosis and evaluation. This article introduces the guiding effect of three-dimensional visualization technique and its derivative technologies in the accurate diagnosis and preoperative evaluation of HAE, so as to provide help for the clinical diagnosis and treatment of HAE in the future.

Application of 3D-slicer software to measure renal volume parameters in evaluating renal function of renal transplant donors / 国际外科学杂志

Objective:To explore the application value of 3D-slicer software in measuring renal volume parameters of renal transplant donors in evaluating renal function.Methods:The data of 31 renal donors admitted to Beijing Friendship Hospital, Capital Medical University from October 2019 to September 2022 were retrospectively analyzed. Glomerular filtration rate (GFR) were measured by SPECT radioactive dynamic imaging, and renal cortex volume (RCV), renal parenchymal volume (RPV) were measured after 3D reconstruction of urinary enhanced CT based on 3D slicer software. The estimated GFR(eGFR) predicted by creatinine-based GFR estimation equations (C-G equation, modified and simplified MDRD equation) and volume-based GFR estimation equations (Herts equation, Choi equation). Different eGFR were calculated, and the correlation between kidney volume parameters, eGFR equations and measured GFR was analyzed. The deviation, accuracy and consistency between different equations eGFR and measured GFR were analyzed and compared. The measurement data of normal distribution were expressed as mean±standard deviation ( ± s), and t-test was used for inter-group comparison. Measurement data with non-normal distribution were represented by M( Q1, Q3), and non-parametric test was used for comparison between groups. Results:The correlation between different eGFR and measured GFR is poor, and the deviation is small, and with good accuracy and consistency. Except for the weak correlation between the Choi equation eGFR and measured GFR ( r=0.382, P=0.034), there was no significant correlation between eGFR by other equations and measured GFR ( P>0.05). Among them, the deviation between the Herts equation-eGFR and measured GFR was the smallest (0.30 mL·min -1·1.73 m -2), with a 10% coincidence rate (61.29%) and a 30% coincidence rate (96.77%), and the best consistency with measured GFR, with a consistency limit of -28.75 to 29.34 mL·min -1·1.73 m -2. Conclusion:Compared with the laboratory index formula method, the Herts equation has better prediction efficiency in estimating GFR, The measurement of renal volume parameters by 3D slicer software has a certain clinical value in evaluating the renal function of renal donors, which is worthy of further application.

Femoral dense insertion of the anterior cruciate ligament with relation to femoral tunnel placement: a 3-D magnetic resonance imaging study / 中华创伤骨科杂志

Objective:To characterize the femoral dense insertion (FDI) of the anterior cruciate ligament (ACL) using 3D magnetic resonance imaging (MRI) so as to guide the femoral tunnel placement in ACL reconstruction.Methods:The 3D MRI data of the contralateral healthy knees were collected from 20 young and middle-aged patients who had been followed up for 2 years at the Department of Sports Medicine, Peking University Third Hospital from June to October 2019 after ACL reconstruction. There were 10 males and 10 females with an age of (34.5±7.8) years. The 3D models of FDI of ACL, as well as of the lateral femoral condyle and its cartilage were reconstructed using Mimics 15.01. The heights and front and rear positions of anteromedial (AM) bundle, center, and posterolateral (PL) bundle of FDI were measured with reference to the apex of deep cartilage (ADC), the deep cortical border of the lateral condyle, and the shallow and inferior cartilage margins.Results:In 3D MRI models, dense fibers of ACL femoral insertion were near the shallow and inferior cartilage margins to the shallow side, and extended obliquely deep and superior toward the over-the-top (OTP) in a band-like shape. The oblique angle was 12.5°. The AM bundle, FDI center, and PL bundle were all higher than ADC, being (4.5±0.7) mm, (3.5±0.8) mm and (2.2±0.6) mm away from ADC, respectively. The median distances to the deep cortical border of the lateral condyle and the shallow cartilage margin were (6.9±1.2) mm and (16.4±1.8) mm for the AM bundle, (11.0±1.4) and (12.1±1.6) mm for the FDI center, and (14.9±1.8) mm and (8.0±1.3) mm for the PL bundle.Conclusions:Dense fibers of ACL femoral insertion are near the shallow and inferior cartilage margin to the shallow side, and extend obliquely deep and superior toward the OTP in a band-like shape. As the height and depth measurements of the FDI in 3D MRI models supplement to the anatomy of ACL femoral insertion, they could be used to guide femoral tunnel placement in ACL reconstruction.

Progress of thoracoscopic segmentectomy with three-dimensional CT bronchography and angiography for treatment of stage T 1a-1bN 0M 0 non-small cell lung cancer / 肿瘤研究与临床

Lung cancer is currently the malignant tumor with the highest morbidity and mortality in the world, thoracoscopic segmentectomy is one of the main surgical procedures for the treatment of early stage non-small cell lung cancer (NSCLC). In recent years, three-dimensional computed tomography bronchography and angiography (3D-CTBA) technology has developed rapidly with advantages of stereoscopic presentation of lung anatomy, accurate localization of lung lesions and design of surgical safety margin model, it provides a reliable method for thoracoscopic segmentectomy. This article reviews the current applications of 3D-CTBA in thoracoscopic segmentectomy for stage T 1a-1bN 0M 0 NSCLC.

Three-dimensional speckle tracking for subclinical left ventricular systolic dysfunction in patients with type 2 diabetes mellitus and hyperlipidemia / 中国基层医药

Objective:To investigate the difference in left ventricular dysfunction between type 2 diabetes mellitus (T2DM) patients with hyperlipidemia and those without hyperlipidemia, and analyze the application value of three-dimensional speckle tracking technology.Methods:The clinical data of 70 patients with T2DM admitted to Heji Hospital Affiliated to Changzhi Medical College from January 2020 to June 2021 were retrospectively analyzed. Among these patients, 35 patients had hyperlipidemia and 35 patients had no hyperlipidemia. At the same time, 40 healthy subjects who concurrently underwent health checkups in the same hospital were included as healthy controls. All subjects underwent routine cardiac ultrasound and 3D-STE examinations. General clinical information and left ventricular function-related parameters, including global longitudinal strain, global circumferential strain, global area strain, and global radial strain were compared between healthy controls and T2DM patients with hyperlipidemia and those without hyperlipidemia.Results:The proportion of left ventricular remodeling increased in T2DM patients without hyperlipidemia, and the proportion of left ventricular hypertrophy was the highest in T2DM patients with hyperlipidemia. Global longitudinal strain and global circumferential strain in T2DM patients without hyperlipidemia were (-16.97 ± 2.59)% and (-17.41 ± 2.50)%, respectively, which were significantly higher than (-18.86 ± 2.46)% and (-18.71 ± 2.92)% in healthy controls ( t = 0.95, 0.57, both P < 0.05). Global longitudinal strain, global circumferential strain, and global area strain in T2DM patients with hyperlipidemia were (-14.98 ± 3.15)%, (-15.80 ± 3.16)%, (-27.17 ± 4.54)%, respectively, which were significantly higher than (-18.86 ± 2.46)%, (-18.71 ± 2.92)%, (-30.62 ± 4.02)% in healthy controls ( t = 0.46, 1.37, 0.98, all P < 0.05) and (-16.97 ± 2.59)%, (-17.41 ± 2.50)%, (-30.06 ± 3.59)% in T2DM patients without hyperlipidemia ( t = 0.37, 1.02, 0.77, all P < 0.05). Global radial strain in T2DM patients with hyperlipidemia was significantly higher than [(51.49 ± 8.94)%, t = 1.35, P < 0.05] in healthy controls and [(47.71± 8.46)%, t = 0.98, P < 0.05] in T2DM patients without hyperlipidemia. In patients with T2DM, fasting blood glucose and hyperlipidemia were independently correlated with all strain-related parameters. Conclusion:Hyperlipidemia can aggravate left ventricular remodeling and dysfunction in patients with T2DM and 3D-STE is one of the examination methods for subclinical left ventricular remodeling and dysfunction in T2DM patients with or without hyperlipidemia.

Open reduction and internal fixation assisted by computer virtual surgery in the treatment of complex proximal humeral fracture / 中华创伤杂志

Objective:To investigate the effect of open reduction and internal fixation assisted by computer virtual surgery in the treatment of complex proximal humeral fracture.Methods:A retrospective case series study was performed on clinical data of 36 patients with complex proximal humeral fracture admitted to Dongfang Hospital Affiliated to Tongji University from January 2018 to June 2020. There were 13 males and 23 females, aged 22-86 years [(56.4±4.8)years]. They were all closed fractures. According to Neer classification, there were 20 patients with three-part fractures and 16 with four-part fractures. Precise pre-surgical designs made by using the digital orthopedic surgery planning system of the E-3D were applied to assist the implementation of precise fracture reduction and internal fixation with the locking plate. The fracture healing was observed. The effect of the real surgery assisted by the virtual surgical designs was assessed by comparing the humeral neck shaft angle and humeral head height measured at the virtual surgery and at day 1 after the real surgery. The humeral neck shaft angle, humeral head height, shoulder range of motion (abduction, external rotation and forward flexion), Constant shoulder function score and visual analogue score (VAS) were recorded at 1 day, 3 months and 12 months after the real surgery. The stability of the medial column was assessed at 1 day after the real surgery. The complications were recorded.Results:All patients were followed up for 12-38 months [(18.5±1.8)months]. The fracture showed bony union in all patients with the union time of 6.6-17.2 weeks [(10.2±1.0)weeks]. The humeral neck shaft angle and humeral head height showed no significant differences measured at the virtual surgery and at 1 day after the real surgery, and were also not significant different at 1 day, 3 months and 12 months after the real surgery (all P>0.05). At 3 months and 12 months after the real surgery, the shoulder abduction [(119.4±11.8)°, (155.3±13.7)°], external rotation [(37.6±6.3)°, (46.8±7.4)°], forward flexion [ (94.8±10.2)°, (126.9±1.6)°] and Constant function score [(66.8±8.4)points, (82.4±9.6)points] were all higher than those at 1 day after the real surgery [(53.8±4.5)°, (21.6±3.3)°, (44.6±7.8)°, (34.3±6.1)points], while the VAS [(4.1±0.5)points, (1.2±0.2)points] was lower than that at 1 day after the real surgery [(8.3±1.4)points] (all P<0.05). The medial column was stable in 34 patients and unstable in 2 at 1 day after the real surgery. Complications included screw cutting out in the articular surface in 1 patient and humeral head necrosis in 1. Conclusion:Treatment of complex proximal humeral fractures with open reduction and internal fixation assisted by computer virtual surgery is conducive to maintaining reduction effect, promoting shoulder joint function, relieving pain and reducing complications.

Application of preoperative three-dimensional reconstruction planning in total hip arthroplasty for development dysplasia of the hip secondary to osteoarthritis / 中华骨科杂志

Objective:To investigate the clinical efficacy of preoperative three-dimensional (3D) reconstruction planning in total hip arthroplasty for development dysplasia of the hip secondary to osteoarthritis.Methods:A total of 80 patients with osteoarthritis secondary to Crowe I-III developmental dysplasia of the hip who underwent primary unilateral total hip arthroplasty from October 2019 to March 2021 were retrospectively analyzed, including 18 males and 62 females and the mean age was 55.7±10.4 years (range 41-72 years). Forty patients in the 3D group, the prosthesis type and installation angle were planed on the 3D reconstruction software based on the full-length CT scan data of the lower limbs, and the length difference of the lower limbs and hip offset were calculated. Forty patients in the control group underwent preoperative planning using conventional film measurement, and lower limb length was judged based on the preoperative measurement data and intraoperative comparison of both lower limbs. The difference of postoperative leg length, hip offset, hip function score, operating time, intraoperative blood loss, and incidence of complications were compared between the two groups.Results:All 80 patients completed the surgery successfully and the follow-up time was up to 3 months after operation. The 3D group was better than the control group in operation time (70.9±7.7 min vs. 81.6±13.3 min, t=-4.91, P<0.001), the difference of postoperative lower limb length (2.78±1.31 cm vs. 5.35±2.15 cm, t=-5.74, P<0.001), and hip function score at 1 week after operation (75.67±3.35 vs. 67.35±4.21, t=12.33, P=0.002), with statistically significant differences. In the 3D group, 95% of acetabular prosthesis and 90% of femoral stem components were consistent with the planned model, while the rate were only 75% and 68% in the control group, and the difference was statistically significant (χ 2=7.51, P=0.023; χ 2=14.92, P=0.005). There were no intraoperative complications such as vascular and nerve injury, and no postoperative complications such as dislocation or periprosthetic infection in all 80 patients. Conclusion:3D preoperative planning assisted total hip arthroplasty in the treatment of Crowe I-III developmental dysplasia of the hip secondary to osteoarthritis can improve the accuracy of the operation, and has a good clinical effect on restoring the leg length and hip offset.

Characteristics of anorectal motility in elderly patients with functional defecation disorders / 中华老年医学杂志

Objective:To investigate the characteristics of anorectal dynamics in elderly patients with functional defecation disorders(FDD), and to provide a basis for their diagnosis, treatment and prevention.Methods:In this retrospective study, 226 patients with FDD receiving 3D high-resolution anorectal manometry were divided into an elderly group(93 cases)and a non-elderly group(133 cases). Results from anorectal manometry parameters were compared and analysis of patterns of anorectal pressure changes in elderly participants based on sex, the Bristol stool classification and clinical symptoms was conducted.Results:The resting anal pressure, rectal pressure and anal relaxation rate were lower( t=-3.407, -2.051, Z=2.548, P=0.001, 0.040, 0.011)and the volume of first sensation was higher( t=1.998, P=0.047)in the elderly group than in the non-elderly group.The maximum anal squeezing pressure, residual anal pressure and maximum tolerated volume were higher( t=4.589, 4.730, 2.025, all P<0.05), whereas the anal relaxation rate and anorectal pressure gradient were lower in elderly men than in elderly women( Z=4.059, t=-3.714, P<0.001 for both). Regarding the types of FDD, both the elderly group and the non-elderly group were dominated with type Ⅱ defecation disorder, with more men than women having type Ⅱ defecation disorder in the elderly group( χ2=10.343, P=0.001). In cases of paradoxical sphincter contraction during simulated defecation, the incidence in the elderly group was 80.65%(75/93), which was higher than 68.42%(91/133)in the non-elderly group( χ2=4.194, P=0.041). The volume of first sensation, volume of first defecation sensation, and maximum tolerated volume of patients in the elderly group without the urge to defecate were(59.86±23.84)ml, (96.76±34.61)ml, and(144.32±30.57)ml, respectively, higher than those of patients with the urge to defecate(46.79±17.20)ml, (75.26±28.75)ml, and(120.00±40.28)ml( t=-2.241, -2.493, -2.891, P=0.027, 0.014, 0.005). The rectal pressure(26.52±16.08)mmHg of patients with defecation dyssynergia was lower than that of patients without defecation dyssynergia(39.91±8.82)mmHg(1 mmHg=0.133 kPa)( t=-3.128, P=0.002), while the resting anal pressure of patients with defecation dyssynergia(90.60±28.44)mmHg was higher than that of patients without defecation dyssynergia(73.65±27.10)mmHg( t=-2.201, P=0.030). The resting anal pressure and maximum anal squeezing pressure in patients with anal blockage sensation[(87.11±24.64)mmHg, (149.28±48.29)mmHg]were higher than those in patients without anal blockage sensation[(72.43±20.02)mmHg, (121.76±26.35)mmHg]( t=2.954、3.066, P=0.004、0.003). There was no significant difference in values from parameters of anorectal dynamics between patients with different Bristol stool types, with and without incomplete defecation or with different degrees of abdominal distension(all P>0.05). Conclusions:Anorectal dynamics in patients with FDD are characterized by paradoxical anal sphincter movements, but older patients with FDD are mainly characterized by inadequate rectal propulsion, pelvic floor muscle dysfunction and reduced rectal sensitivity.

Application of three-dimensional imaging device to colonoscopy / 中华消化内镜杂志

Objective:To evaluate the application of three-dimensional (3D) imaging device to colonoscopy.Methods:A total of 60 patients who underwent painless colonoscopy in Beijing Friendship Hospital, Capital Medical University from November to December, 2019 were enrolled and divided into 2 groups according to random code. Each patient underwent colonoscopy twice, while 2D colonoscopy was used for cecal intubation. Thirty patients were assigned to the experimental group (primary withdrawal used 3D colonoscopy, and secondary withdrawal used 2D colonoscopy), and 30 others to the control group (primary withdrawal used 2D colonoscopy, and secondary withdrawal used 3D colonoscopy). The detection of polyps, the withdrawal time, operating experience, image quality and complication were evaluated in the two groups.Results:The polyp detection rate at the first colonoscopy in the experimental group was 77.3% (17/22), which was higher than 43.5% (10/23) in the control group ( χ2=5.351, P=0.021). Ten operators in the experimental group had dizziness, while the operators in the control group had no dizziness ( P=0.001). There were no significant differences between the two groups in the polyp diameter [0.50 (0.70) cm VS 0.30 (0.20) cm, U=57.000, P=0.170], withdrawal time (4.6±1.5 min VS 5.2±1.9 min, t=-1.189, P=0.239) or image quality (27 cases with 3 points in the identification of lesion nature, and 28 cases with 3 points in the identification of duct both in the two groups, P=1.000) at the first colonoscopy. No complication occurred in either group. Conclusion:Application of 3D imaging device is feasible for colonoscopic polyp detection, and it can be used in clinical practice.

Guiding role of three-dimensional simulation modeling technology in laparoscopic-assisted radical resection of rectal cancer / 国际外科学杂志

Objective:Three-dimensional simulation modeling technology was used to conduct three-dimensional reconstruction, classification and measurement for the anatomic structures of colorectal canal, tumor and key blood vessels in patients with rectal cancer before operation. And the accuracy of the data and information obtained for the prediction of anastomotic tension, important types of vascular variant, positioning of anatomical landmarks, etc. in laparoscopic-assisted radical resection of rectal cancer, and the guiding effect of operation was evaluated.Methods:The clinical data of 50 patients with laparoscopic-assisted radical resection of rectal cancer treated in the General Surgery Department, Beijing Ditan Hospital Capital Medical University from January 2019 to February 2021 were analyzed retrospectively, including 31 males and 19 females, aged from 42 to 83 years old, with an average age of (62.72 ±15.21) years. The patients were divided into two groups according to whether the patients underwent three-dimensional simulation reconstruction before operation. The patients who underwent abdomen pelvic enhancement CT and further three-dimensional reconstruction before surgery were taken as reconstruction group ( n=24), and the patients who were only routinely performed abdomen pelvic enhancement CT before operation were taken as control group ( n=26). For the patients in the reconstruction group, the CT images were modeled by Mimics software before operation, and the key data such as the length of colorectal and tumor, the correlation length of rigid structure of pelvic wall, the length of inferior mesenteric artery (IMA) from the bifurcation point of left and right arteria iliaca communis, the type and proportion of IMA variation, the length of left colonic artery (LCA) from the beginning of IMA and the distance between LCA and IMV were measured, and the consistency correlation coefficient (CCC) was analyzed with the actual data obtained during operation. And then the accuracy of three-dimensional simulation modeling technology for surgical guidance was evaluated. MedCalc 19.0 software was used for statistical analysis. Results:In the reconstruction group, regarding the data of each dimension of the model (intestinal tract, pelvic cavity, blood vessels) and the corresponding structural measurements during the operation, the consistent correlation coefficient (CCC) evaluation was more than 0.9. One case was predicted to have free splenic flexure of colon and one case actually had free splenic flexure of colon. The prediction accuracy was 100%. The IMA variants in the reconstruction group were divided into 4 types, all of which were verified by operation. Compared with the control group, the operation time ( P=0.011) and the location time (IMA, P=0.043; LCA, P=0.007; IMV, P=0.034) of each vessel in the reconstruction group were shorter, and the amount of intraoperative blood loss was less ( P=0.017). Conclusion:The application of three-dimensional simulation modeling technology before operation is helpful for the operator to accurately predict the intraoperative anastomotic tension, the type of IMA variation and the related diameter length, based on which the accurate operation plan can be made to guide the operation.

Surgical effects of rehabilitation protocols on dental arch occlusion of children with cleft lip and palate

Aim: to evaluate the surgical effects of two rehabilitation protocols on dental arch occlusion of 5-year-old children with or without cleft lip and palate. Methods: this is a retrospective longitudinal study the sample comprised 45 digitized dental casts divided into followed groups: Group 1 (G1) ­ children who underwent to cheiloplasty (Millard technique) at 3 months and to one-stage palatoplasty (von Langenbeck technique) at 12 months; Group 2 (G2) ­ children who underwent to cheiloplasty (Millard technique) and two-stage palatoplasty (Hans Pichler technique for hard palate closure) at 3 months and at 12 months to soft palate closure (Sommerlad technique); and Group 3 (G3) ­ children without craniofacial anomalies. Linear measurements, area, and occlusion were evaluated by stereophotogrammetry software. Shapiro-Wilk test was used to verify normality. ANOVA followed by posthoc Tukey test and Kruskal-Wallis followed by posthoc Dunn tests were used to compared groups. Results: For the measures intercanine distance (C-C'), anterior length of dental arch (I-CC'), and total length of the dental arch (I­MM'), there were statistical differences between G1x G3 and G2xG3, the mean was smaller for G1 and G2. No statistically significant differences occurred in the intermolar distance and in the dental arch area among groups. The occlusion analysis revealed significant difference in the comparison of the three groups (p=0.0004). Conclusion: The surgical effects of two rehabilitation protocols affected the occlusion and the development of the anterior region of the maxilla of children with oral clefts when compared to children without oral clefts.